What ‘Dope Sick’ Really Feels Like

See Author Article Here
By Brian Rinker

Detoxing off heroin or opioids without medication is sheer hell. I should know.

For many users, full-blown withdrawal is often foreshadowed by a yawn, or perhaps a runny nose, a sore back, sensitive skin or a restless leg. For me, the telltale sign that the heroin was wearing off was a slight tingling sensation when I urinated.

These telltale signals — minor annoyances in and of themselves — set off a desperate panic: I’d better get heroin or some sort of opioid into my body as soon as possible, or else I would experience a sickness so terrible I would do almost anything to prevent it: cold sweats, nausea, diarrhea and body aches, all mixed with depression and anxiety that make it impossible to do anything except dwell on how sick you are.

You crave opioids, not because you necessarily want the high, but because they’d bring instant relief.

Quitting heroin was my plan every night when I went to sleep. But when morning came, I’d rarely last an hour, let alone the day, before finding a way to get heroin. My first time in a detox facility, I made it an hour, if that. As I walked out, a staff member said something to the effect of “I didn’t think you’d last long.”

After my parents moved out of town, in part to get away from me, I would show up at their new home five hours away with big hopes of kicking the habit and starting a new life. But after a night of no sleep, rolling on the floor convulsing while vomiting into a steel mixing bowl, I’d beg them for gas money to drive the 300 miles back to where I lived and a little extra cash for heroin. I did this so often my mother once told me in frustration, “You show up, throw up and then leave.”

Going through “cold turkey” withdrawal is, not surprisingly, impossible for many. That’s why the medical community has largely embraced the use of methadone and buprenorphine — known medically as medication-assisted treatment, or MAT — combined with counseling, as the “gold standard” for treating opioid addiction. As opioids themselves, these drugs reduce craving and stop withdrawals without producing a significant high, and are dispensed in a controlled way.

“Detox alone often doesn’t work for someone with an opioid use disorder,” said Marlies Perez, chief of substance use disorder compliance at the California Department of Health Care Services, who estimated that it might be a realistic option for only 15 out of 100 people.

Studies have also shown that MAT reduces the risk of overdose death by 50 percent and increases a person’s time in treatment.

Yet even with strong evidence for MAT, there is debate over whether to offer MAT for people struggling with opioids. Some states, like California, have vastly expanded programs: The Department of Health Care Services has 50 MAT expansion programs, including in emergency rooms, hospitals, primary care settings, jails, courts, tribal lands and veterans’ services; the state has received $230 million in grants from the federal government to help with these efforts. But many states and communities hew to an abstinence or faith-based approach, refusing to offer MAT as an option. In 2017, only about 25 percent of treatment centers offered it.

Just as each person’s journey into addiction is unique, different approaches work for people trying to find their way out. Public health experts believe they should all be on the table.

Diane Woodruff, a writer from Arizona who became addicted to opioid medication prescribed for a bad back, described withdrawal like this: “If you’ve ever had the flu it’s like that but times 100.” Woodruff went through the sickness every month for five days until she could refill her prescription of OxyContin.

Other people described the sickness as if ants were crawling under their skin or acid was being injected into their bones. Woodruff was able to quit for good after she went cold turkey, sort of. She used kratom and marijuana to help with the detox.

Noah, a 30-year-old from San Francisco who asked that his last name not be used, said that MAT was a “miracle,” therapy adding, “It saved my life.” Noah spent five years on Suboxone, a brand-name formula of buprenorphine and naloxone, right around the time fentanyl began taking lives with impunity. Suboxone took away his craving for heroin, but he kept drinking alcohol and injecting cocaine and using other drugs for a while until joining a sobriety community. He finally weaned off MAT half a year ago.

“There’s no debate that MAT works — the evidence is clear,” said Dr. Kelly Clark, president of the American Society of Addiction Medicine. Opioid use changes the chemistry of the brain, sometimes permanently. Buprenorphine and methadone stop the withdrawals, diminish cravings and, when taken as prescribed, block the high from other opioids. These medications “tone down and reset the brain,” helping to “normalize” the individual, Clark added.

Within the nine years of my heroin use, I tried to get sober many times: detox, residential rehab, and with morphine and methadone under the guidance of a health care professional. For me, Suboxone didn’t prove the answer, although (to be fair) I never took it as prescribed under the supervision of a doctor. I was ambivalent and incapable of following directions, let alone a treatment plan. I didn’t want to be shackled to another opioid or have to check in with a health care professional every week or month or have to go to counseling — even if all that could have helped me to function better. (A common critique of methadone or buprenorphine is that it is just replacing one drug for another.)

