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| (C) Adam Turman; www.adamturman.com |
"I never meant to cause you any sorrow..."
I had a goal with this blog not to talk about any political topics and/or not to give any strong opinions about anything that might be a lightning rod for controversy or that could come across as trolling. One of the reasons I despise social media so much is that it's often people just posting opinions and a quick stroll through the comments section will show you how little listening and compromising comes from these web based vehicles for information. Often, in my opinion, these social media platforms have become a tool for isolationism and fear mongering on hot topics. That's where I'll stop. This week drugs have been heavy on my mind. I'm a pharmacist so this statement should not come as much of a surprise.
The reason I write this blog is to respond to questions from family and friends... or give info about my daily life that might lead to meaningful conversation when we re-connect. In the past couple months I've been thinking a lot about heroin and opioid abuse because of the happenings in the world as well as strong opinions I've heard regarding what to do about the abuse of these drugs. Some family members made strong statements to me about their perceived ineffectiveness of methadone treatment clinics (which is where I've been spending a lot of my time over the summer due to an unfilled vacancy and another co-worker's unexpected sick leave). Separately, a random conversation with a beach tennis acquaintance led to their opening up to me about their family member's death from heroin overdose. Finally, a few weeks ago one of the younger patients at our opioid treatment program (OTP) left and relapsed. When he returned as a completely broken person he told us he relapsed in order to use with his brother again, but this time the dose was too high and his brother died right in front of him. Oh yeah... and Prince. These are the things that have me obsessed. I have no solutions just observations. I think the conversations themselves are what's important and this is my hope from this opinion based blog. From dissemination of true information and transparency I don't think we will solve the problem but be hopefully be better prepared to help those in need.
Over the past year or so I have fallen into a hybrid world of mental health and drug rehab within the VA, not so much due to having my interest fall into these fields/topics but more so that that's where the needs of our department have been due to staffing shortages. In fact I have done everything in my power throughout my schooling and first few years on the job to stay as far away from mental health as possible. My fear is that I would become too entrenched in the patients and their issues. I feel that I approach life and relationships with a lot (too much?) empathy. Sure enough, as I predicted, I have become deeply connected with the people I work with, both staff and patients, and obsess over their stories and the paths that have led them to the moment they are spending with me. Let me tell you, working with a patient to help them through a diabetes diagnosis and medication initiation is much easier, in my opinion, than helping someone find the right medication or combination of medications who is coming to terms with blatant bi-polar symptoms or that is working through opioid addiction treatment. None-the-less here I am working closely with heroin addicts and folks with mental health issues of all varieties.
"... I never meant to cause you any pain..."
Opioid pain killers. Here's the culprit. Why are they the culprit? Who really knows? Why can some people take them for years safely and others just take one pill from their dentist after a procedure then they are hooked? It's likely because of their unparalleled ability to numb pain and dull your senses. For someone not feeling well and looking to escape, whether it be from physical pain or emotional opioids provide an out. Codeine, methadone, hydromorphone (Dilaudid), morphine, oxycodone (Oxycontin and Percocet), hydrocodone (Vicodin), fentanyl, diamorphine (Heroin) are all opioid analgesics and are given for good reason during surgeries and acute post surgical recovery. Beyond the initial surgery and recovery though their effectiveness becomes a very debatable topic. They don't fix anything but they do shut down or mask pain quite well. Anyone that has taken one post-surgically can surely attest to this. Pain, and especially chronic pain, is not very well understood. So, we have a extremely strong reliever of pain, poorly understood pathophysiology of chronic pain, and the American belief that if a doctor prescribes it it must be safe. These are the ingredients, in my opinion, that has led to the opioid epidemic that we've been experiencing over the past 15 years.
We as providers are quick to give a pill. We as Americans are quick to ask for and accept a pill. For anything. There is plenty of blame to go around in the population based health perspective, but those that should not be blamed are the people that have been too uninformed or naive in regards to the nature of these medications and are now battling addiction.
"... I only wanted to be some kind of friend..."
Heroin seems to be the end all of most users that I come across in our OTP clinic. So, what makes heroin different... and the same? The reality is that heroin (diamorphine) is the same as the rest minus one metabolite it kicks off during metabolism, 6-monoacetylmophine, (6-MAM) which the other opioids do not produce. This is the metabolite that gives the fast onset of action and euphoric rush of heroin that makes it more likely to lead to addiction. Veterans that I've talked with in depth about their different experiences with different drugs state that it's a euphoria that can never be repeated. An escape land that is so powerful it needs to be chased. The problem with heroin (and all opioids) is that when too high of doses are taken too quickly the same receptors that kill pain also slow respiratory rate, often to a pace of death. So, the people who have taken these drugs and have seen the other side of the brain that the rest of us haven't have certain experiences that the feel they need to get back up to... and the only way is to flirt with death. They become very aware of the realness of reality. It's terrifying.
