By Dr. Mercola
Heroin addiction is a serious problem in the U.S. According the Centers for Disease Control and Prevention (CDC), deaths from heroin overdoses more than quadrupled between 2000 and 2013.1 Heroin use also more than doubled in 18- to 25-year-olds between 2002 and 2011.2
Use of the opioid prescription painkiller Oxycontin has been a primary driving force behind the rising problem with heroin and prescription painkiller addiction. Although the drug company manufacturing Oxycontin claimed the medication was non-addictive, it has since gained the ruthless label as the gateway drug to heroin.3
The alarming rise in Oxycontin and heroin addiction was fueled by misleading and false advertising to both the public and prescribing physicians.
In a financial-driven orchestrated marketing effort, Purdue Pharmaceuticals, makers of Oxycontin, unleashed a monster on American citizens, beginning in 1996 with more than 20,000 educational programs to encourage long-term use of opioids to control pain.4
This released an epidemic of colossal proportion that continues to claim lives and cost Americans billions of dollars each year in direct medical costs and lost productivity.
Pharmaceutical Company Pushing Opioid Prescriptions
Like all businesses, the manufacture and distribution of medications is driven by profit. While Purdue promised physicians their patients wouldn't get addicted to an opioid strikingly similar in chemical structure to heroin,5 they also neglected to inform them that no studies supported the use of long-term opioids for pain control.6
Opioid medications were once limited to terminally ill patients or those diagnosed with cancer. Once Purdue had the patent on time-released Oxycontin, they began a push for looser guidelines and found the journey an easy one.7
Purdue created a drug from an available compound, which they re-patented as a time-release formula, and proceeded to claim the risk of addiction was under 1 percent.
Oxycontin's high rate of addiction is the result of a short half-life, or the amount of time the drug stays in your system before you are left wanting more. Before the 1980s, the main source of income for the drug company was a morphine pill intended for cancer patients called MS Contin.
As the patent for that drug was set to expire, Purdue Pharmaceuticals was granted a patent for time-released Oxycontin. In the first year (1996) sales reached $45 million.
Purdue continued a highly successful campaign to reach patients experiencing ordinary chronic conditions, and by 2003 primary care physicians were writing over half of the prescriptions for Oxycontin.10 The time-released capsule is easily altered by peeling away a wax coating, making the drug easy to abuse.
In a similar move to capture a large market for their newly approved drug, based on the active ingredient found in marijuana, drug company Insys Therapeutics infused the campaign against legalization in Arizona with one of the largest single contributions.11
This could level the playing field between opposing camps and ensure a healthy market for their drug, aimed at AIDS and cancer patients.
How the US Food and Drug Administration Is Involved
Despite a near consensus among pharmacists, doctors and medical groups, the U.S. Food and Drug Administration (FDA) has ensured the public health damage is not likely to end soon.
On the same day in 2013, the FDA issued both a strong warning against the use of opioids to control pain and approved the long-acting drug Zohydro. The drug has five to 10 times the potential for abuse.
When asked why the FDA had apparently discounted warnings from researchers, physicians and their own advisory committee, spokesperson Morgan Liscinsky said to Alternet:12
"Prescribers now have a hydrocodone option for patients who require an extended-release opioid."
Then, in 2015, the FDA approved the use of opioids in children as young as 11.13 While a welcome and effective means of reducing end of life pain, misuse could effectively lower the potential age someone may get hooked on opioids.
In April 2016, a law was passed that restricts the Drug Enforcement Agency's (DEA) ability to track and charge pharmacies and wholesalers who are expanding the epidemic. Andre Kolodny, director of Physicians for Responsible Opioid Prescribing, and an addiction specialist, responded to this news saying:14
"I'm shocked that Congress and the president would constrain DEA from taking on corporate drug dealers in the midst of the worst addiction epidemic in U.S. history. This law allows opioid distributors to reap enormous profits and operate with impunity at the public's expense."
Cities Taking Action Against Pharmaceutical Companies
Federal regulators and executives of pharmaceutical companies routinely meet privately under the umbrella of an organization funded by 11 drug companies, Initiatives on Method, Measurement and Pain Assessment in Clinical Trials (IMMPACT).15
Their stated mission is "improving the design, execution and interpretation of clinical trials of treatments for pain."16 This collaboration between the agency that oversees clinical trials and companies that have a vested interest in the outcome of the trials, is a clear conflict of interest.
Taking matters into their own hands, allegations have been filed by local governments, including Suffolk County in New York, the city of Chicago, Orange and Santa Clara counties in California and the state of Mississippi against several drug companies, claiming deceptive marketing to physicians and patients increased the risk for addiction.17
According to the CDC, more than 40 Americans die each day as the result of an overdose to opioid painkillers.18 Governments from these respective states have charged the drug companies with broadening the potential market for opioid painkillers and creating a false perception of safety among physicians and patients.
The Suffolk County lawsuit was the most recent one filed. Lawsuits from California have been indefinitely delayed, and Chicago recently came to a settlement with Pfizer in exchange for information about marketing strategies for opioid medications.
The Elderly Have Unique Challenges
The American Geriatrics Society (AGS) also urged physicians to use opioids for all patients with moderate to severe pain, even before trying over-the-counter options, such as ibuprofen or naproxen,19 especially in those 75 and older.20
At the time these guidelines were issued, investigative reporter John Fauber stated that half the panel experts were financially tied with opioid companies.
Senior citizens have unique challenges that increase their risk of both addiction and misuse of medications. While use of heroin has increased in a younger age group, the elderly have become a prime market for prescription painkillers.21
Side effects from the medication include drowsiness, loss of balance, confusion and disorientation.
