Oxycontin Linked to Heroin Overdose

heroin and oxycontin linked

Photo by K. Wolfman

If you watched 60 Minutes as we did last night, you might have been shocked at the fact that high school and college kids in some of the most well-to-do and conservative parts of the country are becoming addicted to heroin.

And the rates of heroin overdose – especially among this segment of the population – have been increasing dramatically.

The continued narrative of the 60 Minutes segment – from both adults and kids – was that many of the kids started off with either a prescription of Oxycontin® (oxycodone hydrochloride – Purdue Pharma) or a similar opioid pain-relieving drug. (Some kids were introduced to the opioids without prescription – at a party or otherwise.)

But then they got addicted. Yes, high school kids in well-off families are being caught in their bedrooms and parties shooting up heroin. That is, shooting up with hypodermic needles.

Oxycontin and other opioid pain-relieving drugs such as fentanyl connect with the same opioid receptors that heroin and morphine connect to (“receive”). These are called opioid receptors because once the receptor receives the chemical, it releases neurotransmitters into the nerves and bloodstream. These include endorphins, endomorphins, nociceptins and enkephalins.

These neurotransmitters reduce pain and stimulate brain regions that produce addictive inclinations.

In other words, oxycontin and other opioids stimulate the same receptors and brain centers that heroin and morphine stimulate. For this reason, those kids and adults who get hooked on oxycontin can easily gravitate to heroin because it provides the same addictive inclinations.

Especially when heroin cheaper

Opioid drugs are not only addictive. They can kill. Lethal doses of both pharmaceutical opioids and heroin are quite easy to consume when there is an addiction. The addictive urge combines with the metabolic reality that it takes more to get the same neurotransmitter sensation. This means that the addict keeps increasing their intake of the opioid until the amount taken becomes lethal.

This is not to say that opioids do not provide a valid medical use in some situations. But their abuse underscores the responsibility of pharmaceutical companies – when they create – and doctors when they unnecessarily prescribe – drugs that are easy to abuse.

Link between oxycontin and heroin overdose

One might figure that the evidence that links oxycontin with heroin overdosing is trivial and anecdotal. Yes, there is certainly quite a bit of anecdotal evidence pointing at this – coming from parents and kids. This anecdotal evidence was provided by 60 Minutes.

However, there is also scientific evidence.

Researchers from Harvard Medical School conducted a study that began in 2003 and ended in 2012. The study included over 31 million people whose medical records were analyzed.

The big thing that took place during this period was that in 2010, pharmaceutical companies withdrew the drug called propoxyphene. Propoxyphene hydrochloride is highly addictive and easy to fatally overdose on – as is heroin.

In late 2010, propoxyphene hydrochloride was replaced in much of the pain-relieving market by extended-release oxycodone hydrochloride (oxycontin).

The research found that within two years of this change in the availability of these drugs, there was a significant decrease of opioid prescriptions, by 19 percent. Immediate-release opioid prescriptions went down as well.

As a result of this, the incidence of prescription opioids went down dramatically – by one-fifth, or 20 percent.

But at the same time, heroin overdose increased by 23 percent.

The evidence illustrates something very clear: The use of opioids may have dropped due to the use of oxycontin and other pharmaceutical opioids that are slower acting – being extended or sustained release.

So yes, these opioids are safer to use than the previous pharmaceutical opioids. But they produce another effect: They still produce the addiction to opioids. But the user is then more easily drawn to heroin use following the addiction to oxycontin. This is due to a combination of the relative ease of initial oxycontin use, and the cheap availability of heroin.

This makes oxycontin the classic entry-level drug.

Over-prescription of opioids

The dramatic over-prescription of these opioids was illustrated in a recently published study from the School of Dental Medicine from Milwaukee’s Marquette University.

The research studied the prescription of opioid drugs given at emergency room visits to people who had what the study referred to as “nontraumatic dental conditions.” The study found that over 50 percent of these ER visits resulted in the patient receiving a prescription of an opioid drug.

In other words, the patient showed up at the ER with tooth pain, so they were given a highly-addictive heroin substitute.

Furthermore, much of these addictive opioid prescriptions were given to younger people. Nearly 57 percent of the patients who were between 19 and 33 years old were given addictive opioids for “nontraumatic dental conditions.”

The main two drugs given to the patients were hydrocodone (oxycontin) or codeine. Codeine is an opioid drug, but it is less addictive than hydrocodone. It is approximately one-sixth as powerful, and thus significantly less addictive.

