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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by WhyandHow on November 29, 2006, at 1:18:02
This is hopefully a much better version of a boring research paper i did ealrier. I still have a few edits to do before this Friday but I hope the message is strong. I incorporated alcohol and tobaco at the last minute. Eventually - maybe for Comp 2 i will expand on things (this is for General Psychology). Ironically enough, I wrote much of it while going through what i was writing about.
America’s Real Drug Problem
By MeWe are a nation of drug addicts. We drug ourselves, our elderly and our children on a daily basis. We do it with prescription medications, over-the-counter pills, alcohol, caffeine, nicotine... and we say it's all fine because those drugs are legal. But wait a minute, you say. Those legal drugs are different from something like marijuana. They're FDA-approved drugs. They have a medical purpose. Drugs are declared legal or illegal not based on how safe they are but based primarily on who benefits from their manufacture, distribution and sale. Its not about your health, it’s about their wealth.
America’s biggest drug problems are not the ones you hear about with illegal drugs but include the abuse of FDA approved pharmaceutical drugs and legal drugs like alcohol and Tobacco.
Some of the pharmaceutical drugs include a class called benzodiazepines (including Valium, and Xanax), painkillers, which are actually made from a derivative of opium (such as Vicodin, and a more commonly prescribed one called Hydrocodone), and the powerful stimulants known as amphetamines (like Adderall and Dexedrine). All of these can be dangerous and addictive not only when prescribed by a doctor but especially when abused and used outside of a doctor’s prescription. An added dimension to the problem includes foreign countries (and some domestic) selling drugs over the internet. Aspects of prescription drug abuse discussed will include, how these drugs work, their history, how they affect the brain and body, characteristics of abuse and dependence, withdrawal effects, and finally, how my personal experiences relate to the information.
For some, the abuse of and addiction to prescription medications starts innocently. After a car accident, back injury, or, even, a mental/emotional breakdown a physician may prescribes a medication for a legitimate use. Over time, tolerance builds up so that more and more of the drug is needed until a state of dependence is reached. At this point, there is no easy way to get off the drug, and stopping can involve painful withdrawal symptoms. Some doctors over prescribe drugs, pharmaceutical companies have huge marketing campaigns, and when people become dependant they may steal prescription pads, go to different doctors for the same drug, or go to the street to get their drug. Others simply go to the street or some individual in an effort to escape reality or “get high”. Regardless of how the problem starts, it is a very serious one.
First discussed will be prescription amphetamines. Murray (1998) discusses many aspects and effects of amphetamine and methamphetamine use. The first thing I find interesting about Murray’s report is that a topic of such specific discussion lumps amphetamines (AP) along with methamphetamines (MA). We have all heard about America’s drug problem involving MA, its dangerous and illegal manufacture, as well as the danger it causes to individuals and society in general, but many of us are not as aware of the fast growing misuse of prescription AP . As its prescribed use in the medical world increases, so does its abuse and use outside of intended purposes. The stigma associated with using something that doctors prescribe may seem much less extreme (as it was with me) as something like MAs, but they are extremely similar in every way that matters.
Murray confirms the medical uses of prescribing this drug to include treatment for obesity, narcolepsy (a sleep disorder), and hyperkinesis (which I confirmed to be the same as “hyperactivity”). Also, not mentioned in this article is the use of it to treat ADHD, which is attention deficit disorder with hyperactivity. How many children really need to be on Ritalin? How many adults need to be on Adderall? I have personally seen these drugs over-prescribed without due concern to its potential for danger and thus people with no real reason to have it end up selling it on the street just as someone would sell MA.
AP’s, a class of stimulants, comes from alpha-methyl-beta-phenyl-ethylamine, a colorless liquid made of carbon, hydrogen, and nitrogen. They were first manufactured in 1887 and historically have been used by various countries during World War II to deal with battle fatigue and also used by American soldiers during the Korean and Vietnam wars. 1970 brought about strict controls after the first epidemic of AP intravenous use in the 50’s and 60’s, in California. This led to a somewhat exponential growth in the development of “clandistine MAP labs.”
