The overwhelming effects of drug addiction in this country are by no means breaking news, with almost everyone you meet being either personally affected, or closely related to someone affected by addiction problems. Since the early 1960’s, when psychedelics and marijuana became a staple in certain aspects of American culture, drugs and the problems that invariably follow them have been a widely debated issue what has taken a toll on the lives of millions. With the major influx of cocaine taking place in the 1970’s came another huge surge of drug-related public health concerns, sparking major questions of how to deal with the growing numbers abusing the drug. Then, in the 1980’s and 90’s, the crack epidemic rocked the US, particularly in low-income, minority occupied, urban areas, leading to what we now know as the “War on Drugs”— a full front effort to try and eradicate the tumultuous effects that these substances were taking on our population as a whole.
Unfortunately, those efforts proved to be futile. Over the course of the last decade, we have seen a tremendous increase in rates of addiction, most of which orbit around opiate based narcotics. Although many cases do involve heroin, an illicit street narcotic which is chemically derived from morphine, a huge portion of opiate-related addiction cases begin right in the hospital or doctors office.
First, a little bit about opiate drugs. Opiates are a class of drugs that were originally synthesized from the poppy plant for their analgesic qualities, meaning that they are effective in alleviating pain, hence the reason that you have probably heard so much about painkillers in the context of the drug epidemic. For hundreds, if not thousands of years, these poppy derivatives have been used around the world for both medical and recreation purposes. Opium, which is also made from the poppy plant, has been used recreationally in China for centuries. However, as I had mentioned earlier, a large percentage of opiate addictions start with legitimately prescribed medications. There are any number of reasons why a person may be prescribed narcotic painkillers, from broken bones to arthritis, cancer, and any number of other diseases that cause immense pain. Unfortunately, many times, particularly individuals who are predisposed to addictive traits, will develop a problematic relationship with these medications.
Within the realm of opiate medications, there are various chemical make-ups, offering different strengths for different reasons. One of the more mild opiate narcotics, hydrocodone—brand name Vicodin, is probably by far the most commonly prescribed of all. It can be given for basic dental procedures or even migraine headaches. For slightly more aggressive treatment doctors often dispense oxycodone, which is anywhere from 10 to 15 times stronger than Vicodin, and also exponentially more addictive. In cases that involve immediate relief from overwhelming pain, or chronic intense pain, many individuals receive morphine, one of the oldest and most commonly utilized opiate medications. In recent years, pharmaceutical companies have developed a number of different fully synthetic chemical substances which mimic the effects of poppy-based narcotics, and can be anywhere from 100 to 1000 times as strong as morphine. These include drugs like fentanyl, which is often prescribed in the treatment of cancer. Drugs like this are extremely dangerous if abused.
Despite their high level of effectiveness in treating pain, these drugs are extraordinarily addictive. Opiates work in the brain in a number of areas, but largely in the nucleus accumbens, where much of our dopaminergic activity takes place. They work by binding to the opiate receptors in the brain, which are largely responsible for sending and receiving signals of pain. As with many other drugs, after a prolonged period of use, the body tries to compensate for a consistent inhibitory effect in the brain by under- and over-producing other neurotransmitters, so as to remain in a regulatory state called homeostasis. This is also why opiate users will develop a tolerance, meaning they will need more and more of a drug to achieve a similar effects. Opiates also stimulate large excretions of dopamine, which creates a euphoric feeling for the user, and reinforces the drug-seeking behavior. Narcotics such as these are classified as Central Nervous System Depressants (CNS Depressants), which means that they essentially slow down many of the basic functions of the body. One of the functions that is largely inhibited by CNS depressants is the respiratory system, hence the reason opiates can so easily lead to overdose, where individuals will simply stop breathing on their own.
So how then, does an innocent prescription for Vicodin given by a doctor, lead to full blown addiction?
Even though almost all people who begin taking these narcotics do so to treat pain, many find that they really enjoy the effects produced by the medication. Be it feelings of well being or the ability to sleep, people can become psychologically addicted to the drug long before the physical addiction starts. But even for those who do not have an overwhelmingly positive response, particularly when they have taken opiates for prolonged periods, addiction can still take hold. Take, for instance, someone with a herniated disk; a 5 mg prescription of Vicodin that may reduce the pain originally, will not be as effective in time, causing the individual to need more as time goes on. In a large number of cases, individuals will stop being prescribed to abruptly as the doctor no longer deems it necessary, but the tolerance already built will kick the user into withdrawals. The fear of this awful sensation can lead people to seek out the drugs elsewhere, even if it means illegally, or resort to street variations of these narcotics. Given the value of prescription medications on the street, which are exponentially higher than those of heroin (diacetylmorphine), people will often make the transition when they can no longer financially support the habit of pharmaceutical opiates.
Unlike Vicodin, morphine, or OxyContin, that are produced in a heavily-regulated laboratory, heroin is made in illicit labs, usually across international borders. This makes the drug extremely dangerous, as varying levels of potency or adulterants can largely impact the way it affects the user. So an individual who may rely on the same dosage of pills to maintain a certain high, or even just remain from getting sick, may buy street drugs two days in a row that are extremely different. Many street dealers will cut heroin with stronger, cheaper additives like fentanyl, to improve the profit margin and ensure long-term “business”, but maneuvers like this are largely responsible for the extremely high number of deaths attributed to opiate abuse. Especially as individuals get into intravenous (IV) use, which is common with heroin, the ability to overdose becomes all the more prevalent, as seemingly similar drugs can wildly vary, causing the user to die abruptly.
Once the cycle of addiction has started, it can be incredibly hard to break. Even those with no prior history of substance abuse can find themselves in the vicious grips of opiate addiction. Meanwhile, overdose has become one of the leading causes of death in people under 50. Rates of opiate abuse have reached an all time high and they have not showed any signs of slowing. It is, indeed, an epidemic. If you or someone that you know is struggling with an addiction to opiates, street or prescription, help is available.