Introduction
Imagine coming home early from work one
afternoon to find a family member on the kitchen floor in a nearly cationic
state. Their breath is coming in scanty gasps, lips, and finger tips are blue.
They are a pale and their pulse is shallow. Emergency response is called and they
soon discover their family member has overdosed on heroin. As they watch the
flashing lights drive away with their loved one, they ask themselves how this
could happen to them.
Tragically,
it happens too frequently in countless homes around the United States.
In 2015, 1.90 % of teens twelve and older,
1.80 % of adults eighteen to twenty-five, and 2.10 % of adults twenty-six and
older are life-time users of heroin (Heroin). Also, .50 % eighth graders, .60 %
of tenth graders and .70 % of twelfth graders report habitual use (1). In
addition, three out of every four people that use heroin report using
prescription pain medication before trying heroin (“The Numbers Behind”).
History
It is important to identify where heroin
came from and how it made its way into the United Sates and into American
homes. Heroin is a synthesized, chemically enhanced form of opioid. Opioids are
used in an important class of medicine to control pain that include natural
opiates such as morphine and codeine and semi-synthetic opiates like oxycodone,
hydrocodone, and hydromorphone (Galanie, Stephanie).
These medications are derived from opium found in poppy plants. Opium and the
other synthetic drugs that have come from it have been used since the 1800’s
(Heroin Overview: Origin and History Methoide). The drug is cultivated from the
sap of poppy plants, and its growth can be dated back to ancient Egypt
civilization (1).
As earlier stated, opium has been grown
since the common era (Opium Throughout History). It started in Mesopotamia in 3400 BC, and spread to
Egypt, Europe, India and China by 400 AC (1). Opium was most frequently used as
a cure-all drug for illnesses as mundane as a cold to more critical issues such
as cancer, and childbirth (Heroin Overview). Physicians treating
patients with opium-based medications were not aware of its highly addictive
nature (Positive Sobriety
Institute). During the civil war, soldiers were given morphine and during
treatment addiction grew substantially for the United States (History of
Heroin) To combat the rising epidemic of morphine addiction a physician in
Germany, in 1874, was the first to successfully synthesize heroin; which
ironically was derived from morphine (1). Soon after, the drug was imported to
the United Sates and staked its claim over the people that lived there.
Social Effects
It is important to discuss how
pharmaceutical companies and physicians have on the production and distribution
of opiates that leads to heroin addiction. Drug smuggling occurs at the United
States borders and the people’s very own nation is an accomplice. Reports in
the media illustrate corruption with physicians. Fox News reports that in
Philadelphia doctors were accused of selling controlled substances to drug
dealers for profit (3 Doctors Accused). The
Diversion Control Division has reported numerous cases of corruption. Two such
cases include, DUBRULE, Rosaire Michel, MD of Tiptonville, Tennessee convicted
in 2014 for distribution of controlled substances and ILEM, Priscilla, MD of
Wayne, New Jersey convicted in 2012 for distribution of oxycodone (Cases
Against Doctors). Pharmaceutical companies provide the medications the doctors
sell either legally or illegally to patients. A Harvard University article
illustrates inappropriate relationships between Big Pharma and their affiliates.
Drug companies fund and supervise clinical trials of medications, which creates
bias on trial design, outcomes, and reports (Safra). The income of
pharmaceutical executives rises as prescription drug sales increase whether the
sales are legitimate or illicit (1). Furthermore, drug firms fund research and
development of new drugs, and they fund important medical activities such as
continuing medical education, medical research, medical journals, and
professional medical societies again creating bias (1).
In
some cases, victims of accidents, war, and crimes are prescribed these drugs
without much thought. The patient with a broken limb is sitting with a doctor and
is given drugs to help with pain. However, during the conversation the
physician may not go over its addictive nature. On the bottles there are
warning labels, but subjects seldom hear information regarding addiction from
the physician. If there is evidence that proves prescription pain medication
can often lead to heroin use, one may assume it is a doctor’s duty to disclose
such information.