I can personally attest to the fact that one person I have interacted with in the past (by far the worst influence I have ever encountered) gets prescriptions for Adderall, a widely used AP as well as Xanax, Clonazepan, and many other drugs all at the same time and from the same doctor! This person, who might as well be a “Meth” manufacturer and distributor, actually gets most of these medications to sell! He comes from a rich family in a smaller community near Cedar Rapids and sweet talks lies and cons about his conditions. One could wonder what kind of doctor would prescribe such a “cocktail” of dangerous and addictive drugs in the first place, let alone doing so for long-term use with no apparent clue as to his patient’s behavior. This doctor and the nurses there have had many red flags they should have been noticing, like his ride showing up in the waiting room “strung out” after 2 days and nights of no sleep. Or how about when this person reported his medications stolen at least 3 times (so he could get more)?
I still don’t totally understand how I was actually stupid enough to be influenced during a brief interaction and bad moment when this “person” tried to tell me the things this medication would be good for while snorting a line. At that time I didn’t realize that he was looking for a new addict to sell to. Since I was having no interactions with a doctor, had no health coverage at the time, and had already come to believe that I could be a better doctor for myself then a couple I had encountered, I made the worst and most dangerous decision of my life – to try it. Nothing could be that harmless if just tried once, could it? As Murray (1998) states on page 230, “Psychological dependence on AP’s can develop quickly, especially in those struggling with depression. Tolerance develops rapidly.” Since I did already suffer from depression and anxiety, I was not only the perfect target for such a “dirtbag” to convince into using it, but it was also extra dangerous for me to do so. Wow, I felt great! I suffered no depression and felt very well focused - even enhanced. While it was by far the shortest period of time I ever spent in active (using) addiction with any chemical, it also ended up being the most scary. Although the dangers and effects are different, I am sure that a few (4 to 8) months of continuous AP abuse can be equivalent to the dangers of 10 to 20 years of ongoing alcohol abuse (which is very dangerous!). It seemed too innocent and helpful at first, boosting my mood, enhancing my abilities, energy, and focus – all without a hangover or noticeable negative effects. It seemed unlike anything I had done before (been through other addictions) and was very deceptive. Another big danger with this involves the use of benzodiazepines to taper the effects of AP and to eventually sleep (now we have two dangerous drugs). It went from the beginning stages to more advanced stages seemingly almost overnight, with no distinguishable transition to change course of action. The benefits and the feeling fed the justifications. In fact, it ended up being far more dangerous in a much shorter time then any chemical I had ever experienced. Before I knew it, I was in way over my head. If there was a scale rating the dangers of individual chemicals in my life and marijuana was a 1, alcohol would be 100, while benzodiazepines and amphetamines would be more like 100,000!
Murray (1998) talks about how the potential for abuse increases as one switches from oral use to intravenous use; however, I found it very ironic that he did not mention what could be the most common form of use, crushing the pills up and snorting them like cocaine. Like intravenous use, this method bypasses part of the body’s systems and causes a more direct and immediate effect to the brain.
The immediate effect of using this drug is a euphoria-like feeling. At first this feeling can be used for productive purposes, increased energy, and enhanced focus as one may typically not sleep for 1, 2, or more nights straight. I would take on all sorts of projects the first day or two: clean every part of my apartment, organize closets, make files to file papers, work on a huge hedge-cutting job, and stay up all night working on school work! After a while, activity becomes more meaningless and I would find something different to focus on like cleaning things I had never cleaned before. In fact, Murray states on page 230 that symptoms can “be difficult to distinguish from paranoid schizophrenia (Bell, 1965; D.E. Smith, 1969)… AP psychosis is a more valid paradigm for schizophrenia than lysergic acid (LSD) and mescaline experiences (Snyder, 1973).” He goes on to say on page 231 that “Short-term indulgence in APs might precipitate a paranoid psychosis in nonpsychotic participants”. AP use clearly has a very significant and direct effect on the central nervous system.
Murray (1998) describes a study involving 50 people who wanted to get off APs. They had all been on the drug for at least five months (slightly longer than my experiences which involved “breaks” in use). This study showed that anxiety and depression increased in every single person! It’s no wonder that using this dangerous drug could be such a blow to someone who already deals with depression or anxiety!
There is no direct connection with AP use and aggressive behavior as that seems to be more connected to the individual personality and/or other factors (e.g., with myself, that would never happen despite the worst of my condition – it would take other forms – swearing or yelling at someone would be the extent of any possible aggression and even that would be very rare).
