About

Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Tuesday, February 28, 2012

Atomoxetine Vault

Atomoxetine 

Trade Names: 

Strattera, Attentin, Tomoxetin

Basic:

Known chemically as (-)-N-methyl-3-phenyl-3-(o-tolyloxy)-propylamine. Atomoxetine is a drug of the NRI (norepinephrine reuptake inhibitor) class. It is not structurally related to the amphetamine family.

Mode of Action:

Atomoxetine is a selective norepinephrine reuptake inhibitor, with negligible effect on dopamine or serotonin transport. It is believed to inhibit the NMDA complex at therapeutic dosages.

Use:

Atomoxetine is used clinically in the treatment of ADHD, and is best known by the brand name Strattera. It has also been used recreationally, and described as a more functional alternative to amphetamines.

In the clinical setting, the drug is taken orally in doses ranging from 10 to 100 milligrams. It may effectively be taken once or twice daily.

Effects:

Atomoxetine differs from other stimulants such as methylphenidate or amphetamine in that its psychostimulant effects are less pronounced than these compounds. It may increase alertness, focus, and energy but produce a lesser degree of euphoria or reward than other popular stimulants. Its effects likely include wakefulness, jitteriness, and increased heart rate. 

Precautions:

Signs of overdose include mydriasis, blurred vision, sweating, confusion, tachycardia, and palpitations. 

Legality:

Atomoxetine is currently not a controlled substance in the US.

Monday, February 27, 2012

"Denial": A Tool of Convenience in the Recovery Culture

(Search keywords: addiction, denial, what is denial, addict in denial, signs of denial, loved one, treatment, intervention, family of addict, recovery, hitting bottom, 12 steps)


Intro:


Thomas Wayburn, Ph.D. in a paper said; The term "denial" is a fallacious appeal to the authority of the treatment community in a dispute with a user who is insufficiently articulate to defend his values and motives. The term "denial" is an impostor."

The author can add to this his own experience; in which case the term denial has been utilized for its appeal to the authority and ideological dominance of the treatment & recovery community or the condescending onlooker, often in dispute with an individual who in fact does articulate his/her personal values and motives for using drugs, and in some cases articulates them reasonably. In many cases, this "addict in denial" may be a productive member of society who has thus far managed to use drugs competently and responsibly - with no bad results aside from being found out or "caught". It is in such cases which the only approach or intervention technique available to the treatment 'authority' or onlooker involves marginalizing the drug user by insisting he/she is suffering from "denial". The irony in this is that all too often, the condescending or intervening party him or her self is experiencing a state of denial; in the inability to come to grips with the prospect that maybe, just maybe, one might be able to use socially-disapproved drugs responsibly and incorporate drug use succesfully into their lifestyle without suffering disastrous consequences.. Intellectual honesty is not a strong suit with the typical drug treatment worker or addiction bureaucrat.


What is "denial"?

Denial is a frequently used buzzword of the addiction & treatment world. The term has no real meaning, even to the recovery fanatics who so casually apply the term to anyone and anything failing to conform with their very narrow doctrine of thinking. It has become a tool of the recovery culture for labeling virtually anyone as "sick", planting a seed of self-doubt and perceived powerlessness.

Convincing individuals they are delusional and cannot trust their own thinking leads many to submit to traditional recovery doctrine. Convinced of their personal and intellectual incompetency, they become dependent on recovery doctrine to do their thinking for them, and to otherwise dictate every facet of their lives and livelihood.

Not only is the term denial used to diagnose the drug user. Their loved ones are diagnosed with denial as well. Tragically all too often, vulnerable friends and family members submit to the notion that they themselves are afflicted with their own condition called "codependence", and subsequently turn their lives & will over to recovery doctrine (yes, an entire branch of the treatment and recovery industry is dedicated to the disease of "codependence", a disease which, due to its complete lack of identifiable pathology, has been conveniently emphasized as very much a "spiritual disease")

The label of denial allows recovery culture to reinforce the subject's self-perceived role as a subservient, sick person, and to emphasize their dominant status as the only party who is seeing reality & truth as it really is.

The diagnosis of denial serves to stamp out any opportunity for meaningful conversation regarding drug use. It is used to reinforce the dominance of recovery doctrine while minimalizing or disqualifying any other conflicting ideology - regardless of its actual merit - while avoiding intelligent or reasonable discourse.

Moderation and discipline do not exist and to believe so is a symptom of denial:

In our time, there is no recognition of such a thing as over-indulgent or excessive drug use. What once, albeit in a wiser age, may have been perceived as excessive drinking or drug use is now indiscriminately labelled as "addictive illness", regardless of the circumstance, and with no verifiable diagnostic measures to speak of. The disease of addiction means whatever the recovery culture says it means at any given time. 

The popular understanding of heavy drug use (i.e. addiction) has never minimalized the notions of responsibility and self-competence to the extent it now does. The idea that a heavy drinker or drug user might do best to cut back on their use or incorporate some self-discipline into their lifestyle is somehow unfathomable. Instead, those who use drugs or alcohol excessively are all sick and "need treatment". Plain and simple. No ifs, ands, or buts. To even attempt claiming personal responsibility and question the merits of medical treatment for such behavior constitutes yet one more "symptom" of the illness itself.


Thursday, February 23, 2012

Utilitarianism & Individual Liberty: Both Straightforward Arguments Against Drug-Prohibition

In an influential and historical work of literature, titled "On Liberty", John Stuart Mill proposed a general doctrine which can be termed the "harm principle" -The works of Mill were largely influential in the birth of American Constitutional Government. The harm principle is a straightforward philosophy restraining the scope of criminal laws by the following means: 

1. Acts may be rightfully criminalized only when they inflict concrete harms on specific individuals.

2. With the exception of protecting children and otherwise incompetent persons, it is unjust to criminalize acts merely on the grounds of preventing potential harm (i.e. harm that is not immenent, meaning preemptive or preventative criminalization is unjust)

3. It is unjust to criminalize a behavior merely because the idea of it is offensive to others (i.e. socially disapproved)

This principle has been one of the main premises underlying my own advocacy for repealing current drug laws.

The Utilitarian Approach:

Mill advocates the harm principle from a utilitarian standpoint, a system of ethics in which rules or laws are made by considering the ultimate results of the given rule (the ultimate proportion of positive to negative consequences), and then contrasting this with the ultimate results of not establishing the rule (again, determined by the aforementioned formula). 

The morally justified choice is always that which, in the long term, provides the greatest aggregate margin or sum by which human pleasure exceeds human pain or suffering. Utilitarianism is essentially a means of quantifying the moral or ethical merit of a given course of action. 

Wednesday, February 22, 2012

Krokodil: Yet Another Product of Idealistic Drug Laws

Opiated Shamanism: Russia's Krokodil Epidemic Continues: Ten months ago I wrote about about "Krokodil" in the former Soviet Union . This week Simon Shuster of Time magazine and Shaun Walker o...

