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Subscribe to RSSSarah Mayer, 27, and her father Randy, 54, of Hilliard Ohio, share her story of addiction and recovery with NBC News.
The use of prescription painkillers recreationally is at epidemic levels, according to the Centers for Disease Control and Prevention. What is it about the pills that makes them so dangerously addictive and a potential gateway for heroin?
The surprising answer, at least to many non-medical professionals, is that the common painkillers that doctors and dentists prescribe to patients after injuries and surgeries have the same active ingredient as the drug that alleyway users inject into their arms. And both act in similar ways on the human brain to produce a sense of pleasure that can overwhelm its reasoning functions.
While many who abuse prescription painkillers think of heroin as a low-class drug that will never make its way into their lives, they don’t realize, they’re already addicted to a form of it.
Prescription painkillers of the sort that 12 million Americans used nonmedically in 2010, according to the CDC, are narcotic opioid drugs, more commonly referred to as opiates. They include hydrocodone and oxycodone, also known by the brand names Vicodin and Oxycontin, respectively.
Reward system
According to the National Institute on Drug Abuse, when opiates are consumed, they enter the bloodstream and activate neurotransmitter receptors in the brain’s reward system. Scientists call the link between the drug and the receptor a lock and key relationship, because one specific neurotransmitter activates specific receptor molecules, the same way only one key fits a particular lock.
When the opiates reach the opiate receptors, the latter release the hormone dopamine. The dopamine – which acts as an “excitatory neurotransmitter” – produces feelings of pleasure and satisfaction. It’s this action at the most basic cellular level that provides the foundation for drug addiction.
Young recovering heroin addicts Tej Yaich, 20, Holly Yates, 20 and Tara McCormac, 22, and Dr. Joseph Gay share their stories and discuss the growing heroin crisis in Ohio.
Although the initial effect of the drug is rewarding and results in a “high,” or feeling of euphoria, the effect is time stamped. When it wears off, the user feels much worse than before having taken the drug.
Addiction psychiatrist Dr. Stuart Gitlow, president of the American Society of Addiction Medicine, compares this phenomenon to alcohol use, saying that people drink for the immediate effect, regardless of the inevitable hangover that will follow.
"The only connection a patient makes is that use of the drug leads to immediate relief -- not the longer-lasting discomfort that follows. Unfortunately, the drug causes both the immediate relief and the following discomfort. As time passes, the discomfort becomes more apparent than the relief and the drug is used merely in an effort to avoid the discomfort that the drug has caused in the first place."
Gitlow explains that humans are not biologically programmed to think about cause and effect in this way. “The only thing a patient connects in their head is with the immediate relief -- not the effect felt days later,” he said.
Also, as with alcohol, the pleasurable effect diminishes over time, he said.
At the cellular level, chronic activation of the opiate receptors eventually saturates them -- requiring higher and higher dosages of the drugs to achieve the same pleasant feeling. It is for this reason that an addict will seek more potent forms of the opioids.
“There are certain medications that invite an escalation to more serious drugs and narcotics and opiates are two of those” said Dr. Nancy Snyderman, NBC News chief medical editor.
The speed with which the different forms of opiates enter the bloodstream and flood receptors depends on the form in which it’s consumed, explains Snyderman. Consuming a pill by mouth can take up to a few hours to have an effect because it has to be digested by the stomach and intestines before it makes its way into the bloodstream. Injection is the second-fastest way to achieve the desired effect, as the drug enters the bloodstream instantly but has to make its way to the brain. Snorting a crushed pill or a powder crosses the blood-brain barrier in a matter of seconds; that’s what makes snorting so addicting and the drug delivery system of choice.
It also means there’s less margin for error if a person has a drug reaction or overdoses, Snyderman said.
In an opiate overdose a person may experience confusion and physical discomfort. In severe cases, a person’s breathing can slow down so much that breathing stops, resulting in a fatal overdose. The CDC estimates that more than 100 people die every day from unintentional drug overdoses -- many of them involving prescription pain killers.
In addition to the immediate effects produced by the drugs, numerous short- and long-term side effects can be associated with opiate use and abuse.
Among the most common side effects reported are constipation, nausea and what’s known as pin-point pupils. As an addict increases consumption, the side effects become more severe and can include extreme sleepiness and slowed respiration and pulse rates.
The most widely known side effect is the physical dependence that occurs with long-term use.
Dr. Joe Gay, director of Health Recovery Services in Ohio, points out that “As tolerance goes up, susceptibility to withdrawal becomes a real factor.” Withdrawal symptoms can be excruciating and including muscle aches, anxiety, sweating and insomnia, to name a few.
Like any addiction, opiate abuse is considered a relapsing brain disease. While you can’t predict whether a given person will become addicted to drugs or not, certain factors can increase a person’s risk, including genetic makeup, environment, socioeconomic status, and others, researchers say.