Murray (1998) gives a very good description of how APs work on page 234: “The dose-dependant depression of the firing rate of catecholamine neurons and noradrenergic neurons in the locus coerulus is part of the physiological effects of AP drugs (King & Ellinwood, 1992). APs block reuptake of the neurotransmitter norepinephrine and directly release the neurotransmitter dopamine from newly synthesized pools.” However, APs raise blood pressure and causes tachycardia (defined as abnormally rapid beating of the heart). EEG recordings show an acceleration, “desynchronizing” (irregular rhythm) and shortening duration of delta sleep waves.
I find it amazing that while technology has increased at an exponential rate over the last one to two generations and advances in knowledge of the brain have been at the top of the list of these knowledge gains, certain things about the brain and things that affect it still seem as mysterious as they were before. As Murray (1998) says on the final page of text (235), “Although much has been learned about the psychophysical mechanisms underlying the action of high-dose stimulants, development of treatment strategies has not progressed at the same pace… the effects of AP-MAP abuse and its physiological mechanisms are not yet clear. Consequently, diagnosis and treatment lag behind knowledge of the psychophysiological aspects of AT-MAP abuse.”
The next dangerous drugs discussed here are benzodiazepines. Ross (1993) published a report that relates benzodiazepines use / abuse with treated alcoholics and other mental conditions. When it comes to drug abuse, there is a high rate of abusers mis-using multiple chemicals (simultaneously or at different times). There is also a correlation between benzodiazepines use / misuse and anxiety disorders, as well as with antisocial personality disorders. Benzodiazepines are often used for short-term relief of severe, disabling anxiety (related to other conditions or otherwise), or insomnia. Long-term use can be problematic due to the development of tolerance as well as physiological and psychological dependency.
A clear message from Ross (1993) is that those who have been or are being treated for alcoholism are much more likely to have used or abused benzodiazepines either recently or in the past. Ross refers to a study involving 427 patients receiving treatment for alcoholism on page 210. He used a combination of self reporting using various questioners involving substance use and mental state as well as urine tests to analyze the participants’ recent benzodiazepines use in the "Addiction Research Foundation Clinical Institute" in Toronto, Canada. Ross states on page 209 that benzodiazepines have been used by 8% to 10% of the general population, but on page 211 points out that they have been used or abused recently by 40% of the alcoholic participants. All of the participants were likely to have long-term problems with anxiety as well as a history of benzodiazepine abuse which, of course, relieves anxiety initially but has a high potential for abuse and dependence. People abusing multiple chemicals are a common theme in the world of addiction.
Ross’s information includes a lot of data, statistics and information but does not address all the aspects of the drug as Longo and Johnson (2000) do. Longo and Johnson, both doctors, discussed more aspects of benzodiazepines such as neurochemistry characteristics, toxicity and side effects, toxicity and drug interactions, side effects, tolerance, abuse, dependence, and withdrawal.
As Longo and Johnson point out in the first 2 pages, there are many therapeutic benefits and medical purposes for benzodiazepines including various
anxiety disorders, panic attacks, alcohol withdrawal, seizures, and a host of other less frequent scenarios. Longo and Johnson (2000) include a table on page 4 demonstrating the different characteristics of various benzodiazepines with the biggest differences involving potency and half-life. Shorter acting ones include alprazolam (Xanax) and lorazepam (Ativan) while a much longer ones include clonazepan (Klonopin), and diazepam (Valium). The more potent ones include the shorter-acting ones such as alprazolam and lorazepam but also include the much longer-lasting clonazepan. The less potent ones include diazepam (Valium) and chlordiazepoxide (Librium) which are both used frequently for alcohol withdrawal.
Benzodiazepine receptors are present throughout the central nervous system. Longo and Johnson describe exactly how benzodiazepines work: “Benzodiazepine receptors are linked predominantly to the g amino butyric acid (GABA) receptors which sensitize benzodiazepine receptors to the neurotransmitter GABA, the most prominent inhibitory neurotransmitter in the central nervous system…. Activation of the benzodiazepine-GABA- chloride ionophor complex is responsible for producing the therapeutic anxiolytic affects of benzodiazepines and for mediating many of the side effects and, possibly, dependence and withdrawal from these drugs.” Other neurotransmitter sites utilized by benzodiazepines include the ones used with other drugs such as barbiturates and alcohol. This would help explain why people with addiction, dependence, and tolerance potential for one of these other drugs may be more susceptible to the same when it comes to benzodiazepines.