Ending The "Epidemic" of Opioid Related Mortality

I've compiled a summary of what I believe to be some of the most efficient and practical measures for reducing opioid overdose deaths. However, to implement these measures will require the commonfolk to come to terms with some uncomfortable realities. To the parents whining about protecting children; I'm perplexed as to how many of you still haven't come to terms with the reality that draconian drug laws do not work. Rather than mindlessly wringing your hands and crusading to ban more drugs, start promoting some intellectually honest policies which emphasize individual responsibility and are actually effective.

The US could spend an extra 500 billion dollars on propaganda & enforcement, and still, these reasonable measures would be far more effective than the current misguided approach:

1) Dispensing opioid antagonists such as naloxone (Narcan) with prescriptions. Along with widespread access to over the counter naloxone in its nasal spray form, sublingual tablet or pre-packaged syrettes for IM use. Narcan has seen wider use in 15 states due to its success in reducing mortality. Even the CDC now claims there is a direct correlation between "harm reduction" policies like this and reduced death rates. If a product is known to be minimize harm and save lives (as opposed to causing harm, as our drug laws have) then it is irrational, immoral, and inexcusable to deny individuals liberal access to this product.

2) Greater efforts toward drug education. To include safety & harm minimization techniques, basic pharmacology, drug tolerance, drug combinations, mechanism of overdose, and emergency antagonist treatment.

3) Publicize and emphasize the danger of polydrug use involving benzodiazepines & alcohol with narcotics. A majority of opioid related overdoses and overdose deaths are due to these poly-drug combinations of opioids with benzodiazepines or alcohol - Simply spreading awareness of this crucial danger could substantially reduce deaths.

4) Distribution of narcotic equipotency charts at treatment centers, needle exchanges, pharmacies, or community service or outreach centers.

5) Encourage patients to take on more responsibility in their medication regimens in part by becoming educated & reading RX literature. 

6) "Good Samaritan Laws" - Introduce policies which grant criminal immunity to those who call to report an overdose. The criminalization of narcotic use serves to disincentivize drug users to seek emergency treatment for overdosed friends or themselves.

Tuesday, February 21, 2012

Cannabis Vault


Also known as marijuana, pot, ganja or bud:

Cannabis refers to a family of flowering plants consisting of three putative varieties; these are cannabis sativa, cannabis indica, and cannabis ruderalis. Cannabis has been historically used for  its psychoactive and therapeutic effects. The cannabis plant contains over 400 cannabinoid compounds, many of which contribute to these effects, however its major psychoactive constituent - or at least that which has been the most researched - is delta-9-tetrahydro-cannabinol (or "THC"). Cannabinoids such as THC exert their effects by acting centrally at cannabinoid receptors in the brain.

Cannabis sativa and to a lesser extent, cannabis indica, account for most of these preparations. The two are distinguished by their physical characteristics and specific cannabinoid content. Sativa tends to be cultivated for its flower buds, while indica is often cultivated for the production of hashish - a compressed preparation of flower matter consisting of small resinous outgrowths called trichomes containing the highest cannabinoid concentrations in the plant.

Cannabis Preparations & Use:

In drug culture (including the therapeutic setting), the terms cannabis or marijuana typically refer to the preparation of the flower bud of the cannabis plant intended for psychoactive or therapeutic use. Marijuana is by far the most widely used illicit psychoactive in the world. Cannabis preparations have many names, the more common of which include the aforementioned marijuana, bud, ganja, pot or green. Due to the lipophilicity of its active cannabinoids, pot is most often smoked, as a rolled cigarrete or with a small pipe. It is also often eaten, either in its crude form or as an ingredient in food preparations.

Cannabis products are also smoked or eaten in the form of the aforementioned resinous product, hashish - often known as hash in the US. "Kief" is also commonly available; it is a sifted plant-powder rich in resin glands (trichomes), or essentially, an unpressed, powder form of hash. Hash and kief can both be incorporated into foods.

Cannabinoid Content:

The two major active cannabinoids in pot will vary in their relative concentrations. Recent research has examined their comparative properties to discover a stark contrast in their effects. The two compounds, when taken separately in pure form, produce very distinct effects, while when taken together as they occur in the cannabis plant, the result is different than with either compound alone.  The proportion of the two compounds produced in the resins of each individual plant is a major determinant of potency and effect quality.

THC properties: anxiety or panic, paranoia, body dysmorphism, social introversion, depression, temporary psychotomimesis (a psychotic like state). 

CBD properties: anxiolysis, anti-psychosis, giggling, lightened mood, body relaxation or buzz.

THC (along with most other related cannabinoids) is a highly lipophilic compound, meaning it is highly soluble in fatty tissue (lipids) - being that the cerebral cortex is the most lipid-rich structure of the body, smoked cannabinoids are rapidly and thoroughly absorbed by the brain.


Note: Due to its psychotomimetic properties, THC users with a history of psychotic illness or a predisposition for schizophrenia may be at a higher risk for developing or precipitating clinical psychosis.

Effects of Cannabis: When smoked, its major effects last only 30-45 minutes, while minor effects may linger for 3-4 hours. When taken orally, its effects can last several hours.

Positive or negative change in mood

Urge to laugh, uncontrollable giggling

Physical or psychological relaxation

Analgesia and anti-emesis

Increased appetite - inhibition of messages from the stomach which indicate one is "full"

Verbal retardation (slow speaking)

Slow driving and reduced focus

Increased sense of taste, smell or sound

Changes in self perception (positive or negative)

Body buzz

Altered perception of time

Sleepiness or sedation

Visual distortion

Impaired linear memory and thought processing

Increased appreciation for music, deeper connection to music

Increased satisfaction with tedious, mundane or boring tasks

Increased capacity for creative or abstract thought, with an accompanying impairment of intellectual capacity (although temporary)

Anxiety, fear, paranoia, panic or panic attacks

Precipitation or worsening of existing psychotic conditions

Red eyes, dry mouth, increased heart rate, headache

Dependence or habituation: Psychological dependence has been reported with marijuana, though there is no reason to believe that marijuana is any more addictive than eating chocolate or jogging, making this a moot point. Regular use of marijuana can lead to a very mild physical dependence - as some minor withdrawal symptoms have been documented. To what extent these symptoms are psychosomatic is not known.










Mescaline Vault

Mescaline Molecule
Chemically known as 3,4,5-trimethoxy-phenethylamine. Mescaline is a psychedelic compound of the phenethylamine family. It is well known as the major psychoactive component in peyote and san pedro cacti. 

Mescaline has a long history of use in Mexico and Central America, in the form of mescaline containing cacti. In North America, the drug is taken for its hallucinogenic as well as entheogenic properties; the Native American church uses it legally for ritualistic purposes. Mescaline joins the ranks of LSD and psilocybin (magic mushrooms) as one of the more well established and universally popular psychedelic drugs.

