Ohio headlines: heroin, opioids and overdose

Columbus Free Press | September 3, 2014 | by Mary Jane Borden

Heroin is a serious concern. A member of the “opioid” class of drugs, “heroin” is actually the trade name assigned by Bayer in 1898 to diamorphine, which is synthesized from the morphine that is extracted from seed pods of the Asian poppy plant.

In its purest form, heroin has the same analgesic and pain relieving properties as its opioid cousins - Oxycontin, Fentanyl, Diluadid and codeine - all available by prescription.

Illegal in all states under the most restrictive Schedule I, the heroin causing problems in Ohio is far from pure. Authoritative estimates compute that the actual drug comprises less than one third of a heroin dose. Adulterants include lactose, starch and sucrose, along with caffeine and quinine. Some have their own deadly side effects.

The worst side effect of opioids is overdose. Pending signs include muscle flaccidity, cold clammy skin, small pupils and low blood pressure. Decreased respiratory rate and the suspension of normal breathing can be followed by unconsciousness, coma or death.

Whether injected, snorted or swallowed, opioids result in overdose when too much is ingested or the level of pure drug is underestimated. To make matters worse, heroin may not be the sole contributor to the deaths attributed to it. Other culprits include the benzodiazapines or alcohol used in combination with it, which similarly cause respiratory suppression.

Contrary to the headlines, the number of regular heroin users has remained steady since 2002 at about 0.1% of the population. What have exploded are deaths from prescription opioids. According to the Ohio Department of Health, “unintentional drug poisonings” jumped 335% from 1999 to 2009, with increases “driven largely by prescription drug overdoses.” There were 1,373 such deaths in Ohio in 2009.

The bridge from legal prescription opioids to heroin can be an easy one to cross. The Cincinnati Enquirer noted that many addicts “got hooked after they were taking opioids for a legitimate injury.” Some also come to the drug to escape from abuse suffered as a child. For those dependent on expired prescriptions, heroin becomes a less expensive, more readily available option with a similar euphoric effect.

It’s not just the euphoria engendered by opioids that keeps users coming back. Severe withdrawal symptoms can result from the abrupt discontinuation of use; long-term use and physical dependence often follow.

Obviously, antidotes to opioid overdose and dependence are being sought. They range from the ridiculous to the sublime. On the ridiculous side lies a plan fielded by a Butler County prosecutor. It would appoint teen “guardians” in high schools to counsel fellow students on heroin addiction. This experiment has been tried before. It was called the DARE program, whose end game found student participants indistinguishable from their non-participating counterparts.

A more successful strategy involves naloxone, also called Narcan. Hamilton, Ottawa, Lake and Lorain county first responders now carry this nasal spray that has proven remarkably successful in stemming the overdose tide. The nasal mist closes opioid receptors thereby breaking the high and reversing the overdose; it takes effect in a matter of seconds. The problems with Narcan lay its one time use and hefty price in a time of restricted budgets and an exponentially increasing problem.

Enter marijuana. A recent study conducted by the Johns Hopkins Bloomberg School of Public, published in JAMA Internal Medicine and reported by Newsweek found that, in thirteen states that permit the medical use of cannabis (marijuana), 25 percent fewer people died annually from opioid overdoses. A study in the Journal of Neuroscience substantiated this drop by finding that “CBD [a component of cannabis] specifically inhibited reinstatement of cue-induced heroin seeking.” The study concluded that, “Movement from more harmful to less harmful drugs is an improvement worthy of consideration by treatment providers and policymakers.”

So Ohio policy makers, when it comes to heroin, opioids and overdose, where you stand with respect to the consideration of less harmful, even beneficial drugs like naloxone and cannabis? Well over 100,000 Ohio voters have already voiced their support by signing a petition for the Ohio Cannabis Rights Amendment. Rumors are afoot of legislation. There is a song whose lyrics lament, “How many deaths will it take till we know that too many people have died?” How many headlines are enough and how overdoses are too many? What are you doing to stem the teeming tide?