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Tuesday, August 8, 2017

Trading Life for Death—Heroin v. Humanity by Brittany Duhon-Leblanc







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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