Doctors and addictive drugs

The major reason why I decided not to go to conventional medical school decades ago was because I didn’t want to become a drug dealer. During my undergrad years in a pre-med program at a state university, I got injured and went to a doctor. The doc gave me a prescription to an opioid – which I never filled. But what did fill me was the sense of how easily I was prescribed this drug – for an injury that wasn’t even that painful.

This is not to say that in an emergency pain situation, it may not be warranted to give such a powerful pain-relieving drug to someone in severe pain. But there is a line that presents itself: It is an ethical line that many doctors and pharmaceutical companies have too easily crossed over in many situations.

As the wisdom of the universe would have it, those who easily cross the line with patients by prescribing more addictive pain-killers also have a higher risk of becoming addicted themselves to these opioid drugs. This is reflected by the reality that up to 14 percent of physicians have substance abuse disorders.

Furthermore, while emergency room doctors represent about 3 percent of physicians, between 7 and 18 percent of emergency room doctors have been treated for substance abuse problems.

In 2014, research from the University of California at Davis compared addiction among emergency physicians with other types of physicians. Emergency physicians typically prescribe significantly more opioids than do other physicians.

The study found that the emergency physicians had nearly three times (2.7) the incidence of substance addiction compared to other physicians. And a solid 38 percent of the addicted emergency room doctors in this population were addicted to opioids.

While physicians have a high rate of success in substance abuse programs, the ability of becoming addicted is ever-present due to the easy access to these addictive drugs. When you play with fire, you are more likely to be burnt.

I have never regretted becoming a naturopath instead of a medical doctor. I don’t envy the position that the pharmaceutical industry has created for conventional doctors: It is quite a responsibility, given the potent drugs out there. I have tremendous respect for conventional doctors. But I still wouldn’t want to deal drugs.

Drugs and nature

Nature does contain some drugs too – evidenced by heroin, produced by a purification process that isn’t so different than pharmaceutical medicine.

But most of nature’s herbs in whole form provide a measure of safety because they contain numerous constituents that balance each other. This prevents most whole herbs from having significant adverse side effects – as evidenced by thousands of studies throughout the world.

But what about the poppy seed? Yes, heroin is the purified morphine extracted from poppy seeds and pods. But will eating a teaspoon of poppy seeds kill someone?

Certainly not. It would take a tremendous amount of poppy seeds to match a dose of morphine in an opioid drug (likely over 40 grams or more). But even then, the morphine would not have the same lethal effect as purified drugs. But yes, eating poppy seeds can become addictive, so be careful.

It is the illegal and legal drug manufacturers’ penchant for purifying and extracting that one constituent that gets us in trouble. This is what has gotten the pharmaceutical industry in trouble with so many drugs that have adverse side effects. And it is what has made the heroin and cocaine drug trades dangerous, and deadly.

REFERENCES:

Larochelle MR, Zhang F, Ross-Degnan D, Wharam JF. Rates of opioid dispensing and overdose after introduction of abuse-deterrent extended-release oxycodone and withdrawal of propoxyphene. JAMA Intern Med. 2015 Jun;175(6):978-87. doi: 10.1001/jamainternmed.2015.0914.

Okunseri C, Dionne RA, Gordon SM, Okunseri E, Szabo A. Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments. Drug Alcohol Depend. 2015 Sep 28. pii: S0376-8716(15)01673-7. doi: 10.1016/j.drugalcdep.2015.09.023.

Turturro MA, Paris PM, Yealy DM, Menegazzi JJ. Hydrocodone versus codeine in acute musculoskeletal pain. Ann Emerg Med. 1991 Oct;20(10):1100-3.

Rose JS, Campbell M, Skipper G. Prognosis for Emergency Physician with substance abuse recovery: 5-year outcome study. West J Emerg Med. 2014 Feb;15(1):20-5. doi: 10.5811/westjem.2013.7.17871.

DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. J Subst Abuse Treat. 2009 Jul;37(1):1-7. doi: 10.1016/j.jsat.2009.03.010.

Case Adams is a California Naturopath with a PhD in Natural Health Sciences, and Board Certified Alternative Medicine Practitioner. He has authored 26 books on natural healing strategies. “My journey into writing about alternative medicine began about 9:30 one evening after I finished with a patient at the clinic I practiced at over a decade ago. I had just spent the last two hours explaining how diet, sleep and other lifestyle choices create health problems and how changes in these, along with certain herbal medicines and other natural strategies can radically yet safely turn ones health around. As I drove home that night, I realized I needed to get this knowledge out to more people. So I began writing about health with a mission to reach those who desperately need this information. The strategies in my books and articles are backed by scientific evidence along with wisdom handed down through traditional medicines for thousands of years.” Case connects with the elements by surfing, hiking and being a beach bum.