• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    The American Opium Epidemic

    By Dr. Arthur Lavin

    Our nation is in the grip of a historic opium epidemic, and our state is one of the hardest hit.  The epidemic has had tragic impact on all groups in America, including our children.

    The American Academy of Pediatrics (AAP) recent published an important review of how this has impacted our children over the last 40 years, from 1976-2015.  This essay goes over some of these key findings and talks about what we can do.

    What is Opium?

    The word opium comes to us from the Greek language, where opos simply means juice, and from that came the Greek word opion meaning poppy juice.

    That word says it all.  The beautiful family of flowers called the poppy includes one that forms a big pod of seeds containing a milky fluid, called opium.

    That milky fluid, opium, contains a number of compounds including morphine and codeine.   The raw mix, the opium from the opium poppy, can be dissolved in alcohol creating a tincture called laudanum, which was the most popular opiate in the 1800’s in Europe.

    Opium itself can be dried and smoked and this was the dominant form of the drug in China during their opium epidemic, also in the late 1880’s to early 20th century.

    Today, the main forms of opium used are synthetic drugs derived from opium.  Those would include morphine, but also heroin, fentanyl, carfentanyl, oxycodone, hydrocodone, and many others.

    How do Opiates Work?

    It turns out opiates cannot do anything without working with our own brain’s opiate-like compounds, the endorphins.  Everyone’s mind makes endorphins, a set of compounds that once connected to the right receptor in our brain, decrease pain and enhance mood.

    All opiates work by directly activating those endorphin receptors causing an unnaturally high spike in decreased pain and enhanced mood.  When these endorphin receptors are activated with such intensity, the other impact is to quiet the mind, depress its activity, including depression of breathing.  It is the high spike in mood and calming of the mind that leads to addiction.  It is the calming of breathing to the point of no longer breathing that causes overdose death.

    Strong addictions draw their strength from the ability of the substance or habit to become a drive, and the stronger that drive, the harder it is to literally live without it.

    The addiction to opiates is one of the strongest known.

    How Strong are the Various Opiates?

    There is a tremendously wide variation in how potently an opiate excites the endorphin centers of the brain.

    The standard is a dose of oral morphine, which is traditionally given a strength value of 1, to allow comparison to all others.

    You might be curious to know that acetaminophen is 1/360th as powerful a pain killer as morphine, and ibuprofen 1/222nd as potent.

    Hydrocodone (Vicodin) is just as strong as morphine, and oxycodone (Oxycontin) 1.5 times more potent.

    Heroin and Methadone are about 5 times as potent as morphine.

    Hydromorphone (Dilaudid) is 5-7 times more potent than morphine.

    The opiates take off in potency when we get to various forms of the anesthetic opiate, fentanyl.
    Fentanyl itself is 50-100 more potent than morphine.

    A new opiate hitting Ohio streets is carfentanyl, which is 10,000-100,000 as potent as an equivalent dose of morphine!

    Addiction

    The way I think about addiction is that it is a reflection of a very normal process.

    That process is the structure of our minds called drives.  Drives are essential to life, no drives, no breathing, no eating, no reproduction.  Just to put that into some perspective, when some of us get old enough, the drive to eat, called appetite, will stop happening.  Once that drive is gone, no one will eat, at all.  Even if fully aware that we need to eat to live, the person with no appetite will not eat, knowing that this decision will end their life.   That’s how powerful drives are, our minds and bodies are defined to a very large extent by them.

    Another example is breathing.  Opiates all weaken that drive, and once it is eliminated, we do not breathe.  Even knowing we have to breathe to live, without the drive, there is no breathing.

    Addiction is the opposite of the disappearance of the drive.  We humans have figured out how to produce chemicals that suddenly boost this or that drive.  Since we are all built to respond to drives, to orient our lives around our awareness of them and response to them, when our minds experience as sudden spike in a drive, it simply overwhelms all other mind functions, we enter into relationship with the chemical that delivers.

    The strength of addiction, then, can be measure best by the relative strength of our relationship to the drug.  In a strong addiction, the drive to obtain the drug is stronger than our love for our family, for having a job and achieving financial stability, for observing the law, for having any friends.

    There are few addictions as strong as those created by any of the opiates.  Some say that most opiates, certainly heroin, create drives that many find impossible to recover from, leaving those affected to find legal means of opiate use, such as methadone.

    The Path to Heroin

    Heroin deserves special mention.  It was created a synthetic form of morphine, with high hopes it would relieve pain without the risk of addiction. This hope failed utterly, but the ironic name persists.

    Heroin has become one of the leading drugs of choice for Americans addicted to heroin.

    There are two main paths for all Americans, including our kids, to become addicted to heroin.

    Both paths are made possible by the historically high production of heroin.  The peaks are both in affordability and purity.

    Sadly, both of these peaks are the result of world history playing out in Afghanistan.  When the Taliban first took over Afghanistan, after the defeat of the Soviet Union, they banned all growing of any opium, and enforced it nationwide.  World opium production sharply decreased.  But when the US invaded Afghanistan to punish the Taliban for their continued support of al-Qaeda after 9/11, our invasion was supported by the Afghani Northern Alliance, which included many warlords who had been opium drug cartel chiefs prior to the Taliban.  When the Taliban fell, opium returned to Afghanistan as a major world supplier of all opium, it is now even grown in the Taliban controlled areas.  This surge in production and supply has yielded massive quantities of amazingly pure heroin.