Peyote Cactus
The drug is available on the illicit market as a lab synthesized product or an extracted crystalline powder. Such powders however are reportedly rare; consumption of cacti accounts for most of its use. Peyote cacti are the most common of the psychedelic cacti and appear as short, round, button-like mounds - these are usually taken orally.

Accounts of its use and its effects have been extensively documented. Both casual and ritualistic users report its effects are uniquely potent. 

Its main mode of action is similar to other psychedelics and involves serotonergic systems as well as dopaminergic systems. Mescaline acts at the 5HT2A (serotonin) receptor as a partial agonist, while its dopaminergic properties are not yet well defined.

Effects of Mescaline: Effects generally last a few to several hours:

Visual distortions

Positive or negative changes in mood

Enhanced capacity for creative or abstract thought

Emotional potentiation

Enhanced sensory perception (taste, smell, sound)

Physical and psychological stimulation

Increased energy

Dream like state

Increased introspection or self insight

Giggling or laughing

Altered time perception

Impulsivity

Euphoria

Altered speech

Vulnerability for distractions

Changes in ego

Restlessness

Body buzz

Tendency for obsessive focus on details

Fear, paranoia, anxiety or panic

Worsening or precipitation of existing mental illness

Pupil dilation, thermal dysregulation, nausea & vomiting, shortness of breath, reduced libido, insomnia, increased heart rate, decreased appetite, increased urination, chest pain

Saturday, February 18, 2012

LSD Vault

LSD

Other Names: LSD-25, Lucy, or Acid

LSD blotter designs
Basic:

Known chemically as lysergic-acid-diethylamide. LSD is a semi synthetic compound of the ergoline family. It is derived from ergot, a fungi of the Claviceps genus which commonly grows on rye and similar grains.

Characteristics:

Pure LSD occurs as a colorless, odorless, slightly bitter solid - as unbroken crystals or a crystalline powder. The drug is highly potent and is therefore usually highly diluted when sold at the retail level. At this level it is often distributed as a liquid solution - which may be applied to various absorbent materials suited for application on an inner surface of the mouth; such materials include sugar cubes, jello squares, or large sheets of an absorbent designer paper (which is lightly dippled into an LSD solution and subsequently cut into many single dose units known as blotters). LSD blotters are taken by applying and dissolving usually on the tounge. LSD containing liquid itself may also be administered as tiny drops under the tounge, eyelid, and elsewhere. LSD is sometimes available as a diluted powder, which is often compressed into a soluble tablet form. Both liquid and powder LSD can be, and have been, prepared for injection.

Pharmacology:

The origins of its psychoactive effects are quite complex, though they have been linked in part with its action on CNS serotonergic systems. This drug has been used for its entheogenic, psychedelic, recreational and psychotherapeutic properties. LSD, along with cannabis, was quite common with the 1960's counterculture movement.

Effects:

Major effects are experienced for about 4-6 hours. Other effects may last up to 12 hours.

In terms of its effects, LSD represents the prototypic psychedelic drug. Such compounds are, in popular terms, known as "hallucinogens"; however few of these compounds produce true hallucinations, at least not as portrayed in media and film. The popular tales of users being approached by "clowns" or "elephants" are merely inventions of pop culture, largely based in fiction rather than reality.

Common effects include:

Sensory enhancement

Physiological or psychological stimulation

Enhanced creative capacity

Synesthesia (seeing sounds, hearing colors)

Introspection

Enhanced spirituality

Positive or negative changes in mood

Potentiation of current emotions

Introspection or enhanced self awareness

Distorted sense of time

Altered speech

Paranoia, anxiety, fear or panic

Overwhelming emotional experience

Sensitivity to touch, smell, or noise

Psychological trauma & "flashbacks"

Physical tension

Hypothalamic dysregulation (thermal, secretions, pupillary)

Precipitation or potentiation of existing mental illness

Closed eye or open eye visuals - hallucinogens such as LSD don't cause hallucinations in the traditional sense of the word; rather than complex hallucinations, visuals from LSD may include trails of light, movement of objects, bizarre distortion of surroundings, enhancement of color and contrast, or strange patterns with closed eyes or in the dark.

Pupil dilation, yawning, jaw tension, increased secretions, perspiration, increased heart rate and body temperature

Further Reading on LSD:

Psychological Effects of LSD (By Marc Anderson)


Thursday, February 16, 2012

"Substitution Treatment" vs "Chronic Drug Abuse": A False Dichotomy


(Search Keywords: substitution, treatment, methadone, buprenorphine, drug policy, addiction treatment bureaucracy, opioid replacement, maintenance)

Wednesday, February 15, 2012

Research Chemicals: About

Basics:

"RC's" (or "research chemicals") are quasi legal compounds sold through certain vendors and consumed for their pharmacological effects. They are, more often than not, chemical analogues of popular drugs currently controlled by federal laws. A controlled substance analogue (or CSA) is a compound derived from the same structural family as a certain illicit drug but with one or more molecular modifications, reductions, substitutions, or additions. Research chemicals are popularly known as "designer drugs", or "legal highs", and are sold in a variety of different forms, under a variety of different product names, usually labeled as non-consumable.

Legality:

In the case of our drug laws in the US, only so many certain compounds are listed specifically as controlled substances. The federal analogue act was enacted to address related compounds that are derived from, or structurally similar to, the explicitly listed controlled substances. This law allows for relatively new or obscure drugs that are not yet known, have not yet been outlawed, or have not even been discovered, to be treated as illicit drugs when they are sold and used for such purposes. This essentially allows law enforcement to keep up with the evolving drug market without having to explicitly enact a new law each time a new drug is discovered.

In order to operate within the law, or at least ambiguously within the margins of the law, RC's can not be marketed as drugs and can not be marketed as food. By marketing RC's as a variety of different non-consumable products, research tools, or novelty items, the compounds are able to avoid the regulative scrutiny of food and drug products. Such products contain clear labeling stating "not for human consumption". Such labeling allows the manufacturer and vendor to disclaim liability for potential consumer hazards (for instance, when someone swallows a powder clearly marked "drain cleaner" or "shoe shiner" and becomes ill, it's tough to argue that the manufacturer is liable). But more importantly, such marketing techniques allow the compounds to remain under the public radar and to avoid being conceptualized by law enforcement as controlled substance analogues. For instance, if the compounds were being sold as "tweak pills" or "nose powder" in the same manner that drugs like heroin and cocaine are sold, the authorities can make a strong case that the compounds are being sold and used as street drugs (as opposed to random home or novelty products with active components which just so happen to structurally resemble illicit drugs). And thus due to the context of their sale and use, along with their structural similarities with illicit drugs, can be treated as controlled substance analogues.

Safety:

Before continuing, let me emphasize first and foremost; despite being legal, easily available, and professionally packaged, these compounds are every bit as powerful and every bit as dangerous as any illicit drug. They are mere variants of the same structural families as their illicit alternatives (mutually related to the same extent as oxycodone is to morphine, diazepam is to alprazolam, etc).

As a general rule, their pharmacology exhibits no substantial difference from that of their illicit corellates. They are, generally speaking, every bit as potent and every bit as addictive.