One example comes out of a new study from the Seattle Children’s Research Institute, in the June issue of the Journal of Adolescent Health. It found that adolescents and young adults with mental health disorders were about 2 ½ times more likely to become long-term opioid (synthetic opiate) users that their peers without such disorders.
Msnbc.com contributor Rita Rubin also contributed to this report.
Read more of NBC's special report:
Crackdown on painkiller abuse fuels new wave of heroin addiction
For parents: Opiate use warning signs and getting help
Leave a Comment:
What would have happened if the drug companies couldn't create new names for their heroin type product? You'd go to the doctor and he'd say, "Well, there's nothing I can do to fix your back, so I'm going to prescribe you 90 days of "Heroin" for the pain."
"Gosh, that sounds dangerous. I don't know... and isn't Heroin addictive, Doctor?"
"Well yes it is, but you won't shut up about your pain and I have been granted the power to prescribe the simple folks like yourself, extremely powerful pain killers like Heroin so Heroin it is. I think you'll love it and if you can follow the simple instructions on the label you shouldn't get addicted. If you do get addicted, you'll become a heroin addict and you'll probably live a short life selling your sexual services to strangers in the bad part of town, breaking into homes and so forth... so be careful."
Our hapless patient goes home after visiting the pharmacy and learning how to inject the Heroin. Is he just gonna leave it on the dresser with his kids running around? And if he gets over the pain and doesn't get addicted is he going to leave it in the medicine chest and forget about it forever, knowing full well the kids are experimenting with alcohol and marijuana? Are the kids going to play around with the heroin even though they know what it is? Or is the name of the drug going to scare them off?
The point is the drug companies knew what they were doing by putting it into pill form and giving it a meaningless, medicinal name. It sounds like any other harmless prescription that serves some ordinary utilitarian purpose. By naming these various products heroin and keeping it injectable we also wouldn't have to listen to addict claims of being totally unaware of what they were experimenting with.
Drug users shave off 15-25 years off of their life. Survival of the fittest and I'm doing well, thank you! Keep up the good work drug users (losers)!
That means they still have 45 years to repeatedly OD, steal constantly, get other people hooked, repeatedly be hospitalized, prowl the streets, run people over while under the influence, and so on. It's not an efficient way to get rid of a certain type of person and there's a lot of collateral damage. It probably is an excellent way to weaken a whole society.
There should be rules WITHIN the medical community to regulate the use advanced painkillers. An uncle of mine, very slowly dying of cancer, was on oxycontin for years and it benefited him greatly. On the other hand, when I had Achilles Tendon surgery, my wise surgeon prescribed ONLY three percocets: one to help me get to sleep each of the first three nights after surgery IF and only if I really needed them. If I had pain on night four: "Take Tylenol and deal with it."
Finally, a truthful article that does not blame all of society's woes and all drug addiction on marijuana. Maybe someone should check out what Rush Limbaugh is using nowadays, since he has been cut off from his supply of Oxycontin -- that he was taking at the rate of 300 a day!
What and/or who do we blame? Should the doctors be held completely responsible since without them writing these prescriptions the problem may not be nearly as bad? Should we put the blame on the person addicted? Should we blame the advertising agencies? Should we blame ourselves? Should we put the blame on the pharmaceutical companies. Do we blame the government for keeping profit above treatment?
I got clean and sober back in 1971 and (God willing) I will stay that way until 2 days after I am pushing up daisies. However, my body has gotten old and begun to give up on me. I now have spinal stenosis, disc degenerative disease and arthritus pretty much everywhere. (I'm just over 69 years old). I use a quad cane and an electric chair when I leave the house. It is painful just to move, as some of you might know.
Genetically, I'm a mess. The folks left me with everything possible. Manic-depression, anxiety, alcoholism, etc...I see a psychiatrist on a regular basis and an internist also on a regular basis and they do communicate.
I mention the history for a reason. I use hydrocodone daily, as prescribed, 1-4 times daily as needed for pain. The bottle sits on my coffee table on a little notebook and everytime I take a pill it is noted in the little book daily, time and date. I know who I am and where I come from but at the same time I can tell you that my body HURTS. My doctor has told me that the day will come when I will not be able to get up and walk and that will be the day when I will call him and we will talk about surgery. I do not look forward to that day. Surgery scares me more. Until then he will treat me with medication willingly as he is a very understanding, but firm, doctor.
