10/30/2014, The New Heroin Epidemic

http://www.theatlantic.com/features/archive/2014/10/the-new-heroin-epidemic/382020/

Excerpts (with my comments):

…the team works to keep recovering addicts sober through a combination of therapy and buprenorphine, a drug used to treat painkiller and heroin addiction.

Sometimes I wonder if I’m the only one with a dictionary… How would you define “sober”? Because as used here, it obviously doesn’t mean “without drugs.”

What Tom (not his real name) was attempting to work his way back up from was the weekly “beginner” group, where advanced patients are sent if they relapse and cannot stay clean. It happens fairly frequently, Sullivan, the director of the treatment program, said.

So, if you relapse, you’re… dirty?  Or maybe… just human.

Moving from the weekly to the biweekly group takes 90 straight days of abstinence, a feat most patients can only accomplish within five or six months because of relapses. They’re also required to attend four 12-step Alcoholics Anonymous or Narcotics Anonymous meetings each week in their home communities.

Abstinence and AA/NA — treatment that is based on religion, not medical science.  So, basically people are required by the government to be religious.

In 2007, Purdue pled guilty to misleading the public about the risk of addiction to the drug in a lawsuit brought by the U.S. Department of Justice, and it paid $634.5 million in fines. Three of its executives also pleaded guilty to criminal charges.

Do you think the Purdue executives spent any time in jail after having been slapped with fines (the cost of doing business)?

Like heroin, the drugs slow breathing down, sometimes until it stops altogether. Mix them with alcohol or other pills, and the chances of accidental death soar. For those who live, one perverse side effect of long-term opioid abuse is hyperalgesia—an increased sensitivity to pain.

Mixing any medication with alcohol is a risk that more patients need to be reminded of.  But suggesting that patients who take painkillers can’t take any other medications is a little short-sided, don’t you think?  Funny, why doesn’t it mention that hyperalgesia is rare?

The crackdown on doctors might have stanched the flow of prescription pills, but it did so with a deadly externality: West Virginians have turned to heroin—a cheaper and, frequently, more accessible high. Law enforcement officials here told me that heroin is now their “number-one problem.”

Suzan Williamson, the DEA resident agent for West Virginia, said that she used to arrest stereotypical “junkies” when she worked in Manhattan decades ago—largely impoverished, deprived inner-city residents. These days in Appalachia, she said, “you have a broad span of addicts. Here you have somebody who might have had legitimate pain, [but] could no longer afford pills, so to keep the high they switched over to heroin.”

Of course the DEA uses the term “junkies” — probably often.  The DEA: only interested if people are getting “high.”  Someone please explain to the DEA how chronic pain patients on long-term opioid therapy don’t get “high.”

Maybe the DEA could listen to a doctor:  “Police are trained that any psychoactive substance is a drug of abuse. They don’t understand when you have pain and take a reliever, you don’t get high. You get pain relief.” Dr. Stephen Connor, Worldwide Palliative Care Alliance

West Virginia is a microcosm of the national drug-abuse picture. Recently, the prescription painkiller epidemic has finally begun to wane, but it’s dragged heroin addiction along in its wake. In 2012, the most recent year for which data are available, nationwide deaths from prescription painkillers dropped 5 percent from 2011, but heroin overdose deaths surged by 35 percent.

C’mon, DEA — get up and take a bow…  Proud of your work?

In a high-profile recent example, the actor Philip Seymour Hoffman died after his prescription painkiller addiction led him to heroin.

Really?  That’s not how I would tell that story…

Sullivan, who has been working in addiction treatment in the region since 1985, said he rarely saw a heroin addict in his early years. “Even 10 years ago, we saw no heroin,” he said.

But, but… the CDC says that over-prescribing of painkillers has been going on for 20 years!

On top of that, federal restrictions limit opioid-addiction doctors to 100 patients each, and all of the Chestnut Ridge doctors are maxed out.

Time for the DEA to get up and take another bow.

“[Suboxone] kind of gives you a buzz when you first start taking it, but after it’s been in your system for a while, that goes away, and, like, I feel good every day when I wake up,” he said. “I don’t crave for drugs and pills and stuff like that anymore. I just feel normal, and I’ve been on it for almost a year and a half now. And honestly I think if I hadn’t come here, I probably would have been dead.”

So, tell me again how Suboxone is different than Vicodin?  And why is everyone pretending that buprenorphine and Suboxone aren’t drugs?

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