Human consumption of these compounds often entails more risk than use of well established "street" drugs, as the RC products may have little to no history of human use, thus their effects and toxicity profiles are largely unknown. So, there is some potential for a very toxic compound to be marketed and to cause great harm or death to consumers - who basically play the role of consenting human guinea pigs by using some of these compounds.

Common RC's:

Currently there are a variety of available RC's covering a wide range of the psychopharmacological spectrum.  The most popular of the RC's fall into the stimulant, enactogen, and psychedelic/hallucinogen categories. Sedatives and anaesthetics are common as well.

The most prominent RC's are currently members of the following chemical and pharmacological families:

Substituted Phenethylamines, Phenylpropylamines, and Propiophenones (Analogues of amphetamine, methamphetamine, MDMA, cathinone, and pyrovalerone) - This category mainly consists of psychostimulants and enactogens. Some have psychedelic properties as well (2Cx and 2Cx derived compounds).

Tryptamines (Analogues of serotonin, DMT, AMT, and psilocybin)  - This group consists primarily of psychedelics, hallucinogens, or enactogens.

Piperazines (Analogues of benzylpiperazine) - This group consists of mostly psychostimulants and anorectics.

Arylcyclohexylamines/Substituted Arylcyclohexylamines (Analogues of PCP and ketamine) - This catagory consists of dissociative, anaesthetic and sedative agents.

Substituted Indoles/Naphthoylindoles (Analogues of JWH-018 - the original active constituent found in "Spice" products) - This class consists of compounds which are active at cannabinoid receptors and thus mimick the effects of cannabis products (particularly, the active cannabinoids in cannabis; such as THC and CBD)

At this particular moment, following recent bans, a few of the most prominent compounds on the market are as follows (for the sake of protecting the market, I'll use the acronyms, though I'm sure most readers can figure out the identity of the compounds from there):

4-MEC: a cathinone analogue similar to mephedrone with psychostimulant and enactogen properties

4-FA: a halogenated analogue of amphetamine with psychostimulant and enactogen properties

2-FMA: a halogenated analogue of methamphetamine with stimulant and possibly enactogen properties

5-IAI: an aminoindane analogue of MDAI with enactogenic properties

Methoxetamine: an arylcyclohexanamine based dissociative compound closely related to ketamine

a-PVP: an N-pyrrolidinyl derivative of the alkylphenone (substituted cathinone) family. It is an analogue of MDPV and pyrovalerone and produces stimulant effects.

Diphenylprolinol (D2MP): an atypical diphenylpyrrolidine-based stimulant with pharmacology similar to methylphenidate

Ethylphenidate: a phenylpiperidine derived stimulant closely related to methylphenidate

UR-144: an indole derived compound acting at cannabinoid sites

A Lack of Opioid RC's:

There is an exception in terms of RC availability - opioid agonists have been for the most part disregarded by commercial drug chemists. They are not available on the RC market to any significant degree, with the exception of isolated kratom alkaloids and the mild analgesic O-desmethyltramadol.

The rarity of opioids on the RC scene may indeed seem odd without further analysis of the very nature of the RC scene, and the fundamental differences between narcotic drugs and recreational or party drugs. With regard to the former, it seems apparent that the predominant consumers of the RC drugs are recreational users. Often sociable, often young and often naive in terms of drug use & degree of drug experience; such users are often intent on using research chems in a social or thrillseeking context rather than in a maintenance or self-medicating context - accounting for the popularity of the empathenogens, stimulants, cannabinoids and hallucinogens.

Another likely factor to consider is the disproportionate societal stigma of opioids at present. With a disproportionate & irrational degree of emphasis by media on prescription "heroin substitutes" and the so-called "opioid epidemic", "dope" has again become public enemy number 1 in recent years. With federal law enforcement having launched a full scale witch hunt against doctors, dealers, distributors and even medical patients. Few commercial chemists would take such a risk.

The witch hunt which would likely ensue following a single overdose - or one bizarre criminal act in which the perpetrator incidentally happens to be under the influence of an opioid RC - could very well be a death knell to the young and delicate RC industry. This is really not a matter of which drug is more dangerous or harmful, but a matter of which drug-associated incident would draw more mindless handwringing & moral panic.

Phenethylamine RC's

Phenethylamines on the RC Scene:

The phenethylamine structure is a common theme for the research chemist and many compounds have been synthesized based off of the structures of phenylpropylamines such as amphetamine or MDMA, and aminopropiophenones such as cathinone or methcathinone. Many of these compounds differ from their homologues with only a minor addition or modification; for instance, amphetamine and methamphetamine can be fluoridated or alkylated at one of numerous positions and marketed as non-food, non-drug product for research or other such use only. Such compounds have been popular as psychoactives sold through head shops, smoke shops and online; with new compounds being introduced quicker than the powers that be can criminalize them.

Phenylalkylamine Chemical Structures:


Tuesday, February 14, 2012

Realities of Current Drug Policy

"The constraints on the power of the federal government, as laid down in the Constitution, have been eroded by a monopolistic medical profession administering a system of prescription laws that have, in effect, removed most of the drugs people want from the free market." (Thomas Szaz)

(Search keywords: US, drug policy, DEA, drug laws, prohibition, drugs, harm reduction, legalization, criminalization, war on drugs, controlled substance act)

Drug criminalization and the "war on drugs" have for 98 years served as tools of cultural and intellectual oppression, a systematic assault on individual liberty and the "free market".

Prohibition has been a failure in terms of stopping or reducing drug use. Both supply and demand reduction approaches have failed.

The global crusade against socially taboo drugs - in large part led by the strong-armed tactics of the US government - has caused a catastrophic shortage of opium and opioid analgesics in 80% of the world; adversely affecting millions suffering from terminal cancer, late-stage AIDS, and other conditions, and creating friction between the US and other Nations. Yet our government continues the bullying, continues imposing its will upon the rest of the world, not to mention its citizens.

Wherever there exists free-willed people, there will always be drug use. As long as there is drug use, there will always be some degree of a "drug problem". 

Drug laws have not  been effective in reducing or diminishing drug problems; we can either continue the oppressive policies which have excacerbated (and in many cases created) these problems or we can learn to cope with the reality that drugs & drug use will not cease to exist, while working to minimize it's dangers through education and an emphasis on accountable drug use.

Individuals who want to use drugs will always obtain drugs. Nothing - (short of violent force & imprisonment) and no one - will stop them from using drugs.

The origins of our current drug policies are based in superstition, moral idealism, and pseudoscience. Furthermore they don't reflect the actual dangers of illicit drugs. These supposed dangers are at best, no more severe than the dangers of legal drugs such as alcohol and caffeine, and at worst, exaggerations, fabrications, or myths.

A large portion, if not majority, of what are currently considered drug induced harms are in fact caused, or worsened, by drug criminalization. This critical fact continues to be overlooked, or intentionally ignored, by the modern drug warrior.

