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Los Angeles Times: Oxycontin as a part of the Opioid Epidemic and the risk of Inadequate Effective Time; Transitioning to Heroin

2016-05-15

The Los Angeles Times has just published a tremendous series of articles online about the development of Oxycontin as a part of the nationwide epidemic of opioid drug consumption.  The major problem with Oxycontin is that it is marketed as a twelve-hour drug but that almost half of patients don’t get the full twelve hours of pain relief.  The company that produces Oxycontin, Purdue, went to great lengths to hide and distort the fact that many patients only got six or eight hours of relief.  The worst part is that, after the period of relief has dissipated, drug withdrawal begins to set in as the pain returns worse than before.  If the pain returns at six hours and you have to wait six more hours to get another dose of pain medication, you develop a paradoxical over-sensitivity which is excruciating and resembles ordinary drug withdrawal because it really is withdrawal– premature, but real.

Many patients have gone through the use of Oxycontin and have been cut off by their doctors, either because of “drug-seeking behavior” or the doctor has become anxious about being labelled a pill-pusher.  Many patients display “drug-seeking behavior” because their doctors mistakenly believe that Oxycontin really does last twelve hours, and this mistake is reinforced by representatives of the drug company who deny that the drug could wear off in less than twelve hours.

There has been a double reversal of physician attitudes towards prescribing pain medication over the last forty years.  At first, few pain medications were given and only in very rare exceptional cases such as cancer pain or for very acute severe injuries.  Morphine was often given in acute myocardial infarction.  In the late 1990s and the first part of the twenty-first century pain medication became more and more popular and easier to justify.  Finally, all of a sudden in 2014-5, pain medications were removed from as many people as possible.  The CDC released a new statement urging caution, and there was a general clamp-down, especially on the part of pharmacists.  The most recent reduction in the use of opioids was justified, according to the CDC, by the tremendous increase in deaths from overdoses that has occurred over the last twenty years.

Some of the patients who are taken off pain pills will go on to take heroin, which turns out to be cheaper.  Others will suffer through withdrawal.  Those who take heroin are susceptible to overdose or infection with hepatitis B and C.  Overdose is a particular risk with heroin because the strength of illicit heroin is never certain.  Heroin has become more pure over the past few years as its cost has gone down.  Some suppliers have even begun to mix illicitly produced fentanyl with the heroin to enhance its strength.  Fentanyl is approximately fifty times as potent as heroin.

Users of heroin who are suffering withdrawal symptoms may accidentally overdose when their sensitivity to the drug’s effects increases during a period when they can’t obtain it.  Resuming use at the former dose when one’s sensitivity to its effects has returned will cause an overdose.  Taking heroin that is unexpectedly pure or has fentanyl mixed in may also cause accidental overdose.

Fentanyl is available by prescription as a skin patch that is designed to last three days.  Removing the fentanyl from the patch and consuming it directly can lead to overdose when the amount of drug designed to be absorbed in seventy-two hours reaches systemic circulation all at once.

Finally, there is the possibility that someone taking heroin will deliberately overdose because there is a subliminal or even overt desire to kill oneself.  There is a distinct feeling of suffering that underlies the desire to use heroin or Oxycontin.  A person who takes these drugs is trying to relieve suffering and is aware that the pain will return after the drug wears off.  There may be a desire for permanent relief which leads to the urge to end it all.

It is important for us to understand that the consumption of these drugs, even when supposedly for “recreational” purposes and not for relief of pain, may be in part related to a psychic sensation of suffering even if not acknowledged.  When the drug wears off, even if there was no suffering before, there will be suffering from withdrawal.  There is a direct relationship between suffering and the illicit or doctor-prescribed use of these drugs which cannot be ignored.

There have recently been dramatic increases in deaths due to overdose as well as suicides and, more generally, losses in overall life expectancy  among middle-aged Caucasians in the United States, who have also suffered from economic reverses and loss of employment.  The degree of suffering among this group of people cannot be overemphasized and should be addressed somehow.  This is the best reason for enacting government policies which will provide relief of economic suffering: this suffering is life-threatening.

 

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