“History has proven you simply cannot prescribe your way out of an opiate epidemic; especially by bringing even more opiates into the already over-prescribed market ”
~ John J. Giordano
“UNCLE SAM IS THE WORST DRUG FIEND IN THE WORLD.” This was the front page headline that appeared on March 12, 1911 in the New York Times. It was an alarming message from America’s first drug czar (United States Opium Commissioner, Department of State; appointed in 1908 by then President Theodore Roosevelt), Dr. Hamilton Wright. He delivered the news two years after returning from the first global meeting on opium, the International Opium Commission, which met in Shanghai in February, 1909. At the time it was thought that China had the largest population of opium addicts. However, upon completion of Wright’s meticulous research and review, it was found that per capita, American’s were the biggest consumers of raw opium and opium based products such as morphine, heroin, laudanum, over the counter medicines and patented medicines, in the world. Dr. Wright’s words are as relevant today as they were when he spoke them over one hundred years ago during America’s first opioid epidemic.
Opium has a long and storied history dating back to the last part of the Stone Age. The drug was used as a medicine and for recreational purposes. The Sumerians called it, hul gil, the “joy plant” in 3400BC. British merchants forced opium on China as a way to balance their trade deficit. The Chinese culture became so devastated by its recreational use that opium was prohibited in 1729, an act that eventually led to the Opium Wars waged by the British on China. Domestically, Chinese immigrants were blamed for importing the opium-smoking habit to the U.S. However, it was the civil war that left an estimated four hundred thousand veteran solders addicted to morphine – an opioid painkiller first synthesized in 1804.
Morphine was the game changer of its time. Derived from opium, it was marketed to the general public by Sertürner and Company beginning in 1817 as an analgesic and also as a treatment for opium and alcohol addiction. As an analgesic, the drug allowed doctors to
perform long and painful surgeries with minimal discomfort for the patient. Morphine also provided comfort for people suffering from chronic pain. However, after the civil war it was found that morphine was more addictive than either alcohol or opium.
Heroin, an opioid derived from morphine, was developed by the Bayer Company to fill the void of a non-addictive painkiller. Beginning in 1898, diacetylmorphine was marketed under the trademark name Heroin as a non-addictive morphine substitute and cough suppressant. It was sold to doctors as ‘stronger than morphine and safer than codeine.’ Heroin was thought to be a cure for morphine addiction or for relieving morphine withdrawal symptoms. It was later discovered that, contrary to Bayer’s advertising as a “non-addictive morphine substitute,” heroin had one of the highest rates of dependence among its users.
Our domestic politics surrounding opium are equally as astounding. Opium and its byproducts were largely unregulated for most of the 1800’s. “Our Congress,” Dr. Wright said, “from the beginning of our Government, legalized the importation into the United States of smoking opium by the imposition on it of various import duties, ranging from $6 on the pound to twice as much. Thus, you will observe, we recognized it (opium) as an evil promptly and quite as promptly, arranged not to prohibit it but to make a profit out of it.” The sentiment has not been lost on today’s lawmakers.
Just a few months ago, Sen. Edward Markey (D-Mass.) and Sen. Rand Paul (R-Ky.) introduced legislation, the Recovery Enhancement for Addiction Treatment Act, that would loosen restrictions on the number of patients a doctor – and/or his nurse practitioner or physician assistant – could treat with buprenorphine (Suboxone) for opioid addiction.
This line of thinking is so counterintuitive that it shocks the conscious. Just who are the politicians trying to help – patients or the pharmaceutical company’s profits?
Politicians please take note: the problem is NOT that we have too few opioids in America today – as the word ‘epidemic’ in the phrase ‘opioid epidemic’ implies – we have too many! Americans, who comprise less than 5% of the global population, consume over 80% of the world’s production opioid painkillers – and 99 percent of the world’s hydrocodone (also an opioid) – every year. Enough prescription painkillers were prescribed in 2010 to medicate every single American adult around-the-clock for an entire month. This empirical data removes any doubt that prescription opiates are the gateway drug to heroin; and in the face of these facts, politicians want to add even more opioids to the already glutted marketplace.Only a politician could possibly try to invoke wisdom by using this twisted logic of pouring gasoline on a fire in an effort to extinguish the hot flames. Fatal overdoses from prescription opioid medications such as oxycodone, hydrocodone, buprenorphine and methadone have quadrupled since 1999. More than 36,000 people died last year due to opioid painkillers – that’s more people then those who died from all illegal drugs combined. According to the CDC (July 7, 2015) Prescription opioid painkiller abuse or dependences was the strongest risk factor for heroin abuse or dependence; 45% of people who used heroin also abused or were dependent on prescription opioid painkillers in the past year.
History has a way of repeating itself.
The similarities are stunning. Nearly 120 years later, Suboxone is using the same spurious marketing model as heroin did in 1898. Just as heroin was marketed as a ‘safe’ non-addictive alternative to morphine only to be proven to be equally or more addictive; Suboxone is being rolled-out as the ‘safer and less stigmatized’ alternative to Methadone. Some doctors and researchers in the field of addiction say that Suboxone has been a helpful tool in fighting opioid addictions without the need to send patients to methadone clinics. Others have called it the “middle class methadone.” I’m not sure I know how to interrupt that last statement. Are they inferring a wealthier addict should be treated in the privacy of a doctor’s office to avoid suffering the indignation of standing in line at a Methadone clinic every morning with the less prosperous addicts or being seen in patient treatment centers?