Our only practical or real-world evidence - that being the historical experience with alcohol prohibition in the 1920's, and the unremarkable results of narcotic decriminalization in Portugal - further suggests that the repeal of current drug laws would not lead to any earth-shattering increase in drug use or additiction. History suggests legalization would not change a whole lot, and would more likely than not lead to an improvement in public health and a reduction in both petty and violent crime.

Harmful forms of drug use such as venous injection are largely a byproduct of drug prohibition; dependent users take their drugs by such routes due to their higher relative bioavailabilities and their sparing effect on dosage, allowing better cost-efficiency. With more widespread and more liberalized access to less toxic and better quality drugs, these hazardous patterns of use will become less problematic and less prevalent.

Drug criminalization has fed not only a violent criminal underworld, but has spawned a massive enforcement & treatment bureaucracy with an major vested interest in securing and perpetuating its own existence (and with that the continuation of current policy); leading to ethical deterioration and outright corruption at the level of government, enforcement & corrections, healthcare, media , and even scientific research.

It is an illusion that these policies are justified by a supposed concern for "the children"; especially considering that because of these policies, illicit drugs are now more accessible to minors than are legal drugs such as alcohol and tobacco. Regardless, the failure of some adults to parent their children and the poor choices of some adolescents is by no means a just cause for depriving consenting adults of the freedom to take drugs responsibly.

Despite prohibitionist talking points; the approval of narcotics merely for medical use is by no means tantamount in its result to a legalization scenario. The harms associated with drugs prescribed in a medical context are not representative of the likely effects of actual drug legalization - In fact, the exclusivity of medical-only narcotic use seems to have complicated the issue of RX misuse and worsened mortality; in part by misleading patients and drug users regarding the nature, safety, and clinical appropriateness of potent narcotics, and by making doctors drug monopolists, who are thus left coping with an overwhelming demand for narcotics by patients & non medical drug users alike, in which case the burden of "responsible drug use", by recreational drug users, has instead become the burden of "responsible drug prescribing", by physicians.

This medical narco-monopoly creates a dangerous smokescreen of ambiguous marketing, prescribing, and consumption. It has led to a breakdown of honesty & clarity between doctor and patient. It has led to a wide scale of ignorance, ambiguity and misconception among drug users and potential drug users regarding the very nature of - and risks inherent with - a particular drug (this often has lethal consequences). The social perceptions, consumer education, personal responsibility, market regulations & safegaurds which should all naturally accompany the distribution of legal intoxicants, are absent in the context of clinical prescribing & distribution. The successful sale of legal intoxicants requires a completely different context than that of their clinical use; the current trend in RX-related addiction & mortality has sent this message the hard way.

The economic costs incurred in a climate of legalized access are very unlikely to approach the costs incurred in today's prohibitive climate of uninformed use, ambiguous purity, and lack of access to education & harm minimization. The most effective way to minimize these costs in a climate of legalization is to adopt social & economic policies which move away from mass entitlements & socialized healthcare; in turn gravitating toward policies which incentivize individual responsibility and emphasize private, rather than public, health insurance.

"we have failed to cultivate the self-reliance and self-discipline
we must possess as competent adults surrounded by the
fruits of our pharmacological-technological age"
Originating with the purpose of protecting us from being fooled and harmed by misbranded drugs, American drug prohibition in the last century has evolved into a coercive totalitatian system now serving to not only protect us from harming ourselves by self-medicating; but to enforce a puritan notion of morality by preventing us from controlling our own consciousness. Through gradual social conditioning, American adults over the last century have, without hesitation, come to accept, even welcome, these instrusive totalitarian measures, to where we now live our lives under a monopoly of therapeutic tutelage -wherein we've been robbed of our capacity as individuals to exogenously pursue our own terms of well being, and placed under the control of drug monopolists and the medical practitioners.

Having been conditioned for generations into this Orwellian-esque environment, as Thomas Szaz explains, "we have failed to cultivate the self-reliance and self-discipline we must possess as competent adults surrounded by the fruits of our pharmacological-technological age"

Opioid Dependence: About

Physiological Tolerance & Dependence 

Homeostatic balance and cyclic AMP induced upregulation:

For a regular opioid agonist such as morphine, subjective effects (including analgesia), for all practical purposes, are dose dependent. More specifically, the agonist effect at opioid receptors which underlies these effects is concentration dependent. As the concentration of opioid in the blood increases, more receptors become occupied, thus increasing the net value of narcotic effect.

Over a period of time with consistent use, a level of tolerance begins to develop for a number of pharmacological effects; namely euphoria, analgesia, nausea, sedation, and respiratory depression. Receptors become desensitized and begin requiring higher blood concentrations of opioid in order to respond.

As opioid use continues, neurons adapt at the cellular level to the inhibition produced through the opioid receptors. They adapt with a compensatory mechanism of increasing neuro-excitatory potential - so that if opioid induced inhibition were to discontinue, vigorous firing of the excited cell would ensue - i.e post-synaptic cells will more easily respond to neurotransmitter reception coming from pre synaptic sites; or presynaptic cells may be more inclined to release excitatory transmitters into their synapse. This compensation is mediated by upregulation of a chemical known as cyclic AMP, and serves as a prototypic model for the process of homeostatic balance (i.e. homeostasis): multiple contrasting mechanisms in the body competing (in this case inhibition vs excitation) in order to maintain a balanced middle ground. If the inhibitory mechanism (i.e. opioid receptor stimulation) were to cease in the heat of this competitive process, the opposing excitatory mechanism would quickly dominate, being unhindered to work at full power, so to speak. Think of it as two people arm wrestling each other - both are working their muscles at full power, but if one is to suddenly give up in the middle of the game, the opponents current strength will cause the quitters arm to fold onto the table.

Pharmacological tolerance and weakened endogenous opioid system:

Meanwhile, once significant tolerance has developed, the body's natural opioid system - essential in modulating sensitivity to pain and emotional affective states - has adapted to the presence of narcotics by producing less of its own. The endogenous (i.e. natural) opioids which are available are no longer sufficient to satisfy opioid receptors, which have become desensitized with the consistent use of powerful exogenous narcotics. This being further excacerbated by the current state of cyclic AMP upregulation and neuronal excitation.

Under the aforementioned circumstances, if narcotic use is to become interrupted in a dependent individual, leading opioid-blood concentration to fall below the needed level; the now opioid tolerant central nervous system throws a fit. With no inhibitive stimulation to satisfy receptors, much less to simply compensate the ever increasing neuroexcitatory potential, the pathways of the CNS fire begin firing, receiving, and transducing stimuli vigourously, functioning to an extent far above pre-dependence levels. The now upregulated autonomic nervous system has more power than usual to work with, but with less opioid than normal to work with. It is now unhindered and left to respond with a dysregulated state of complete excitation - i.e. sympathomemesis or hyperarousal. This manifests as the acute withdrawal syndrome: panic & anxiety, agitation, tension, spasms, sensitivity to pain & touch, and a raw state of general pain & discomfort, these are mediated in large part by the hypothalamic pituitary adrenal axis (HPA) - to include the locus coeruleus (LC), an area of the brainstem rich in norepinephrine neurons which, when inhibited, plays a key role in the calming & anxiolytic effects of opioid agonists.