I have worked with addicts for over 10 yrs,I ask them what was the first drug they ever used & at what age. Guess what ? Yup.. Cannabis - a typical assessment shows cannabis at 12/13 , then alcohol approx 15/16, then pills=lsd,mdma amphets,cocaine or crack then heroin usually kicks in early to mid 20's to ease comedown from amphets or crack. Is cannabis a gateway drug? ask any class A drug user what their 1st drug was & make up your own mind - after 10 yrs in the business I have seen many class A users stop heroin & crack but dont want to stop cannabis saying 'well I've got to have something now I've stopped heroin/crack etc'. The truth is that ALL mind altering drugs, including alcohol, need to stop being used as addicts will transfer their addiction, thats why many don't like the 12 step drug programmes that promote total abstinance, its hard but sure appears to be worth it for the ones who manage it. I remember one fella collapsed with kidney stones, crying out in pain but refused an opiate injection from paramedics because he had been a heroin addict, they were able to get him something else then & for after his operation = a brave man, so many 'ex' addicts are on daily tramadol 'opiate type' painkillers -sadly just transferring their addiction.
Having been on Percocet for about ten months, after having a lung lobectomy, I think I can speak somewhat credibly to pain and narcotics issues. The immediate post-op pain was unspeakably horrible, and I flogged the PCA box continually, and when I wasn't hitting the button, the nurses were doing if for me, because they probably couldn't stand my screaming. They discharged me after ten days, and sent me home with a percocet prescription. The pain from the thoracotomy is something I still have to live with all day, every day and it is now about 18 months post-op. I don't know if it will ever go away, but what I did decide was that if I had to be drugged into a zombie-like state all day, every day, just to get through the day, and sleep at night, for the rest of my life, I would rather be dead.
I went through a phased withdrawal under medical supervision, and while it didn't end up in convulsions or wallowing in my own vomit, excrement, and pee, it was not an experience I ever wish to repeat. I took almost two months to taper off, and still went through cold sweats, tremors, and the feeling that I was on the road to certain death. But I made it, and haven't taken any opioids since then. At the beginning, I really needed the medication because when they make a hole that long in your chest, a lot of nerves get badly damaged. But I never failed to notice that the drugs didn't actually make the pain stop. They just made you not care so much about it. I still need to take a different, non-opioid drug for the pain, and I know it is necessary and does help because I also later attempted to withdraw from it, and succeeded, and then started hoping I would die soon if I had to live with this pain, so I went back on it. It still hurts. I can tolerate it.
I know people who have been on very long term narcotics for pain for legitimate medical reasons, or at least that was the case at the beginning, and they can barely function enough to take care of their basic needs. They cannot drive a car, because the drugs impair them severely, and they would be arrested for DUI if pulled over or involved in an accident. I do not consider that to be living in a manner that would be acceptable to me.
When you get to the point that you think you would murder anyone who stood between you and your next opioid dose, you start to realize that you have a problem, and your problem is not pain management, but opioid dependence. And of course, over time, tolerance goes hand in hand with the dependence. Breaking that cycle can be tough, and when I got to the end, I then realized that the drugs were actually not doing anything for the pain, and actually were making it feel worse, so you would want to take higher and more frequent doses. That's basically circling the bowl, and sooner or later, you either climb out of that bowl, or get flushed.
While the experience did give me a certain empathy with junkies, I still won't give them a pass on quitting. And the one thing that still puzzles me is how come I never got the slightest high, buzz, or euphoria from these drugs? Nothing. Nada. Zilch. I still have a few pills left from my experience, in case I break my leg and it's the middle of a blizzard and the ambulance can't come until the roads are plowed, but that is the kind of circumstance I reserve that for. I haven't taken one since I quit, and that was last year, but if I had to, for a short term emergency, I think I could safely do so until I could get proper medical attention. Even though I was physically dependent for a long time, it was not a psychological need, and so the temptation is simply not there. If were a recovering junkie, they would have to be flushed down the toilet. If I am fortunate, I will never have to take a narcotic pain reliever again, but if I must, I will not refuse it, but try to get off it as soon as practical, instead of accepting it as a part of daily life like coumadin, and beta blockers.
1/2 a codone will even out a bad hang-over every time. There's a hint you won't find from Heloise.
Hi, I am sharing a music video made by the students of a music production class I teach at the Media Arts Collaborative Charter School in Albuquerque, NM. It is dedicated to Haley Paternoster, a fellow student we lost to heroin addiction in 2010. I am trying to spread the word about the project in the hopes that it can help in the prevention of future tragedies like her death. If you can, please share!
Thank you,
Blake Minnerly
bminnerly@nmmediaarts.org
Sorry to hear that, Blake. I live in Rio. Always a shame when people lose their will to these drugs. I lost a friend to meth... well, he was murdered, but it was meth that put him in that circumstance.
Apparently, as a new user, i cannot post links, so the link to the video referenced in the previous comment was removed. The video may be found by searching for "haley we miss you" in google. Look for the thumbnail of a candle light vigil.
http://www.youtube.com/watch?v=dAVcE6QIJvs
I don't know if this is the exact link, but it's to the song on youtube.