Side effects of benzodiazepines include drowsiness, poor concentration, dysarthria, and problems with motor coordination as well as decreased memory, depression, and more. The worst dangers with this drug would include rebound effects of the conditions it was taken to relieve as well as tolerance and withdrawal. Initial withdrawal includes the same types of conditions the medication may have been taken for in the first place (but likely much worse after continued use) such as anxiety and insomnia.
Longo and Johnson talk about dependence and withdrawal to benzodiazepines that develop at different rates and degrees depending on the dosage, particular type of benzodiazepine, and the length of time on it, (and I would also add: the history of the individual, and biological factors of the individual). One fact that is very relevant and that I think should be looked into further is mentioned on page 6: “A protracted abstinence syndrome has been observed by addictionologists who are familiar with benzodiazepine addiction. Symptoms include prolonged (for several months) anxiety, depression and insomnia… physical symptoms related to gastrointestinal, neurologic and musculoskeletal effects may occur… This is hypothesized to result from chronic neuroadaptation.” This seems very relevant and means that if one has a history of abuse or dependence to benzodiazepines, the body’s neuro-system remembers the drug and thus psychological and even physical withdrawal symptoms occur much sooner than in the average population. I can personally attest to this happening.
While benzodiazepines have many medical uses, their potential for abuse and dependence is also very high. It could eventually put a person into rebound symptoms much worse than the ones they had to begin with. It may be too easy to prescribe this quick fix to solve immediate problems. There must be other alternatives to long-term problems, especially for those who are or have been prone to addiction. Addiction is a very serious problem and these prescription drugs offer some of the biggest dangers even when compared to dangerous illegal drugs like cocaine, methamphetamines, mescaline, and even heroin.
Today’s pharmaceutical companies are among the wealthiest of all industries in the world – much like, but more so, than the tobacco companies in the 80’s who almost shut down CBS when someone wanted to tell the truth about how they were intentionally manipulating chemicals to make nicotine more addictive. Obviously cigarettes do not have a medical purpose as pharmaceutical drugs do, but I believe a comparison can be made. Attention needs to be paid to how these companies use their power to influence and market to the medical field. They flood doctor’s offices with free samples, and spend billions on television commercials to convince you that their drug may be the right thing for you. Is there any chance that like the wealthy tobacco companies, the wealthy and powerful pharmaceutical companies want you hooked on their medication? The fact that they do sometimes serve a medical purpose might actually make the issue harder to deal with than tobacco companies. A person with an eating problem cannot totally give up food, much like society cannot totally give up its medications. To one person a certain pharmaceutical drug may be exactly what they need but more often than not, it may not be what they need and create more of a problem than a solution.
While our country spends billions to fight marijuana which is a big step down when it comes to level of harm when compared to the dangers of many pharecuticals, people import pills via the internet just as easily as they would buy something on EBay! They then can sell them in the same manner as one would sell “meth” or cocaine. Why are we not refocusing some of our “war on drugs” to combat this problem? Why are billions of our federal tax dollars spent to criminalize medical marijuana in places like California going against the laws passed by the cities and states in regards to medical use of it, while the fastest-growing and far more dangerous drug problems seem to go unchecked? Imagine if this money was spent on things like stopping the import and distribution of dangerous pharmaceuticals, anti-alcohol campaigns, and close monitoring when it comes to doctors handing out dangerously addictive drugs.
It is interesting that while crack cocaine and powder cocaine are the same drug (both dangerous like the drugs that have been discussed here), our laws literally penalize crack possession and sale 100 times harsher then powder cocaine! Is this because it is more the poor “undesirable” people who are more likely to possess crack? There are many examples of how drug policies make no sense at all.
Many sources of information can verify that tobacco kills more than all illegal drugs combined! Nicotine also the most addictive drug on earth yet it is available legally everywhere. Back in the 50’s and 60’s you could find a doctor smoking in his office! Campaigns using tobacco settlements have been partially used for campaigns but more often than not states use the money for other things. Cigarettes remain just as legal and available as ever. As Hall points out, there is no correlation between laws that govern drugs and the harm that they actually cause.