Opioid Withdrawal: A Syndrome of Autonomic Imbalance:

A majority of the physiological symptoms in opioid withdrawal are mediated by the aforementioned state of autonomic imbalance - Characterized by excitation (over-firing of neurons) in areas of the midbrain and brainstem, to include the HPA axis. In terms of symptoms, this manifests asl; insomnia, thermal dysregulation (fever or chills & gooseflesh), hypertension & tachycardia, mydriasis (dilated pupils), hyper-arousal of the sympathetic system (anxiety, panic, muscle spasms, sweating), anorexia, nausea and vomiting.

Sensory hypersensitivity or hyperalgesia often occurs due to excitation at the dorsal horn of the spinal cord.

Dysregulation of cholinergic neurons in the GI tract results in diarrhea and bowel discomfort.

Due to their action on limbic structures involved in the emotional perception of pain, opioid withdrawal is often accompanied by depression or emotional hypersensitivity, whether or not a subject is psychologically dependent on opioids.

In cases of severe psychological dependence (see below), limbic dysregulation and emotional stress often serves to precipitate or potentiate the physiological symptoms of withdrawal; taking an otherwise moderate flu-like experience and producing some terrible discomfort. - this is known as a psychosomatic response.

Psychodependence: A Syndrome of Learned Reinforced Behavior

This term is used to describe a phenomenon in which a drug user becomes psychologically and emotionally dependent on opioids; typically after a period of regular use. This form of dependence often contributes to a behavioral pattern of drug seeking and habitual drug use (in this case, narcotics).

For the sake of convenience, lets refer to this phenomenon variably as habituation or addiction.

The biological mechanism underlying addiction to opioids is but one of multiple components contributing to what is predominantly a behavioral phenomenon of opioid habituation; It is important to not that the biological components to addiction discussed herein serve as an associative, influential or predispositional factor rather than a causative factor. After all, humans are not robots devoid of intelligence and free will.

Use of an opioid agonist results in 2 psychological responses:

1) the subjective perception of the opioid itself and its CNS/physiological effects. These effects are mediated by the mu1 receptors in the midbrain as well as mu2 receptors throughout the spinal cord.

2) a mu-1 mediated increase in dopaminergic firing throughout the limbic structures of the brain; also known as the pleasure centers or reward, reinforcement & learning pathways. Note: dopaminergic activity in the limbic regions not only mediates reinforcement and learning, but exhibits a blunting effect on the emotional perception of pain.

Reinforcement:

The result of #2 is largely dependent on one's subjective perception of the narcotic effects. Reinforcement can be positive or negative, depending on whether one perceives the effects of a drug as pleasurable, aversive, or perhaps neutral. The users' perception of the drug (1) dictates whether he is taught through reinforcement (2) to seek the drug, or to avoid the drug, in the future.

When one finds the experience aversive, there is typically no point in repeating the experience again - with the exception of treating pain - and no desire to repeat the experience again.

When one finds the effects particularly pleasant, the associated positive reinforcement can lead to a desire for repeating the experience, whether it be right away or at another time - as you can already see, the phenomenon that is known as "addiction" is simply driven by biochemical changes in the brain; so many factors in this process are completely subjective to ones own decision making and ones own behavior. This is exactly the problem with pathologizing such a phenomenon.

When the latter subject repeatedly uses the drug, his limbic system continues to reinforce this behavior positively, eventually teaching him to continue repeating the experience. Such drug use is a LEARNED behavior, in the same way that evolutionary behaviors are learned - sex and reproduction, the struggle for food, water, or shelter. Drug use is not the only non-evolutionary behavior learned & reinforced through this process; other hedonistic behaviors are learned this way as well, including but not limited to masturbation, comfort-eating, gambling, excercizing, socializing, falling in love, kissing, shopping, skydiving.

Continued use of the drug (or continuation of such other aforementioned hedonistic behaviors), not to mention all environmental & sensory stimuli which have become associated with the use of this drug (including and perhaps especially, its pharmacological effects), over time become wired into the instinctual or evolutionary drive. This here is the biological component referred to when addiction, or the popular "addicted brain" scans, are spoken about. These behaviors become prioritized, and desired, behaviors - while the unique personal manner in which an individual responds to this phenomenon being completely subjective, distinct.

The important distinction between behavior and biology:

The neurobiological component of addiction can make it very difficult to change such behaviors, even if they've become self-destructive. After all, they've been prioritized. However as I have emphasized and will continue to emphasize, this is not to say that the dependent subject has no control over this behavior - he does. Opioid addicts (or those addicted to other drugs) have every bit as much control over their drug-desires as they do over their sexual desires. Our human civility, motivation, and intelligence (all of which by the way have just as much neurobiological basis as our cravings or instincts) are the forces which restrain us, keep us from acting on primitive sexual or survival impulses and other animalistic behaviors, not to mention our hedonistic drive.

It is very important to note; opioids do not inevitably cause pleasure. A major portion of those who try or take opioids for any purpose find the effects boring or undesireable. Most individuals report opioids simply making them drowsy or nauseated.

Meanwhile, as I stated earlier, drug induced reinforcement can be positive or negative. The pharmacological effects produced by a drug are but one of many sensory/environmental/experiential factors with which our limbic brain associates with the behavior of drug taking. If one can understand this concept, one will understand the important distinction between behavior and biological disposition; that which distinguishes drug related brain changes with the act itself of seeking, obtaining, and using drugs, all which in modern discourse have been wrongfully classified as inexorable from brain chemistry. Schaler makes a great analogy with alcoholism & chronic smoking - drinking is a behavior, while cirrhosis of the liver is a disease; smoking is a behavior, while lung cancer is a disease. Drinking is not cirrhosis and smoking is not lung cancer. Unless we're ready to consider the pathological desire for drugs itself to be a disease, we cannot accurately classify opioid dependence as an illness.



Sunday, February 12, 2012

Background Reading On The Disease Model of Addiction

The literature here serves as a basic pretext for a rational understanding of drug use, drug habituation and the lack of reason behind the current popular perception of the supposed drug "problem": 


(search keywords: hijacked brain hypothesis, disease model, chemical enslavement theory)

Misc. Sources:


Independent of Our Will: The false notion that control is an illusion and human behavior is controlled by brain chemistry 





Stanton Peele defines addiction


Alternative hypothesis of problem drug use


The similarities of the addictive disease hypothesis & the concept of demonic possession


Complications caused by the chemical enslavement theory


Pseudoscientific origins of the disease hypothesis


Rational insights into addiction from a sociological perspective - Peele


The "evidence" Page


Drug demonization


An interesting take on the prevalence of pseudoscience in psychiatry


Logical inconsistencies in the symbolic meanings arbitrarily attached to drugs


Disease Concept: A Perspective (Umanoff, M.D.)


