Heroin addiction often begins with the medicine cabinet, where people develop a dependency on oxycoton, percocet or another opioid-based painkiller prescribed to treat their condition. But how do patients taking legal medications switch to abusing heroin? According to Dr. Bobby Dey — a retired pain-management specialist — the answer lies in the chemistry of common painkillers like percocet.
"Percocet is 98 percent the same structure as heroin," he told Civilized. "So once a person is taking opiates, if they violate the agreement they have with their doctor by taking too much, and the doctor has to discharge them as a patient, what they do is they go to the street, where heroin can be purchased very cheap compared to percocets."
And getting discharged for violating medical agreements is common thanks to a flaw in all opioid-based medications. Regardless of what dose you begin taking, your body will develop a tolerance that requires increased doses over time to achieve the same level of pain relief.
"There are many downsides to opiates, one of them being that people develop a tolerance over time, so you need higher and higher doses over years and years for the treatment of chronic pain," Dey explained. "If opiates didn't cause tolerance, we would not be here [in the middle of the opioid epidemic]. If I could give somebody 20 milligrams of Oxycontin a day or four Percocets a day, and ten years later, still be giving them that amount, they would be fine."
But that's not how those drugs work. And when doctors and patients disagree over proper dosages, patients often take desperate measures to relieve their pain. "If it's not being relieved, the patient thinks, 'I need more.' The doctor says no, the patient says yes, so they'll go out on the street and take heroin."
In other cases, patients resort to taking heroin because of another downside of opioids: withdrawal sickness. "You can substitute heroin for opiates and not have the type of withdrawal symptoms that no one wants to have," Dey said. "Many times the withdraw symptoms are driving patients either to need more or to crave more. And that has horrible, lethal consequences."
In 2015, over 33,000 Americans died from overdosing on heroin and other opioids. The death toll for 2016 is expected to be even higher when the CDC finalizes the tally later this year. And the number of opioid-related deaths will likely continue to increase until doctors have a safer alternative. Medical marijuana could be that alternative according to small studies and anecdotal evidence.
"I personally noticed that cannabis has medicinal benefits," Dey added. "There have been small studies showing that cannabis works both from a bio-molecular perspective as well as from a treatment standpoint as a treatment of chronic or constant pain, but no developed studies. It's just never been looked at properly. Still to this day as we're speaking, there's no solid, large-scale, medically accepted study on it."
And that frustrates researchers because federal policy has hindered marijuana research for decades, leaving physicians with no alternatives to opioids.
"When you put together the fact that an opiate that has 98 percent the structure of heroin is a Schedule II drug — meaning that it is official medically and addictive, whereas cannabis is a Schedule I drug, meaning it's not considered beneficial medicinally, that's where it gets crazy," Dey explained. "You're taking something that's 98 percent the structure of heroin and saying that it's okay to take orally. Yet cannabis, which has no relationship to heroin — it's a naturally growing plant — isn't okay because they shelved it it in the 70s and said, 'We'll take a look at this later.' But they never got around to it because they were too busy fighting the drug war."
So for the sake of saving lives, Congress needs to get out of the way of marijuana researchers and help them find an alternative to opioids.