Altered State?

America’s first anti-drug law was passed by San Francisco in 1875 to combat the use of opium. The law only forbade the smoking of opium in opium dens; it did not forbid the sale or use in other ways. This law was intended to target the large Chinese population which was seen a being a threat, especially to white women. The preferred method of use by the Chinese at this time was smoking and opium dens quickly became popular with the local white population. Its popularity was cause of concern for the city fathers and in an effort to protect the morals of the city; anti-vice laws were passed that included the banning of opium dens.

In 1890 the Federal Government passed its first opium related regulation by levying a tax on opium and its derivative morphine. The Federal Government has been involved in the regulation of use, possession, sale, manufacture, and control of opium and related substances ever since.

Opium has a long history of use in the medical profession. In the 1930’s it was used to calm cranky babies and soothe nervous women. It has been used as a treatment for asthma and as a pain reliever. The list of treatment uses is long indeed. It was thought to be more humane than shackles for the treatment of the insane and because of its propensity to cause constipation has been used to treat diarrhea and dysentery. Morphine was synthesized from opium and became available in 1817. It was thought to be safer than opium and because of its purity the dosage could be better controlled. Laudanum is another opiate which is powered opium mixed with alcohol.

After the Civil War, opium, laudanum and morphine were regularly prescribed or marketed to women as a treatment for female complaints. There were no regulations on laudanum and it could be manufactured and sold by anyone. As a consequence, by the late 19^th century it is estimated that there were up to 200,000 opiate addicts in the United States with up to 75% of those being women.

Heroin is the brand name of a product developed by the pharmaceutical company Bayer that was released around 1895. Bayer is a German company that was founded in 1863. (Hmm! Heroin and Hitler). Heroin was developed and marketed as a treatment for morphine addiction but it soon became a favorite of the recreational user and it became illegal in the U.S. under the Heroin Act of 1924.

Early in the 20^th century addiction became a political issue and in the case of opiates the public placed much of the blame on doctors. In 1914 the Harrison Act was passed to make it harder for doctors to prescribe opiates. This law was very effective and the medical profession by and large reserved opiate prescriptions to the most severe types of pain such as that associated with cancer. Heroin became a black market product and has remained such ever since.

The cause and process of addiction was little understood and was thought primarily to be a psychological issue as opposed to a physical problem. As such it was widely believed that addicts could affect their own cure by force of their will. They could quit taking opiates or stop drinking if they wanted to bad enough or if they were surrounded by better influences. This school of thought therefore views addiction as a moral failing, something that only weak people are susceptible to. Bad choices equals bad behavior equals bad person. In many respects this view still holds sway.

The “War on Drugs” resulted in huge increases in the number of peopled jailed as a result of nonviolent drug offenses since the 1980’s. Currently there are over 2 million people in jail and over 4.5 million under correctional supervision in this country. About 20% of those were convicted of nonviolent drug offenses. Bad person equals jail!  Is jail one of those better influences they were thinking about?

Opposing this moral failing view of addiction is the view that addiction is a disease and that medical science will someday unlock the mysteries of the brain and be able to find a cure. Much work had been done in this area in recent years and medical professionals now in fact have a better understanding of the mechanics of the addicted brain. There is not a cure and based on what has been learned there probably never will be what we think of as a disease cure.

This is complicated stuff and I am not sure that as an old Tennessee chicken chopper I am the guy to explain it, but here is my simple version.

Opiates stimulate the pleasure center of the brain, much like food and sex. The brain says to itself that was good, let’s remember that. Just like eating and sex, the brain wants to do it again. Most people have the ability and the physical brain construction to maintain the line of separation that prevents over indulgence. Most people don’t binge eat or have sex all the time. However, with continued use this line of separation can be physically deconstructed. The part of the brain that keeps most people from over indulgence is literally by-passed by the creation of new pathways and when this happens the person crosses the line into addiction.

The desire for the drug is then transformed into a need. The brain literally equates the drug with survival and in fact places that need above even the need for food. When deprived of the drug the brain creates severe physical discomfort and commands attention. If you are hungry enough you will steal an apple. This is the brain state of craving and any time the brain does not have its satisfaction the addict is in a state of misery. This I think is the key, the whole enchilada, the bottom line, the whole kit and caboodle.

The addict cannot choose not to have cravings!

 This is the genius of Alcoholic’s Anonymous. Well before this science was understood, this group of people understood this instinctively. “I am powerless over alcohol, my life has become unmanageable.”

