Eyeworld

EW NEWS & OPINION 30 May 2017 addresses the demand side and fits a physician's skill and training. We must not stand idly by. The night- mare Life-in-Death is she—heroin— kills. EW References 1. Hill K. Cannabis use and risk for substance use disorders and mood or anxiety disorders. JAMA. 2017;317:1071–1. 2. Murthy VH. Surgeon General's Report on Alcohol, Drugs and Health. JAMA. 2017; 317:133–4. 3. Frank RG and Pollock HA. Addressing the fentanyl threat to public health. N Engl J Med. 2017;376:605–7. Editors' note: Dr. Noreika has practiced ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. The title of this column is inspired by The Velvet Underground's 1967 "Heroin," written by Lou Reed. Contact information Noreika: JCNMD@aol.com and out of vogue. Cocaine is still big where I live. But heroin's coming. It's cheaper," he said. The demand for illicit opioids has skyrocketed as regulators walked back the supply of prescription painkillers. Incorporating mass-in- dustrial proficiency, manufactur- ers in Mexico and China produce synthetics. Frank and Pollock wrote that heroin costs about $65,000 per kilogram wholesale whereas fentan- yl costs about $3,500 and is 50 to 100 times more potent. 3 One kilo of fentanyl can produce more than 650,000 pills that sell for $20 to $30 each. As it did Prince, a few grains of the white powder called China White or Apache can kill. Heroin, cocaine, and marijuana are cut with the cheaper synthetics. Affording no margin for dosage error, users die without knowing why. He also said, "I did speed every day. I kept this from my wife. Trust was lost. But you can't fool the kids. I gave it up because I didn't want to be that kind of father. None of them have embraced the drug lifestyle. I was lucky. I never felt isolated or alone." Quest Diagnostics reported the positivity rate of drug testing admin- istered to American workers in 2015 at a 10-year high. Heroin positivity increased 146%. It underestimates drug usage. Fentanyl testing is not readily available. In some locales, highest death rates occur among people aged 45 to 54. "Strong family ties, social connection and emo- tional resilience reduce the risk of developing a substance use disor- der." 2 Those most at risk are isolated, disconnected, lost. A law enforcement and public health problem, substance abuse is a societal tragedy affecting families, friends, and co-workers. Use-reduc- tion concerns the supply side and is best left to the police. The prom- ising province of harm reduction stupid. But speed gave me energy I needed for the stage. I felt like I was playing great, but it was an illusion. It helped me get through the night. Opioids are different. It's all about warm and fuzzy. You actually do play better. Why do you think all those jazz greats back in the '50s OD'd on heroin? It helps you get inside the music. The hardest thing I had to kick was cigarettes. Harder than drugs." Drug addiction is a disease of the brain. Chronic use causes changes affecting the basal ganglia, amygdala, and prefrontal cortex. These structures are associated with perception of pleasure, the reward system. Structural and functional changes lead to tolerance. More drug is needed to re-amplify its effect. The risk of relapse persists long after discontinuation. "Look, there are always going to be addicts. Drugs have been around for thousands of years. Drugs go in Heroin continued from page 28

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