Furthermore, heroin has consequences that
society may fail to recognize. As illustrated in this article found on the
National Institute on Drug Abuse webpage, “social consequences of drug use,
such as hepatitis, HIV/AIDS, fetal effects, crime, violence, and disruptions in
family, workplace, and educational environments, have a devastating impact on
society and cost billions of dollars each year” (Letter From the Director). Medical
treatment of diseases that are spread through shared needles is an estimated $535
million in direct medical costs (Injection Safety). Death rate from these
diseases are an estimated $1.3 million a year. Hepatitis B virus is highly
infectious and globally effects 21.7 million people, Hepatitis C virus effects
two million, and two percent of new HIV cases each year (1).
What often follows addiction is crime and
violence. Users of illicit drugs are rarely coherent and make ill-fated choices.
The crimes that couple with addiction are possession of narcotics, theft
directly related to drug use, and lifestyle such as gang related crime (Principles
of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based
Guide). Unfortunately, statistics show that abuse of narcotics such as heroin
is not limited to adults. According to the NIH, “As many as two-thirds of detained juveniles may have a
substance use disorder (SUD)” (1). The take-away from that statement is not the
number of juveniles detained, but children under the age of eighteen have a
substance abuse disorder.
Examples
No doubt the nation is effected, but what
about the average citizen, how does it resonate there? According to a medical director
in Florida the current wave of heroin addiction “is because we are consuming
ninety-eight percent of the world’s Oxycodone supply, prescribing enough for
every man, woman, and child to have a thirty-day bottle of it … then we started
cracking down on the pill mills and they had to go somewhere” (America's New
Heroin Addicts). The same medical director injures his foot climbing to his
roof and subsequently has surgery on his foot. He is prescribed oxycodone for
the pain. The substance has such a profound effect on his mind that soon he
injects himself with fentanyl in the operating room (1). In other words, a
person can do routine work around the house, injure their foot, have surgery,
and end up with a drug problem.
Equally important, is the substantial
impact opiates have on the brain. Understanding how the drug works in the body
can help clarify the nature of addiction. The brain naturally makes its own
chemicals, such as dopamine, adrenaline, or serotonin. These chemicals are
passed through the nervous system through a network of neurons. The process in
which this happens is precise, leaving no room for error. The brain does it
perfectly. If the process is changed it can cause severe consequences such as
chemical imbalances. Examples include depression, bi-polar disorder, and
anxiety. When opioids are introduced to the body, they not only disrupt the
process, but they take over entirely. The neurons in the brain are designed to
fire and send messages though the body to indicate pain or pleasure. While
generous amounts of chemicals are supplied, only what is needed is used and the
rest is recycled and the sensations fade. Opioids inhibit the recycling system.
In turn, the feel-good sensations given off by the body’s normal chemical structure
is long-lasting. The production of chemicals changes when opioids are used for
long periods of time, therefore, when a person tries to stop, withdrawal
occurs.
Ultimately, addicts are crippled by the
effects of heroin and in 2015, an astonishing 10,574 deaths occurred from overdose
(America's New Heroin Addicts). Users quickly build a tolerance to heroin
resulting in many fatal and non-fatal overdoses. When a tolerance is built, the
addict will not be stimulated as before, and it causes withdrawal—this is
painful and debilitating. Withdrawal
from any opioid include symptoms such as agitation, anxiety, muscle pain,
nausea/vomiting, insomnia, diarrhea, sweating and abdominal pain (Opiate and
opioid withdrawal). It is a small wonder that people using find it impossible
to quit.
Solutions
The solutions scholars have created
are somewhat contradictory, but scientifically speaking are worthy efforts. The
first treatment is methadone. It is a synthetic, narcotic analgesic (pain
reliever) that has many of the same characteristics as morphine (Methadone
CESAR). Ironically, it was manufactured in Germany as a less addictive
substitute for Morphine (1). Side effects of methadone include: restlessness,
vomiting/nausea, slowed breathing, constipation, severe sweating, lung and
respiration problems, sexual dysfunction, and death (1). It can cause serious
or life-threatening breathing problems during the first forty-eight to
seventy-two hours, which is why its use must be monitored by a physician and
tailored for each patient (Methadone). Treatment with methadone changes the way
the brain processes pain and blocks the euphoric effects of opiates (Walsh). However,
addiction to methadone is still a possibility, as well as withdrawal. When using
it as treatment, patients must remain on it for twelve months, but in some
cases several years (Methadone CESAR).