But Suboxone ultimately kick-started me into sobriety. One day in December 2008, I tried one more time to detox successfully off heroin at my parents’ house. To make it easier, I had a couple of pills of Suboxone, illegally obtained. So, after the body aches and that weird feeling when I peed, the buzzing ball of anxiety began to grow in the pit of my stomach and, just when life began to seem unbearable, I crushed one of the Suboxone tablets up and snorted it off my dresser. Unbeknownst to me at the time, when Suboxone is crushed, it releases an anti-tampering chemical that sends the user into full-on withdrawal.

I spent the next three days shut up in a room as my body and mind began to unravel. I barely slept and there was plenty of diarrhea and vomiting. After the worst of it was over, I apathetically roamed my parents’ house, not sleeping for two weeks. Then, I joined a sobriety community and haven’t touched an opioid in 10 years.

MAT was not the escape route from addiction for me, personally, and I have mixed feelings about these medications. But with tens of thousands of opiate overdose deaths each year, it makes sense that people struggling with addiction and facing the terrifying specter of withdrawal have every option available.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Marijuana Access Is Associated With Decreased Use Of Alcohol, Tobacco And Other Prescription Drugs

See Author Article Here
By Paul Armentano

A significant amount of data has been generated in recent years showing that cannabis access is associated with reduced levels of opioid use and abuse. But emerging data also indicates that many patients similarly substitute marijuana for a variety of other substances, including alcohol, tobacco and benzodiazepines.

Last month, a team of researchers from Canada and the United States surveyed over 2,000 federally registered medical cannabis patients with regard to their use of cannabis and other substances. (Medical cannabis access has been legal across Canada for nearly two decades).

Investigators reported that nearly 70 percent of respondents said that they substituted cannabis for prescription medications, primarily opioids. Forty-five percent of those surveyed acknowledged substituting cannabis for alcohol and 31 percent of respondents said that they used marijuana in place of tobacco.

Among those who reported replacing alcohol with cannabis, 31 percent said they stopped using booze altogether, while 37 percent reported reducing their intake by at least 75 percent. Fifty-one percent of those who reported substituting cannabis for tobacco said that they eventually ceased their tobacco use completely.

 

This documentation of cannabis substitution is not unique. A 2017 study of medical cannabis patients similarly reported that 25 percent of the cohort reported substituting cannabis for alcohol, while 12 percent substituted it for tobacco. A 2015 paper published in the journal, “Drug and Alcohol Review” also reported that over half of patients surveyed substituted marijuana in lieu of alcohol. A placebo-controlled clinical trialperformed by researchers at London’s University College reported that the inhalation of CBD — a primary component in cannabis — is associated with a 40 percent reduction in cigarette consumption.

Numerous studies also indicate that legal cannabis access is associated with reductions in overall prescription drug spending. While much of this reduction is the result of the reduced use of opioids, studies also report decreases in patients’ consumption of other prescription drugs, such as sleep aids, anti-depressants and anti-anxiety medications. A 2019 study by a team of Canadian researchers reported that the use of marijuana is associated with the discontinuation of benzodiazepines. (The popular anti-anxiety medication was responsible for over 11,500 overdose deathsin the United States in 2017, according to the US Centers for Disease Control). In their study of 146 subjects, the initiation of medical cannabis resulted in significant and sustained reductions in patients’ use of the drug.

By the trial’s conclusion, 45 percent of participants had ceased their use of benzodiazepines. In a separate study, also published this year, of over 1,300 US medical cannabis patients suffering from chronic pain conditions, 22 percent reported substituting marijuana for benzodiazepines.

These scientific findings run contrary to the so-called “gateway theory” – the long-alleged notion that marijuana exposure primes users to ultimately engage in the use of far more intoxicating and addictive substances. By contrast, for many people cannabis appears to act as an “exit drug” away from potentially deadly pharmaceuticals, booze, cigarettes and even other illicit substances such as cocaine.

As more jurisdictions move away from cannabis prohibition and toward a system of regulated access it will important to monitor the degree to which these trends continue and to assess their long-term impacts on public health and safety.

Paul Armentano is the deputy director of NORML — the National Organization for the Reform of Marijuana Laws. He is the co-author of the book, Marijuana Is Safer: So Why Are We Driving People to Drink? and the author of the book, The Citizen’s Guide to State-By-State Marijuana.  Laws.