The Self Fulfulling Prophecy of the Powerlessness Myth (Shaler Ph.D.)


Does AA Lead to Binge Driniking?


Critique of the Involuntary Drug Use Theory


Stanton Peele's Critique of the Involuntary Drug Use Theory


Drug Library Links:


Why do people use drugs?


Our Rights to Drugs


The Case for decriminalization & "normalization" of drug use


Themes in chemical prohibition


Mythical Roots of US drug policy (Addiction & the American Civil War)


Orange Papers:



Explaining the relation between the instinctual drive & the higher brain, in the context of drug use


Critical analysis of pseudoscientific 12-step booster studies


Crtique of the first step of AA/NA

Note: A large portion of the public, and unfortunately, the medical and research community, mistakenly subscribe to the notion that if a behavior is influenced by the neurochemistry of the brain then the behavior of the affected individual is involuntary. Simply put, they believe that because the neurochemical adaptations of the brain are beyond an individuals' control, then the behavioral correlate must be involuntary. Underlying this silly idea is the leaping assertion that we as humans are not free willed creatures, but empty vessels (i.e. robots) with a neurochemically or genetically determined fate. That we are machines carrying out the dictates of our wayward genetics or brain chemistry. It's difficult to imagine how so many well educated physicians or researchers could be led to believe such pseudoscience without any critical analysis. 

There is a biological and genetic correlate underlying every human behavior, and any experience which influences future behavior does so by altering the brain - So the relevant question in considering the nature of addictive drug use, is not whether experience and behaviors alter brain chemistry - they certainly do - but whether these changes in brain chemistry are capable of bypassing the influence of self-control and the natural sense of restraint. They are certainly not and there is no evidence to suggest so. However if this were the case, then most "addicts" might be a bit perplexed as to why their hands reach for a pipe or needle and prepare a dose while they kick & scream in horror. If an individual can control their instinctual sexual urges, then one can certainly control an instinctually wired urge to use drugs. Addiction is not a brain disease. Addiction is a choice - a dysfunctional pattern of learned & reinforced behavior. 


Friday, February 10, 2012

Opioid Therapy: Other Uses

(Key Search Terms: antitussive, cough relief, opioids for cough, antidiarrheal, diarrhea, opioids for diarrhea, cough syrup, codeine, dextromethorphan, tussionex, hycodan, cough centers, medulla, cholinergic, gut motility, GI tract)

Cough Relief:

Opioids with rigid structural characteristics have generally been found to be effective antitussive agents. The 3-ether derivatives of morphine (i.e. the codeine class) are nearly as effective as morphine for supressing cough, despite substantially reduced analgesic activity. Codeine compounds are frequently used as antitussives due to high efficacy, reduced dependence and their high oral bioavailability. There are several codeine compounds which are currently used or have been used for this purpose. They include codeine, dihydrocodeine, hydrocodone, thebacon, ethylmorphine, benzylmorphine and pholcodine.

Morphine compounds are at least as effective, but are not typically a first choice due to their higher dependence liability and tighter control status. Morphine compounds commonly used for cough include dilaudid, metopon, morphine and heroin. All usually given low dose syrup form. The latter two compounds are obviously not used or available in the US.

Several synthetic compounds are used as well - the narcotics propoxyphene or levopropoxyphene, methadone or isomethadone; as well as the the non-narcotic opioid analogues dextromethorphan and dimemorphan.

Cough supression is not a "true opioid effect", as it is not inherently co-occurring with analgesia and is not antagonized by naloxone. Dextro-isomer opioids retain strong antitussive properties similar to the levo-isomers, despite their virtual absence of mu, delta, or kappa activity. Dextromethorphan is the non-narcotic stereoisomer of the narcotic drug methorphan and retains the antitussive qualities of narcotics. DXM is the gold standard antitussive in the US and elsewhere due to its ability to treat cough without causing morphine-like dependence. It is available without a prescription in most areas.

Diarrhea Relief:

Opioids relieve diarrhea by reducing gastric motility and producing constipation. Mu and delta receptors located on neurons in the gut play an inhibitory role on gastric motility. Specifically, opioid inhibition of acetylcholine reduces propulsive contractions of the GI tract, while opioid inhibition of adenylate cyclase reduces gastric secretions - Together, these actions produce constipation. The most frequently used antidiarrheal agents are novel compounds sharing structural features of the meperidine and methadone class. These antidiarrheal agents primarily consist of - diphenoxylate, difenoxin and loperamide, the latter of which is for the most part peripherally acting and therefore not a controlled substance in most parts of the world.

The Reasoning Behind The So-Called "War On Pain Management"

Analyzing the Primary Concerns of Those Speaking Out Against Casual-Access to Opioid Therapy: 


(Key Search Terms: chronic pain, opioid therapy, war on doctors, pain patients, chronic opioid use, dependence, long term effects, toxicity)

Summary:

There is an increasing level of social and medical skepticism surrounding the liberal utilization of opioids by doctors, particularly in non-terminal patients. Among their primary concerns:

A scarcity of applicable evidence - i.e. A lack of long term studies to support this practice (Though critics conveniently fail to mention that this is because the FDA does not require 'chronic' clinical studies to prove that a drug actually works; therefore, why would a drug firm waste the money?)

Existing research can not be generalized to everyday clinical practice in the general population; this especially applies to settings such as general practice & primary care.

An increased incidence of opioid "abuse" and addiction which has accompanied an increased utility of opioid therapy for non-cancer pain over the last decade. An increased incidence of opioid related overdose deaths (note: "opioid related death" includes any drug related death attributed to opioid toxicity alone or in which opioids are among multiple drugs detected)

Let's Analyze These Concerns:

Accounting for virtually all of the actual 'evidence' which critics feel justifies more regulation and less access to these drugs is, strictly epidemiological or statistical studies of addiction and mortality rates, or the scarcity of evidence itself to support opioid therapy in the general population - the former of which reflects on sociological and behavioral trends as opposed to the inherent properties of opioids themselves and the effects of their use on health. 

In terms of the pharmacological and medical research regarding the physiological or psychiatric impact of opioids themselves, there is actually no meaningful evidence of damage or toxicity with chronic opioid use. In fact, aside from the unthinking social disapproval toward the idea of narcotic dependence itself, there is no evidence to suggest any significant long term deterioration of health caused by chronic opioid dependence. Likewise, the major harms associated with actual chronic opioid addiction are predominantly by-products of the casual lifestyle, poor hygeine, and improper drug-administration techniques common among of the addicted population; rather than due to any inherent properties of the drugs themselves.