Another pill used for the treatment
of addiction is suboxone, which is a combination of naloxone and buprenorphine.
Naloxone is the drug used to bring people back from an overdose and
buprenorphine is used to block opioid cravings (Painkiller Abuse Treated by
Sustained Buprenorphine/Naloxone). With both methadone and suboxone treatments,
heroin use dropped up to forty-nine percent in some cases, but once treatment
ceased, patients would relapse (1). While these drugs are helpful, the addict is
still dependent on prescription medications for lengthy periods of time.
Is it too far a reach to assume
addicts who are addicted would like to be free from the use of all substances
and live a fulfilling life? Any freedom from heroin addiction is desired of
course, but there is another solution that encourages complete abstinence from
all mood or mind-altering substances. The solution is not medical, but
spiritual in nature and focuses on an unseen three-tier malady some addicts
have—sickness of the mind, body and spirit. The method is not found in
expensive counseling sessions, although such sessions are not discouraged, it
is found in an anonymous society known as Narcotics Anonymous (NA). The group
was formed from another private society whose common name is Alcoholics
Anonymous (AA). Both organizations provide a twelve step program built on
camaraderie that is formed from a common bond shared by people who have been
through the worst parts of addiction. The program promotes abstinence from all
drugs and twelve steps to help addicts work through their past, present and
future.
Often, people who attend NA meetings can stop
using and feel nearly immediate relief from the burdens of addiction. The
length of abstinence is directly related to attendance, involvement, and the desire
to stop. Here is a short description illustrated by the National Center of
Biotechnology Information, “people that attended meetings, considered
themselves a member, work steps and have regular attendance achieve sustained
abstinence over one year” (Krentzman,
et al). If the behavior continues
with frequent attendance people can achieve three or more years (1). “Across
recovery stages, individuals were 4.1 to 8.6 times more likely to achieve
sustained abstinence by continuous 12-Step meeting attendance and involvement”
(1). AA and NA provide a long lasting support
system and answers to ailments not directly related to their acute disease. They
are able to offer sufficient council because they have first-hand experience in
addiction and recovery. While soboxone and methadone treat what may be
perceived as the root cause of addiction, NA and AA treat the malady that
drives an addict to use in the first place. Thus, potentially eradicating the
problem all together.
Camus
Albert
Camus was a peaceful rebel who shares his odd views of the world though
literature. He believes there is no purpose to life, and those who try to make
sense of its secret meaning though the concept of God or transcendence are
committing a philosophical suicide (The Ruged Pyrrhus). He also believes those who commit
physical suicide are people who try to find meaning and fail (1). Camus would
probably view this heroin epidemic as people struggling again to make sense of
the world and how it is meaningful to them. He may be absolutely right. Some
addicts may have a handicap that causes them to feel eternally unique and
unable to identify with others around them. It is possible that the separation
they feel would be enough for a person to have a desire to escape reality by
way of illicit drug use. It would make sense then, if it were true, why NA and
AA would work better than prescription medicine. However, it may be equally as
easy to draw the conclusion that drugs, although branded as prescriptions, will
ultimately fix a drug problem.
Conclusion
In 2015, fifty million Americans report suffering
from chronic pain (“NIH Study Shows Prevalence”). It is impossible to know who
could be effected by the heroin epidemic because opiates are frequently
prescribed to treat pain in all stages and three of every four people report
using prescription pain medications before trying heroin (“The
Numbers Behind”). The epidemic is
not biased against age, race, or social class, but people may not understand
the devastation the disease can bring to their life until it is their loved one
on the kitchen floor.
Works Cited
“3 Doctors Accused of
Selling $5M in Prescription Drugs.” Fox News, FOX News Network, 12 May
2016,
www.foxnews.com/health/2016/05/12/3-doctors-accused-selling-5m-in-prescription-drugs.html.
Accessed 25 July 2017.