Alcohol is a dangerous drug and actually kills more than any other drug (other than cigarettes) but yet it is legal and socially acceptable. Is this because it is part of the upper-class culture and because big business has huge amounts of money in the industry? (like huge pharmaceutical companies have huge amounts invested in the drugs they market to the medical field). Pharmaceutical company’s primary concern is profit not people’s health and the FDA might as well be called the “Fraud and Drug Administration”. They are influenced by the drug companies just as congressmen are influenced by huge corporate lobbyists. The upper class culture has no money invested in marijuana as it does with alcohol, nor it is a preferred drug of the upper class and hence it is criminalized despite being perhaps the least harmful of all the drugs in society. What would happen to the huge industries that include grapes for wine in California, the growing of tobacco in the south, and many other businesses if we criminalized alcohol and nicotine? How many people have alcohol and marijuana killed compared to marijuana? (I estimate that it would be about 1 billion to 1). Meanwhile, while we are looking the other way, (just like the pharmaceutical companies, tobacco companies, and alcohol industry want us to), the much more serious drug problems grow.
In our age of excessive medical lawsuits driving our health costs up at an astronomical rate, why are doctors not held accountable for oversubscribing many of the medications that may end up destroying lives rather then helping them? Some people who were put on Valium in the 70’s for many years ended up having to stay on the drug for life because if they quit after so many years the withdraw could kill them! Why is the alcohol industry not held accountable for the massive damage it inflicts on society?
In an editorial listing many sources, Hall (2006) addresses the many non-biological factors contributing to drug abuse/dependence and talks about how we also need to look away from genetic factors and science involving the brain and also focus on the many social factors that contribute to the problem. If we simply blame the brain and genetics, the solutions become more vague. It is very clearly pointed out that social policies, norms, laws, and attitudes have a great deal to contribute to drug problems.
Hall also points out that social policies and laws seem to have little to do with brain science or anything else involving how harmful a drug is. Again, why is alcohol legal and socially acceptable? What about cigarettes that kill more than all other drugs combined? Not only should these things be put on a level with illegal substances but the next battle in America's war on drugs must draw a bead on pharmaceuticals.
Technology and big business have created most of the world’s most dangerous drugs and they need to be held accountable for the problems they cause. As individuals we need to be aware of the dangers prescription drugs involve, be educated and question the very doctors we should be trusting. A little knowledge on the issue can go a long way. Be aware of the basic categories of highly addictive and problem causing drugs. When I am offered a painkiller for some condition, I need to “just say no.” Drugs are declared legal or illegal based primarily on who benefits from their manufacture, distribution and sale. Its not about your health, it’s about their wealth.
Probably the most difficult issues a person can ever face involve “medications”, weather it be with or without the “care” of a doctor. We need to at some level take control of our own mental and chemical health because nobody else will do it for us. One does not have to learn this lesson the hard way as I did.
The only real solution to addiction of any kind involves a real change in one’s self and many believe the only way this can happen is through spirituality – a belief and understanding of God. Could the complexity of the human brain and existence of humans in general really be an accident that started with a collision of gasses in a state of nothingness? Is there a higher power who not only gave us the means to destroy ourselves but who also provides the solution?
ReferencesLongo, L.P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines – Side effects, abuse risk and alternatives. American Family Physician®. Vol. 61 actual page numbers here
Murray, J.B. (1998). Psychophysiological aspects of amphetamine – methamphetamine abuse. The Journal of Psychology, 132(2), 227-237.
Ross, H.E. (1993). Benzodiazepine use and anxiolytic abuse and dependence in treated alcoholics. Addiction, 88, 209-218
Hall, W. (2006). Avoiding potential misuses of addiction brain science. Put internet site here?
Posted by Dr. Bob on December 13, 2006, at 2:13:22
In reply to America's REAL drug problems..........., posted by WhyandHow on November 29, 2006, at 1:18:02
> This is hopefully a much better version of a boring research paper i did ealrier.
To consolidate replies, I'd like to redirect this thread to Psycho-Babble Substance Use. Here's a link:
http://www.dr-bob.org/babble/subs/20060727/msgs/713134.html
Thanks,
Bob
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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