Eyeworld

EW NEWS & OPINION 28 May 2017 Insights by J.C. Noreika, MD, MBA country, many picking scrap to pay for their habit. They were called junkies. Recurring like Kondratiev waves, the latest epidemic occurred despite costly attempts by government to stem the illicit trade. The literature on dependence, causes, and cures fills libraries. I discussed this with a friend familiar with drug usage and its realities. The best lead guitarist you never heard of, he asked to remain anonymous. A rock n' roll artist in the 1980s, he survived relatively unscathed. Now 60 and a success- ful musician, he is not a user. He told me, "As a teenager, I started on weed. It was the thing to do, a social thing. It was the '70s. Of course it's a gateway drug. It alters your mental state. It's easy to go from weed to raiding your parents' liquor and medicine cabinet." Research has shown that the risk of substance abuse disorders significantly increases within 3 years of starting cannabis. Marijuana users are much more likely to become substance abuse users than non-us- ers. The more it is used, the greater the likelihood of becoming depen- dent on other drugs. 1 My friend commented, "Why drugs? Kids are going to experiment. And this was rock n' roll. I was doing 320 shows per year perform- ing more than 4 hours per night. It was grueling. Everybody wants to be your buddy. Coke and speed were always backstage. You'd go to these parties—I'm not talking crack houses—money and drugs mixed easily. It was fun. I developed back problems. I'd save the Percocet I was prescribed." Opioids are the drugs du jour. The crisis has many fathers. Venal practitioners grab headlines, but the unintended consequences of the Joint Commission's standards for pain amelioration in 2000 led to a deluge of legitimate prescriptions for painkillers. Pain treatment became a patient rights issue; abuse and addic- tion followed. In November 2016, the Office of the Surgeon General issued a report on alcohol, drugs, and health: nearly 21 million people in this country are abusers. 2 From my friend: "I didn't like weed. It made me feel sluggish, Used in the United States since at least 1800, opium is a mood-al- tering substance. In 1805, it was refined into morphine. Named after the god of sleep, Merck commer- cialized it in 1827. By the end of the U.S. Civil War, tens of thou- sands of combatants were addicted. Morphine's side-effects prompted a search for safer alternatives. In 1898, Bayer tested a new wonder drug. Bayer's employees reported they felt heroic after ingesting the substance; hence, the name heroin. It was pronounced safe, non-addic- tive, and sold unregulated in the U.S. until 1920. By 1925, there were an estimated 300,000 addicts in the C anton, Ohio, recently cap- tured the news cycle with video of a white trailer em- blazoned with the words "Disaster Response." These portable morgues are used to stash the burgeoning inventory of hero- in's dead. Last August, 174 people in and around Cincinnati overdosed on opioids in 6 days. Columbus has one fatal overdose everyday. West Virginia, New Hampshire, Kentucky, and Rhode Island have higher rates. Heroin deaths exceed mortality from automobile accidents, gun violence, and suicide. This plague engulfs city, suburb, and farm. It spares no age, race, gender, or economic strata. Soaring death rates, grieving communities, and shattered families, the heroin epidemic is everyone's problem. Physicians can be part of the solution. "Heroin, be the death of me" J.C. Noreika, MD, MBA continued on page 30

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