By the 1990’s, doctors were still reluctant to prescribe opiates and their more powerful new cousins opioids except in cases of extreme pain or end of life circumstances. They were well aware of the addictive similarities of these products to heroin and morphine and their potential for abuse.

One of the most effective of these cancer pain relievers was a morphine based drug called MS Contin, made by Purdue Pharma. The patent on MS Contin was set to expire in the 90’s and to prepare for this, Purdue developed a new and very powerful opioid call Oxy Contin. It was marketed as 12-hour pain reliever and as such was non-addictive and was therefore suitable for almost any pain symptom.

Purdue aggressively marketed this new wonder drug to doctors, patients and perhaps most importantly to regulators. How ‘bout a hat doc?

Don’t need a hat? This would look great on your office wall. How many you need, Doc? I got pens, notepads, refrigerator magnets, coffee mugs, key chains, calendars; I even got golf shirts and windbreakers. You play golf? I got balls. Yes you do!

How’s the little lady, Doc? Here, take a sample; works wonders on the nerves, know what I mean? Chuckle, chuckle, back slap. Did I mention I got balls, Doc? Yes you do!

In 2010 Purdue generated $3.1 billion off Oxy Contin. Overall since its introduction Oxy Contin has generated over $30 billion for Purdue Pharma.

 In 2016 over 50,000 Americans died from drug overdoses, 20,000 from opioids. By comparison about 13,000 died from gun violence and about 38,000 in automobile crashes. Purdue’s marketing of Oxy Contin was found to be a big ole pants on fire lie from start to finish and they paid a $653 million fine in 2007. It’s a big number but I don’t think it caused them too much pain (if it hurts I know where you can get some pills).

No one expects drug companies to give away their products and the development of new drugs is an incredibly expensive undertaking. These companies have done some remarkable work and have helped save or prolong countless lives. Many good Americans work in this industry but the reality is the opioid crisis would not be so severe without the political influence wielded by these companies. These are the major players in the opioid market

• Purdue Pharma
• Abbott Labs
• Johnson & Johnson
• Pfizer
• Novartis
• Covidien
• Watson Pharmaceuticals
• Endo Pharmaceuticals

The lobbying group Pain Care Forum (PCF) was created on behalf of Purdue Pharma for the purpose of influencing politicians to protect the opioid market. Since 2007 PCF has given approximately $750 million on its lobbying efforts. Here is one example from salon .com

“In Tennessee, Pain Care Forum members contributed more than $1.6 million to the state’s politicians over the past decade, including contributions to state representatives sponsoring opioid-friendly bills that make it easier for doctors to prescribe painkillers for workers compensation patients.”

The current opioid crisis is revealing some interesting traits of the American character. People of lower economic status and minorities tend to prefer drugs like cocaine, methamphetamine and heroin. These groups have been subjected to the moral failings theory of addiction and typically have been jailed as a result of their use and addiction. The “War on Drugs.”

More prosperous white people tend to be the victims of opioid addiction and many of these people are now turning to heroin due to the high cost of black market opioids and the current low cost of heroin. These white people with money tend to be treated medically rather than judged morally and incarcerated. It is a very troubling development and one that should be part of our national discourse.

We need now to insist our political and religious leaders educate themselves on the latest science of addiction and come to understand that addiction is not a moral failing. Addicts cannot stop just because they want to or because they are surrounded by better influences. Their brains have been physically altered, but the brain can heal itself if given enough time and we all know someone that was an addict but is now living a sober, loving, fruitful and productive life. We know people that have overcome great misery, debilitating loneliness, herculean struggles, and gnawing self-doubt. We know these people and we rightfully admire them for their achievements and for their resolve.

Theirs is the example we as a society should emulate and explore as we fight this battle. If the politicians are going to allow these products to remain widely available and if doctors are going to continue to prescribe them as if they were lollipops then it is up to the rest of us to insist on a different and better approach in dealing with this epidemic.

The resources now being devoted to the massive American prison system would be better spent on treating addiction like the medical condition it is and not on locking people up who are powerless. Locking up addicts IS the moral failing, our moral failing as a society.

I am all in on this one so expect to hear more from me in the near future. It is time that our elected officials put the health and welfare of the people of this country above drug company profits and campaign contributions. It is time our elected representatives and the people that are charged with regulating these products stop being influenced by baseball caps and coffee mugs. It is time for our elected leaders to take the time to educate themselves on the science of addiction, come down from their moral high horse and somehow find the courage to do the right thing for once. It is time for the medical profession to begin policing itself and help to expose and punish the doctors that are pedaling this poison and ruining lives all in the name of their pocketbooks.

Thanks for your patience.

Love to all!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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