Opioid Expert Accuses FDA of ‘Willful Blindness’ After It Approves Powerful New Painkiller

National Addiction News Article Here

An expert tasked with helping the Food and Drug Administration weigh potential new opioid drug approvals is openly calling out the agency for what he alleges are its continued missteps in handling the opioid crisis. In an interview with the Guardian Thursday, Raeford Brown claimed that the FDA has failed to learn from its past mistakes by approving the drug Dsuvia last year, the tablet form of an opioid painkiller up to ten times more potent than fentanyl.

Brown, a professor of anesthesiology and pediatrics at the University of Kentucky, was tapped to chair the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee in 2018. One of the committee’s duties involved recommending whether or not Dsuvia should be approved. (The FDA rarely goes against the recommendations made by its outside committees.) Ultimately, the committee voted 10 to 3 for its approval. But Brown alleged to the Guardian that the approval process had been manipulated, and that the FDA has still largely avoided taking any serious action to curtail the role of legal opioids in the crisis.

“I think that the FDA has learned nothing. The modus operandi of the agency is that they talk a good game and then nothing happens. Working directly with the agency for the last five years, as I sit and listen to them in meetings, all I can think about is the clock ticking and how many people are dying every moment that they’re not doing anything,” he told the Guardian. “The lack of insight that continues to be exhibited by the agency is in many ways a willful blindness that borders on the criminal.”

In 2017, Dsuvia was actually rejected for approval by the FDA, with the agency calling for additional safety data from its maker, AcelRx. But the vote by the panel convened last October occurred while Brown was unable to attend—a decision Brown contends was intentional. Brown had long criticized the potential approval of Dsuvia, a stance he says the FDA was well aware of.

“There’s no question in my mind right that they did that on purpose,” he said. “The FDA has a lack of transparency. They use the advisory committees as cover.”

Brown isn’t the only one who had trouble with how the FDA ultimately approved Dsuvia. In a letter sent to the FDA last October, senators Joe Manchin (D-WV), Edward Markey (D-MA), Richard Blumenthal (D-Conn), and former senator Claire McCaskill (D-Miss) criticized the agency over Brown’s absence during the panel vote. The senators also criticized the FDA’s decision to not fully include another panel of experts, the Drug Safety and Risk Management Committee, in the approval process of Dsuvia.

Soon after its approval in November, FDA chief Scott Gottlieb went out of his way to tamp down criticism. In a statement, Gottlieb said that there were “very tight restrictions being placed on the distribution and use of this product.”

Dsuvia is a form of the opioid sufentanil, taken as a tablet that dissolves under the tongue. It’s currently approved for people with moderate to severe pain who haven’t responded to other treatments. The drug is supposed to be administered only in medically-supervised health care settings, such as hospitals and emergency rooms, by approved medical staff.

But sufentanil tablets like Dsuvia can still potentially be abused or improperly dosed to patients, according to the National Institute for Health and Care Excellence in the UK. And there’s still the possibility they can end up in the black market. The European Union approved a similar tablet version of sufentanil made by AcelRX, Dzuveo, last summer.

Brown, for his part, doesn’t buy Gottlieb’s assurances. And he thinks until the FDA has gotten its act together, no new opioid drugs should hit the market at all.

“They should stop considering any new opioid evaluation,” Brown told the Guardian. “For every day and every week and every month that the FDA don’t do the right thing, people drop dead on the streets. What they do has a direct impact on the mortality rate from opioids in this country.”

The FDA as well as AcerRX have not immediately responded to a request for comment from Gizmodo on Brown’s accusations.

How Big Pharma Profits From Overdoses & More News On America’s Opioid Epidemic

I used to be a drug addict. I haven’t touched an opioid since August 22, 2011, but I get the struggle and barely made it out. I can’t count on all of my fingers and toes how many of my friends and acquaintances have died from overdoses. I know if you are in the throes of addiction, this won’t make you quit, but keep it in your back pocket.

I don’t know why I am surprised at these headlines anymore:

Study Finds Disturbing Link Between Opioid Overdose Deaths And Big Pharma Payments to Doctors

Opioid Makers Are Looking Especially Evil This Week

*The rate of overdoses AMONG FUCKING CHILDREN has doubled.
*The percentage of opioid overdoses seen in emergency rooms across the country has gone up 30%
*The life expectancy in the U.S. is down because of the spike in OD’s.

CNN provides a really informative “visual guide” for these statistics
America on Opioids

**A little dated, but number of overdoses has greatly increased even since 2015

Be well. Always here for support