On the other hand: the primary toxicity risk of the opioids themselves is the acute risk of overdose, manifesting as potentially fatal respiratory depression. Aside from acute toxicity risk, which no drug is without, the adverse effects of chronic use of opioids typically consist of addiction and dependence, constipation, low testosterone, decreased libido, emotional changes, and a greater vulnerability to contagious illness. Objection to opioid therapy based on these adverse effects is reasonable - assuming it is based on a lack of comparable potential benefit compared with these risks. There could also be a reasonable objection made to the use of chronic high dose opioid therapy in the treatment of relatively minor symptoms. Although the choice should ultimately rest with the affected individual, it could be argued that such unnecessary use of potentially dangerous drugs by the order of a respected physician should not be discouraged.

Due to a lack of evidence of any significant physiological damage directly attributable to chronic opioid use or even "abuse"; critics tend to make use of hyperbole (i.e. pseudoscientific arguments which appeal to emotion and shock value), citing the relation of the morphine-derived opiates to heroin. The "synthetic heroin" hyperbole, though it is misleadingly used out of context and omits key clarifying points, it is largely effective when the public mindlessly accepts at face value the underlying popular perception of heroin as some sort of uniquely toxic & mystically powerful entity. Though there is a wide spectrum of functional properties which sufficiently distinguish each and every drug of the epoxymethylmorphinan family (i.e. morphine family) from its counterparts, more relevant to consider is that there remains a large disconnect between the actual pharmacological and toxicological nature of heroin and the popular mythological perception of the drug; which in fact when used chronically, arguably poses less risk to physiological health and function than does alcohol or tobacco, perhaps even fried fast food. Serving merely as a lipophilic prodrug for morphine, the effects of heroin are essentially the effects of morphine itself. For more detailed info on the actual dangers of heroin use and heroin addiction, read the literature on the 19th/20th century so-called opiate "epidemic" - The 'Consumers Union Report on Licit & Illicit Drugs' remains the textbook standard for University curriculums.

Historical Clinical Excerpts Regarding the Opioids:

"The addict under his normal tolerance of morphine is medically a well man." (Dr. Walter G. Karr - University of Pennsylvania - Light-Torrance Study 1932.)

"it has not been possible to maintain that addiction to morphine causes marked physical deterioration per se." (Dr. Harris Isbell - Public Health Service's Addiction Research Center in Lexington - 1958)

"It was shown that continued taking of opium or any of its derivatives resulted in no measurable organic damage. The addict when not deprived of his opium showed no abnormal behavior which distinguished him from a nonaddict." (Dr. George B. Wallace - Bellevue Hospital NYC Study)

"The study shows that morphine addiction is not characterized by physical deterioration or impairment of physical fitness aside from the addiction per se. There is no evidence of change in the circulatory, hepatic, renal or endocrine functions. When it is considered that these subjects had been addicted for at least five years, some of them for as long as twenty years, these negative observations are highly significant." (Philadelphia General Hospital Landmark Study Re: Chronic Narcotic Abuse - Committee on Drug Addictions of the Bureau of Social Hygiene & Philadelphia Committee for the Clinical Study of Opium Addiction)

Nature of the Prescription Drug Problem

Why examining its roots requires re-examining our approach to the "problem" itself:


(Key Search Terms: opiate, opioid, epidemic, overdose death, addiction, prescription drug abuse, supply, demand, pill mill, doctors, florida, pain patient, narcotic, prohibition, DEA, law enforcement)


"The constraints on the power of the federal government, as laid down in the Constitution, have been eroded by a monopolistic medical profession administering a system of prescription laws that have, in effect, removed most of the drugs people want from the free market." (Thomas Szaz)

When examining the factors underlying the so-called "opiate epidemic", we must reconsider the real source of the problem, and indeed, the so-called problem itself. The current trend of prescription opioid "abuse" is not a result of rogue clinics or the "aggressive" treatment of pain - The assumption is backwards. The entire "pill mill" phenomenon - exemplified by the current state of affairs throughout Florida - is but a symptom of a deeper underlying dilemna, one which thus far has gone largely unexamined, with catastrophic consequences.

These phenomena (i.e. pharmaceutical McCarthyism & the corruption of the medical profession) are responses to an insatiable appetite which we can no longer afford to ignore. It is intellectually dishonest to believe that the pain profession and the pharmaceutical industry has "created" addicts out of naive & vulnerable patients simply seeking meaningful treatment; while resisting the uncomfortable reality that there is, and always will be, a monstrous demand - both hedonistic & therapeutic - for pleasure producing narcotics and other psychoactive drugs, which exceeds the supply we currently offer.

The 98 year prohibition of nonmedical drug use has had many unintended consequences. One of which has been turning doctors into monopolists of the opioid trade - or more generally, the controlled substance trade. 

Currently, we have an enormous demand for narcotics not only from the sick or injured medical patient, but from millions of casual, habitual, or recreational drug users as well (many of whom, due to our drug control laws, have few other sources than a medical clinic). The inevitable result; a flooding of doctors offices with patients whom practitioners should not even have to be dealing with, along with the unnecessary liability that accompanies mass prescribing. Meanwhile, law enforcement is breathing down the necks of practitioners, who are now tasked with policing their patients - never mind the fact that humanely treating pain and effectively policing patients are two irreconcilable practices; impossible to achieve without compromising one or the other - i.e. without either letting a number of "seekers" slip through the cracks, or compromising patient care. 

Narcotic addiction is not a matter to be trivialized, and my deepest sympathies goes to all those whom have been affected by a loved one or friend with a self-destructive habit. However, in responding to the problem of prescription drug addiction, particularly in the state of florida; when we allow raw emotions and mindless panic to dictate our understanding of, and respone to, such a complex social issue, the response will never be rational or effective - and in the case of clinical practice and drug use,  has brought unintended consequences which deeply affect many individuals - including needy patients and well-intentioned physicians. In fact, more than just affecting individuals adversely, the situation, which under different cultural circumstances might manifest otherwise mildly, has been made far worse.

To put it simply, drug addiction and drug related deaths are senseless and tragic, but remain one of many inevitable occurences in a free society. All efforts should be put into educating individuals regarding drugs and drug use - learning to respect drugs and use them competently - rather than irrationally & hopelessly pursuing a puritan "drug-free" utopia, while trampling individual freedom and ruining lives in the process. The minimization of drug related harm can be accomplished more effectively through policies which emphasize individual freedom, consumer education, market freedom and honesty, and personal responsibility.

The "abuse" of prescription drugs is not the problem; and the easy availability of these drugs through unethical doctors is not the problem; as bizarre as it may seem to the indoctrinated mind, it is the fact that the drug user is unable to "medicate" without the approval of a doctor, along with the cultural & market conditions inherent with this system, that is the problem.

If individuals were left free to palliate their own ailments and fulfill their own hedonistic desires, unscrupulous doctors would quickly be driven out of business, while real doctors could be left to deal with critical ailments and save lives by proactive means. There would be few cases of the naive and vulnerable patient being misled by the authority of a doctor in regard to the true nature of opioids and other addictive drugs; while the individual who does medicate using such drugs does so on his own informed volition. In time, a majority of our current "prescription drug problem" would be left to correct itself.