"... it's such a shame our friendship had to end."
The list of people that have fallen victim of opioids is long and distinguished. Prince, Philip Seymour Hoffman, Corey Monteith ("Glee"), Heath Ledger, John Belushi, Chris Farley, Janis Joplin, Mitch Hedberg, Jim Morrison, and sadly, etc. From this list it appears that there is something about pushing the limits of the brain and human experience that has led them down this road. A lot of us are significantly risk averse and prefer to stay within the margins. We do what we are told and follow the path of those that were successful and healthy before us. The ones that change the game and change our world tend to be the rule breakers. Sadly the breaking of rules pushes into all aspects of their life and the reality that they live in is no longer livable and drugs end up being one boundary that they wish to push... but one in which there are irreversible consequences.
Gateways.
I quickly want to mention marijuana because of both it's place in media as more states legalize it as well as perspectives I grew up hearing and still hear as it's consideration as a "gateway" drug. My personal opinion is that it has become a gateway only because it is lumped in with all the other drugs in the world due to naivety in drug and abstinence education. For someone that was raised to truly believe it's "bad" just like all the other drugs out there, then they smoke it, only to find out it's not really addictive and not really that "bad", it might cause them to question what they've learned about every other drug, including heroin, cocaine, and meth. "Reefer Madness" is a strong, albeit old and nowadays almost satirical, example of uneducated propaganda that could have an unintended consequence of disillusioning people that would otherwise be able to differentiate the consequences of various chemicals. The lack of understanding of this drug has led to decades long delay in possible research and discovery of it's positive effects such as being a safe alternative in chronic pain, anti-nausea and appetite stimulant in cancer patients, as well as epileptic seizure prevention. Don't get me wrong, I don't believe that weed is good for you and I think we are approaching a slippery slope with it's possible recreational legalization in many states. Mainly I consider it a public health risk because of it's main vehicle into the body which is smoke. Any combustion product inhaled, whether it's cigarettes, or a campfire is bad for you. It's the combustion that leads to cancer, not nicotine and not THC. Marijuana has it's own host of issues even without the smoke: lack of motivation, increased paranoia, and depression to name a few.
There are many challenges that lie ahead in the discussion of drug education in the US. But let us not be so naive to the fact that of all the drugs out there, the most common one, alcohol, is likely the most costly and dangerous to our society. The true costs of alcohol may never truly be known due to the driver of all things, $$$$. The issue with alcohol is that we are all sheep, money talks, and any negative research on alcohol is strongly opposed by the likes of Anheuser-Busch and friends much like Big Tobacco did for decades. At the moment, there is little to no lobbying power (relatively) for the marijuana industry. Also, due to it's laughable federal regulatory status, conducting meaningful research on possible (and likely) positive medical uses, as outlined above, is extremely difficult.
Life or something like it.
So while I believe that if possible the best way to be is stone-cold sober there is no denying that we all have different chemical and hormonal balances in our brains and bodies. We all experience different emotional responses to similar stimuli and sometimes chemicals help us cope with or heighten certain experiences. To make illegal any mind altering substance would be ludicrous, instead, let us inform a generation and respect humbly the many ways in which drugs and medications affect us. We smoke cigarettes, pop benzo's, have a glass of wine after work, get prescribed anti-depressants, etc. all to deal with the stress of life or to change our experience of the moment. Are any of these things, or the purpose behind why we take them, really so different? Once again, let's understand the truth behind all that we put in our bodies and that in which our general population is exposed to on a daily basis. Transparency and open dialogue can help inform and save lives.
Finally, if you ever come across friends or loved ones that are stuggling with substance abuse of any kind remember that research has shown interventional means of approaching these people are the LEAST effective. Threatening legal consequence and isolating from a true family structure more often than not leads to relapse and continued hopelessness that the addicted mind uses as proof to continue drug-seeking behavior. Instead consider first providing safety to the individual, then encouraging through positive motivation (of course while keeping your own physical, financial, and emotional safety the highest priority). Love one-another, y'all... and try to be free of judgement, often we just have no idea.
Talk soon.