“America's
New Heroin Addicts - BBC News.” YouTube, YouTube, 16 Nov. 2016,
www.youtube.com/watch?v=zeU2tDRTlMM. Accessed 22 July 2017.
“Cases Against Doctors.” Resources - Cases Against
Doctors, www.deadiversion.usdoj.gov/crim_admin_actions/index.html. Accessed 25
July 2017
Galanie, Stephanie, et al. “Complete
Biosynthesis of Opioids in Yeast.” Science (New York, N.Y.), U.S. National
Library of Medicine, 4 Sept. 2015,
www.ncbi.nlm.nih.gov/pmc/articles/PMC4924617/. Accessed 25 July 2017.
“Heroin.” NIDA, 27 May 2016,
www.drugabuse.gov/drugs-abuse/heroin. Accessed 18 July 2017.
“Heroin
Overview: Origin and History | Methoide.” MethOIDE - methamphetamine and
other illicit drug education,
methoide.fcm.arizona.edu/infocenter/index.cfm?stid=174. Accessed 18 July 2017.
“History
of Heroin.” Narconon International, www.narconon.org/drug-information/heroin-history.html.
Accessed 19 July 2017.
“Injection
Safety.” WHO Western Pacific Region, WPRO | WHO Western Pacific Region, 3 Feb.
2012, www.wpro.who.int/mediacentre/factsheets/fs_20120204/en/. Accessed 22 July
2017.
Krentzman,
Amy R., et al. “How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
Work: Cross-Disciplinary Perspectives.” Alcoholism Treatment Quarterly,
U.S. National Library of Medicine, Dec. 2010,
www.ncbi.nlm.nih.gov/pmc/articles/PMC3140338/.
“Letter From the Director.” NIDA,
www.drugabuse.gov/publications/research-reports/heroin/letter-director.
Accessed 22 July 2017.
“Methadone.” MedlinePlus Drug Information,
medlineplus.gov/druginfo/meds/a682134.html. Accessed 30 July 2017.
Methadone
CESAR, cesar.umd.edu/cesar/drugs/methadone.asp. Accessed 30 July 2017.
“NIH
Study Shows Prevalence of Chronic or Severe Pain in U.S. Adults.” American
Pain Society, 18 Aug. 2015, americanpainsociety.org/about-us/press-room/nih-study-shows-prevalence-of-chronic-or-severe-pain-in-u-s-adults.
“Opiate
and opioid withdrawal.” MedlinePlus Medical Encyclopedia,
medlineplus.gov/ency/article/000949.htm. Accessed 24 July 2017.
“Opium
Throughout History.” PBS, Public Broadcasting Service, www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html.
Accessed 19 July 2017.
“Painkiller Abuse Treated by Sustained
Buprenorphine/Naloxone.” National Institutes of Health, U.S. Department of
Health and Human Services, 27 July 2015,
www.nih.gov/news-events/news-releases/painkiller-abuse-treated-sustained-buprenorphine/naloxone.
Accessed 30 July 2017.
“Positive
Sobriety Institute.” Heroin's History | From the Birth of Heroin to Today,
heroin.net/about/a-brief-history-of-heroin/. Accessed 19 July 2017
“Principles
of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based Guide.” NIDA,
www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations/introduction.
Accessed 24 July 2017.
Safra,
Edmond J. “The Pharmaceutical Industry, Institutional Corruption, and Public
Health.” Harvard University Center for Ethics,
ethics.harvard.edu/pharmaceutical-industry-institutional-corruption-and-public-health.
Accessed 30 July 2017.
“The Numbers Behind America’s Heroin
Epidemic.” The New York Times, The New York Times, 30 Oct. 2015, www.nytimes.com/interactive/2015/10/30/us/31heroin-deaths.html.
Accessed 18 July 2017.
The
Ruged Pyrrhus. “Camus: The Absurd Hero.” YouTube, YouTube, 26 Jan. 2015, www.youtube.com/watch?v.
Accessed 1 August 2017.
Walsh,
Lynn. “Methadone” SAMHSA, 28 Sept. 2015,
www.samhsa.gov/medication-assisted-treatment/treatment/methadone. Accessed 30
July 2017.
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