    These events now allow for the two paths to American heroin addiction:

    1. Via prescribed opiates.  An adolescent or adult breaks her leg, the doctor prescribes Oxycontin, leading within a few weeks to a potentially lifelong addiction.  After some rounds of renewing the Oxycontin, doctors and pharmacies will no longer refill, and even if they do, Oxycontin is dearly expensive.  Heroin works as well, is always available, and far cheaper, the shift is made, the broken leg leads directly to heroin addiction.
    2. Via parties and peers.  Heroin is so pure and cheap, it floods American high school parties and peer groups.  The purity allows for a powerful high without injecting, a simple sniff will do.  And the cheapness allows for the supplier to offer free doses to new users with ease.  A couple parties, and a couple friends, and a new addiction Is launched.

    The State of the American Opiate Addiction

    Opiates are used by those addicted to them mainly in the form of smoked or injected heroin, or as oral solutions or pills.

    If you take all the powdered heroin and all the opiate pills created in the world, Americans consume roughly 80% of the total amount,every year.

    Opiate addiction is everywhere on the planet, but no country eats and smokes and injects more opiate than the United States.

    A detailed look at the American Opiate Addiction Epidemic is found in this essay:

    https://www.firstthings.com/article/2017/04/american-carnage

    The death toll is 52,000 Americans dead from opiates in 2015.

    That is up dramatically from past years.

    It is 4 times the number of Americans killed by guns, and 50% more than died by cars.

    No illegal drug in the history of the country has killed more people.

    [Alcohol, as we recently read, still reigns as the #1 drug of death at 100,000 deaths a year]

    The impact of the American opiate addiction epidemic has actually led to life expectancy dropping, only in white America.

    And that brings up an interesting pattern in today’s opium epidemic in America.  It is the element of despair, of color, of place.

    The biggest jumps in American opiate use are in the white population, in rural America, where futures are bleakest.

    Some say the opium epidemic is only a symptom of pockets of American hopelessness, vast swaths of rural America where the economy has stalled or stopped, where hope is absent.  But we do see opium addictions in every ethnicity, amongst rich and poor, so that’s not the whole story.
    To the extent it is a disease of despair, it directly links it to the opium epidemics of China at the end of their imperium.

    The Opiate Epidemic in Our Children

    http://pediatrics.aappublications.org/content/139/4/e20162387

    Now we come to the trends in opiate addictions and use in our kids.

    The key findings can be summarized as follows:

    1. Our kids are using opiates, and have been for decades.  Most opiate use in our kids started with the prescription of opiates.
    2. About 15-20% of our kids will be given a prescription for opiates sometime by the end of their senior year in high school.
    3. About 5-15% of our kids will try out and use an opiate without any prescription by the end of their senior year in high school.
    4. As opiate prescription rates go up, opiate use without prescriptions go up, and as the prescription rate drops so does the other.
    5. The peak use hit in 1991, 1989, 2002 (the highest).  2002-2013 were the highest use rates in our kids since 1975.
    6. Prescriptions of opiates to our kids have dropped since 2013, but the rate in 2015 is still 15%.  Same goes for non-prescribed use of opiates, but the rate in 2015 was still 8% or so.
    7. This is an epidemic that affects white kids more than Hispanic or African-American kids- affects us all, just whites more.
    8. Males tend to use opiates more to get high, females to relieve pain.

    What to Do

    One town in West Virginia has a population of 400 people.

    The pharmacy in that town dispensed 9 million opiates pills last year.

    So what to do?

    1. Get drug companies and doctors and states to prescribe opiates very, very carefully to our kids.
    2.  Know that opiates do not treat chronic pain well, and should not be prescribed for that reason.
    3. Doctors should only dispense a few days worth of opiates at a time for post-injury or post-op pain, this is now a law in Ohio.
    4. Pediatricians should screen adolescents for use of opiates that are not prescribed, to try to find those leaning into addiction as early as possible.
    5. Once diagnosed, support ease of access to effective recovery programs and support for families experiencing the powerful cruelty of addiction.
    6. Beyond all these actions steps lies the ultimate to do, namely:  find a path to managing the drives of the human mind and soul.  Find society wide solutions to despair.  Find neuroscience pathways to relieve us of the burden of an overly powerful drive.

    BOTTOM LINES

    1.  This is an alarm bell.  More than any other illegal drug on our history, opiates are ripping across America, about 1 in 6 of our kids are affected.
    2.  Much opiate addiction starts with doctors prescribing opiates for pain relief, the time is NOW for all doctors to use these drugs far more sparingly.
    3. Attention to screening for non-prescribed opiate use, and to responding to signs of addiction is essential.
    4. At the national level, efforts to monitor drug production (legal and not) and use (legal and not) is urgently required. To promote recovery.  To find paths to weaken the grip of the addiction- by decreasing despair, and by finding neuroscience paths to relieving the burden of a too powerful drive

    To your health,
    Dr. Arthur Lavin

    No comments yet.

    Leave a Reply