The reality is that no proponent of the Medication Assisted Treatment Program (MATP – the use of opioids in the treatment of opioid addictions) wants to discuss the fact that Suboxone, Methadone and all the other maintenance drugs used in the MATP program are opioids just like their organic brothers morphine and heroin – and are just as addictive and deadly if not more! As an opioid, MATP drugs are subject to the same abuse, overdoses, black market sales, misuse, unscrupulous doctors over-prescribing, emergency room visits, crime, broken families, health complications and deaths as any of the other opioids – both prescription and illicit. Simply put, if it’s an opioid, it’s addictive and potentially destructive.
Moreover, MATP advocates do not have a long term-plan to get addicts drug-free and off of opioids – the only plan in place is to get addicts on pharmaceutical opioids. There are people who have been using the lower cost Methadone for ten years or more at an average cost of $5,000.00 per year. However, Methadone and the more expensive Suboxone both have manufacturer discount coupons and rebates available online for smart shoppers who want to save a few bucks. And for those who are experiencing bloating and constipation due to your opioids, there’s RELISTOR – the first opioid-induced constipation (OIC) treatment that targets the underlying cause of OIC without impacting opioid-medicated analgesic effects on the central nervous system. Again I have to ask: just who are the politicians trying to help – patients or the pharmaceutical company’s profits?
Suboxone, even in its limited supply, has already found its way onto the black market and into the streets of America as evidenced by Dylann Roof, the suspect in the deadly shooting at the Emanuel AME Church in Charleston. He was carrying a pack of thin orange strips, which later proved to be the oral version of the drug Suboxone. Roof was charged with felony possession, meaning he did not have a prescription for the narcotic, which is in the same class as other opiates like morphine, heroin and oxycontin.
Years ago I was fortunate enough to contribute to a scientific paper authored by my good friend and colleague Dr. Ken Blum, the co-discoverer of the reward gene that is also referred to as the addiction gene. The paper titled ‘Long Term SuboxoneTM Emotional Reactivity as Measured by Automatic Detection in Speech’ was published July 9, 2013 in the peer reviewed journal PLOS one. In it we revealed the results of our evaluation of the long-term effects of Suboxone. What we found in long-term Suboxone patients was significantly flat affect (p<0.01); they had less self-awareness of being happy, sad, and anxious as compared to both the GP and AA groups. In layman terms, over time Suboxone has a zombie like effect on its users.
Opioid drug addiction has plagued this country for hundreds of years. In the early 1900’s Dr. Wright had the moral fortitude to take the lead in pushing the American government into a well reasoned and effective drug policy. It was more often than not a messy political process. Wright lost more friends than he gained. But his efforts led to The Harrison Narcotics Act of 1914 (HNA), which among other things, prohibited doctors from prescribing narcotics to narcotics addicts “to maintain their addictions.” The plan was effective and worked. The rate of opioid addiction dropped like a rock and stayed low for quite some time.
But then in the late 60’s soldiers returned home from Viet Nam, bringing with them their heroin addictions. In 1971, then President Nixon ordered the creation of the first federal program for methadone treatment of opiate addiction and with it, The Narcotic Addict Treatment Act of 1974. NATA effectively blocked doctors from prescribing methadone from their office.
Buried in ‘The Children’s Health Act of 2000’ that was signed into law by President Clinton on October 17, 2000, is an amendment, ‘The Drug Addiction Treatment Act of 2000 (DATA 2000),’ that effectively reverses the HNA ban on doctors from prescribing Suboxone to addicts “to maintain their addictions.” The amendment included a limit as to how many patients a doctor can treat. Now Senators Markey and Paul are proposing to expand the limit, making Suboxone more available. Why!? So that more affluent addicts can hide their shame and avoid the long checkout line at the local Methadone clinic?
You might find that legislation such as the bill proposed by Senators Markey and Paul to be well intended; or not. You may, or may not, get the impression they’re acting on your behalf with your best interest at heart. Regardless of how you feel, it’s difficult to argue that our lawmakers have learned from their past mistakes. Chipping away at the The Harrison Narcotics Act of 1914 does nothing to combat the opioid epidemic in America today. In fact, legislation such as this is nothing more than rearranging the deck chairs on the Titanic while assuring anyone fool enough to listen that the situation is okay and under control. It’s not. If we’ve learned anything at all from history, it is that you cannot prescribe your way out of an opioid epidemic. History has shown that the only way out of an opioid epidemic is by reducing the amount of available opioids while maintaining a tight grip on its distribution. We know this to be true, yet our lawmakers want to do the exact opposite.
Is this bill really about helping desperate people in need of life-saving therapy or is it just legislating trade? Are politicians really concerned about addicts or is this bill more about expanding the economy of scope and of scale for doctors with an 8 hour education in addiction treatment while opening channels of distribution for a multi-billion dollar product? If approved, doctors and/or their nurse practitioner and/or their physician assistant get to sell the more expensive Suboxone from the privacy of their office while the less expensive Methadone must be sold at the clinic level. This toothless bill has more political, money and social implications than health benefits.
“But it soon developed that we were importing (opium) into the United States, and legally importing, in our selfish greed to fill our own fat purses, undreamed of quantities of the same drug which we believed the Chinaman should cease to use.”
– Dr. Hamilton Wright (1911)
John Giordano is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: www.holisticaddictioninfo.com
‘Long Term SuboxoneTM Emotional Reactivity As Measured by Au-
tomatic Detection in Speech’ www.journals.plos.org/plosone/article?id=10.1371/journal.pone.0069043
UNCLE SAM IS THE WORST DRUG FIEND IN THE WORLD New York Times March 12, 1911