heroin

TOC:

Central Dogma of Opioids
Short Summary
Medium Summary
Curated Documentary Links

Central Dogma of Opioids

Brain has receptors for opioids, regardless of source.
Prescription opioids have the same chemical structure as heroin.
Brains habituated to opioids eventually end up at one of:
- increasing prescription usage to maintain baseline functioning (due to tolerance)
- abusing prescriptions (accelerating oral dosage or snorting/injecting)
- switching to street heroin (cheaper, but more dangerous)

Short Summary

pain management drugs induce addiction and dependence
people become addicted to their opioid prescription drugs (oxycodone/oxycontin/percocet/etc)
prescription opioids are just professionally synthesized heroin
heroin is cheaper than prescriptions, easier to access
heroin is unregulated, has unpredictable strength, often with toxic fillers
heroin is often cut with fentanyl, increasing the potency 50x to 100x
unpredictable strength of dosage leads to respiration ceasing leads to death

Medium Summary

drug companies incentivize doctors to prescribe high value, high danger meds (lawsuit summary (2014), lawsuit dismissal summary (2015))
In the USA, companies run direct-to-consumer advertisements for addictive opioid pain medication
addictive drugs increase pharma profits (tautology, also see: tobacco)
bad actors include, but are not limited to: Purdue Pharma (oxycodone/OxyContin, morphine/Dilaudid, hydrocodone), INSYS (fentanyl spray), Endo Pharma (oxycodone/percocet)
opioid use changes the brain, causing physical addiction and dependence
prescription opioid dependence requires increasingly strong prescriptions
prescriptions are expensive
heroin is cheaper than meds
heroin triggers the same brain receptors as prescription opioid meds
- it would be more accurate to say prescriptions are “legally obtained heroin”
- heroin was first created in the late 1800s as a less addictive morphine. They were wrong.
dealers often cut heroin with fentanyl (up to 100x stronger than heroin alone) resulting in unpredictable dosages and rapid onset death when unknowingly administered

In recent news (Feb 2016), CVS started allowing individuals to buy opioid blocker naloxone without needing a prescription. Naloxone (Narcan) “reverses” opioid overdoses resulting in restored consciousness and breathing. https://www.cvshealth.com/content/cvs-health-make-overdose-reversing-drug-available-without-prescription-all-cvs-pharmacy

If you’re curious about basic brain pain science, a great introductory lecture on brain/pain/drug interactions (including some pharmacology of heroin/opioids and naloxone) is Pain and the Brain (90 minutes): https://www.youtube.com/watch?v=gQS0tdIbJ0w&t=3m0s (his previous lecture “The Bane of Pain Is Plainly in the Brain” from 2006 is slightly better, but it isn’t online anymore and this one covers the same material.)

Opiates vs. Opioids: they are essentially the same. Opiate is a term used for anything derived from a natural poppy plant. Opioid describes any chemical capable of binding to brain opioid receptors regardless of whether it comes from a natural source or an artificially synthesized source.

Opioid treatment involves methadone or suboxone. Reversal of acute opioid overdose requires naloxone.

Documentaries

The documentaries and reports below are weakly ordered from most to least informative with a bias towards newer reporting.

Drug abuse documentaries structure themselves as one or more of:

Personal Story
- “a day in the life” of people habituated to drugs
- unwinding the personal story of “how they turned into this”
- “a day in the life” of family members for “how addictive behavior affects others”
Corporate Story
- tracking the upstream causes of downstream abuse
- attempting to discover individuals responsible for society-level exploitation
- tracking the profit motive of getting populations addicted to expensive drugs
Doctor Study
- investigations into doctors abusing prescription writing ability
- investigations into facilities trying to help people recover from abuse

LA Times

‘You want a description of hell?’ Oxycontin’s 12-hour problem

May 5, 2016

http://static.latimes.com/oxycontin-part1/

Frontline

Chasing Heroin (2 hours)

February 23, 2016

Focuses on Seattle opioid issues.

http://www.pbs.org/wgbh/frontline/film/chasing-heroin/

Fusion

Heroin, Fentanyl, Pharma Fraud, OxyContin, Narcan/naloxone (45 minutes total)

February 1, 2016

Part One (13 minutes): https://www.youtube.com/watch?v=vbl19waROcA

Part Two (6 minutes): https://www.youtube.com/watch?v=TEclE4-QIJo

Part Three (9 minutes): https://www.youtube.com/watch?v=wJ29FCBSvUA

Part Four (8 minutes): https://www.youtube.com/watch?v=YGfLbkWa5w0

Part Five (5 minutes): https://www.youtube.com/watch?v=37VYO7Yt4ao

Part Six (5 minutes): https://www.youtube.com/watch?v=ApQbJV0DvlM

The Heroin Trail (45 minutes total)

December 15, 2015

https://www.youtube.com/playlist?list=PLxd0bZ1RXEzvzMKVJSB40AG78v6FvmR6Z

HBO

Heroin: Cape Cod, USA (1 hour, 15 minutes)

December 28, 2015

Preview: https://www.youtube.com/watch?v=QxpGYyHOtvc

https://www.youtube.com/watch?v=YW3lRKbQqpY

Official site: http://www.hbo.com/documentaries/heroin-cape-cod-USA

Vanguard

The OxyContin Express (50 minutes)

October 19, 2009

Focuses on Florida oversubscribing (e.g. 1500 pills prescribed by one doctor in less than two months) and how it bleeds into other states.

“9 million pills prescribed by 50 doctors in 6 months”

Covers prescription problems only.

https://www.youtube.com/watch?v=wGZEvXNqzkM

Peabody Award for the episode: http://www.peabodyawards.com/award-profile/the-oxycontin-express

Gateway to Heroin (45 minutes)

June 20, 2011

OxyContin and Heroin in Boston.

“90% of the pills we find in Boston come from Florida.”

YouTube source: https://www.youtube.com/watch?v=IwKqTAqm6Ww

Daily Motion source: http://www.dailymotion.com/video/xjfjt0_vanguard-gateway-to-heroin-s05-e01_shortfilms

Atlanta 11 Alive

Inside The Triangle (20 minutes)

February 25, 2016

Map of suburbs with heroin deaths.

Original video URL: http://www.11alive.com/videos/news/local/2016/02/29/81100456/

Overview site: http://www.11alive.com/story/news/2016/02/25/inside-triangle/80756752/

The original URL has so much advertising garbage it barely plays the video, so I’ve copied the videos here for easier viewing:

Local copy: Inside the Triangle (720p)
Local copy: Inside the Triangle Reporter Interview (720p)

Slideshow: http://www.11alive.com/media/cinematic/gallery/80871356/young-addicted-and-dead/

Overview: http://www.11alive.com/local/heroin-triangle/

Canadian Broadcasting Corporation — CBC the fifth estate

OxyContin: Time Bomb (45 minutes)

March 9, 2013

Covers Canada, the OxyContin origin story in rural Virginia, tolerance, pharma lies and manipulation, and Canada moving to OxyNeo (a non-crushable OxyContin) away from direct OxyContin prescriptions.

Covers prescription problems only.

Official site: http://www.cbc.ca/fifth/episodes/2011-2012/time-bomb

YouTube copy: https://www.youtube.com/watch?v=iNOHAJs9dBY

Al Jazeera America

Opioid Wars (25 minutes)

January 16, 2016

Covers prescription to heroin pathways as well as how Purdue Pharma launched opioid painkillers as underplaying “fear of addiction” resulting in “population wide experiment on American citizens by giving them all opiates.”

https://www.youtube.com/watch?v=WkkF9M9h3XA