These side effects, in combination with the excess number of medications elderly patients are already taking, plus a potentially failing memory, increases their risk for overdose and death.
Since 2007, the number of opioids dispensed to people 60 and over for pain control has increased by 32 percent. That's double the rise in prescriptions for 40- to 59-year-olds.22
An increasing number of patients are being admitted into the hospital on multiple medications to treat a variety of conditions. Often people are seeing different specialists who prescribe medications filled at different pharmacies.
Without a case manager to identify conflicting or duplicate medications, many of our senior citizens are taking between 14 and 18 prescriptions a year.23
Physiological changes with aging, including impaired metabolism and excretion of drugs, make prescription of opioids in the elderly population a risk for both the patient and their family.24 Researchers recommend a meticulous review of the indications for use of the drug, both before prescription and at regular intervals if one is prescribed.25
On the Street
The transition from Oxycontin and other opioid drugs to street heroin is an easy one. Physical addiction to the drug drives behavior to seek more of the same drug. When a prescription runs out, a physician refuses to renew or as the cost of the prescription becomes too high to manage each month, many addicts turn to heroin, as the high they get is very similar to that from Oxycontin.
Without additives, street heroin is as dangerous as Oxycontin, and just as addictive. However, when dealers cut the drug with other drugs, the result may be deadly. In just six days in August 2016, 174 overdoses of heroin were recorded in Cincinnati, Ohio, the largest number of overdoses in one week on record.26
On average, the city records between 20 and 25 overdoses each week. This unprecedented number of overdoses was precipitated by heroin cut with carfentanil.27 Meant to deliver a stronger and more extended high, it resulted in greater overdoses and deaths. This is to be expected, when you consider the drug was originally developed as a tranquilizer for large animals, such as elephants.
Cincinnati Hamilton County Commissioner Dennis Deters is calling this uptick in overdoses a public health emergency.28 Officials are begging people to stop using heroin, at least until this potent batch is off the street. Carfentanil is the strongest commercially prepared opioid. Dealers find it delivers a stronger and more addictive high. Newtown Police Chief Tom Synan told Channel 9 WCPO:29
"These people are intentionally putting in drugs they know can kill someone. The benefit for them is if the user survives it is such a powerful high for them, they tend to come back ... If one or two people die, they could care less. They know the supply is so big right now that if you lose some customers, in their eyes there's always more in line."
Another complication to the treatment of heroin or Oxycontin overdoses is that Narcan, the nasal spray version of Naxalone, used to reverse the side effects of opioids, is no longer effective at doses used in the past. The recent overdoses in Cincinnati and other cities have required doses two and three times greater than before.
Has DEA Squashed a Plant That May Reduce Pain and Aid Opioid Withdrawal?
Opioids have a strong physical addiction component that makes withdrawal painful and sometimes life-threatening. A plant from Southeast Asia, called kratom, has been used by some addicts to self-treat withdrawal symptoms. Almost as quickly as it came to the attention of researchers looking for an alternative pain reliever without the side effects, the DEA made it a Schedule I drug. The ban takes effect September 30, 2016.30
This move has frustrated some researchers who believe, from initial testing prior to the ruling by the DEA, that kratom may hold the key to a non-addictive painkiller or even a route for treating addiction. They found the ingredients activated just the pain relief receptors and not the secondary receptors responsible for the deadly side effects from opioids, such as respiratory depression.31
Although also addictive in nature, kratom effectively treats withdrawal symptoms from heroin without life-threatening side effects, and has been useful in treating chronic pain without the potentially lethal effects of opioid overdoses.32 The CDC lists minor side effects, including headache and nausea.33
Forbes contributor David Kroll cast doubt on how the DEA framed the ban on kratom as a solution to the opioid public health emergency and was quoted in the Mint Press News, saying:
"As an example of the risks of kratom, the DEA cites a CDC study published this summer that counted 660 poison control calls during a five-year period from 2010 to 2015 on behalf of people suffering untoward reactions to the herb or teas made from the plant material. To put kratom risks in perspective, poison control centers received 6,843 reports of young children ingesting single-load laundry pods in just the first seven months of 2016."
What This Means at Home
In this video, Dr. Beatrice Golomb reveals how pharmaceutical companies can manipulate research evidence in their favor. It is important for you to discuss your concerns with your physician about any medication prescribed, and to seek safer alternatives when available.
Scientists need further study to understand how kratom could potentially help, but the DEA has effectively made such research a legal nightmare for the next two years. While the FDA and the DEA don't appear to support rulings that would help stem the tide of opioid addiction, there are options you can take at home.
The toll of opioid addiction is high, both financially and emotionally. Families are being torn apart, children and parents are dying early and public safety workers are strained by the load in their community. In August 2016, the U.S. Surgeon General sent a letter to every doctor in the U.S. asking for help to stem the tide of opioid abuse.34
You are responsible for the health and wellbeing of yourself and your family. While knowledgeable about a great many things, your doctor is only human. If he recommends an opioid painkiller, speak up and ask for alternatives. Opioids should never be used for long-term chronic pain, as your body builds a tolerance to the drug and it takes more over time to achieve the same pain relief.
Together with addiction and tolerance, opioids have not lived up to the promises manufacturers have made. There are many non-drug and dietary alternatives that may help manage your pain. You can read more about these options in my previous articles, "Astounding Amounts: Opioid Epidemic Filling up Morgues" and "Prescription Painkillers Lack Evidence of Safety and Effectiveness for Long-Term Use."