Stories of a modern day opioid eater

Anthony Ferrule, Research Chemist, Majoring in Chemistry at the University of York, Pennsylvania.

 

The use of opium dates as far back as 3000B.C by Sumerians and named it “Gil Hul” or the Joy plant, such use has been dated until the modern day, leaving its marks culturally, historically and becoming part of historical literacy.

Books such as De Quincy’s Confessions of an English Opium-Eater, where his addiction to the Opium tincture Laudanum is reported are solemnly a small droplet of the histories reported by this compound, many of them remained untold, forgotten even.

These are the stories of Benzzzy and Calvin. 

 

Benzzzy:

I got put in an institution for troubled youth at the age of 8 stayed there for 2-3 years and got sent back home where I stayed till I was about 13-14.

From the age of 8 till now 23 been in either institution for youth or psychiatry whit probably over 25 different places… They tended to transfer me every 6-12 months and had the habit of not giving my progress to the next institution so when I turned 16 and legally I dropped out due to the lack of efficiency.

During that period I experienced various substances ranging from Cannabis to MDMA, psilocybin to 2C-B, at the age of 16 I  had some major anxiety so I had a pretty big script for benzos at some point which I pretty much just saved up to binge. I was then introduced to opioids via tramadol, and at the age of 19, I experienced my first experience with oxycodone.

I liked them but they were so expensive and since I’ve always been someone willing to try absolutely everything I got into fentanyl and heroin.

I got charged and put in forensic psychiatry for 2-3 years, while staying there I stayed sober for about a year maybe a year and a half until my old plug messaged me that he had ketamine. I got some and smuggled it back in. From that moment I started using every Thursday after my drug test. Usually just Ketamine or 2c-b but later also research chemicals.

Afterward, they transferred me to a low-security level and I got government benefits. So pretty much already really prone to addiction I got a 15x in income and security was a lot less. Which led to me using a variety of drugs all day including opioids.

My girlfriend introduced me to IV two months ago, even though I’m phobic of needles, she helped me administrate as I couldn’t stop shaking.

Recently I fell off my apartment while on MDMA and Klonopin, fractured my wrist and got caught by the police, had to get two surgeries, and got deported back to my country. 

As we speak I’m currently going under treatment for addiction, as soon as I stay sober, I will be assigned to leave the center. I doubt I will stay sober though.

Addiction was my way to cope with life. I didn’t have to cope with addiction.

I truly advise you to seek help, there are free services that’ll help you like NA there’s also outpatient treatment.  For a lot of things, there’s even pharmacological intervention like with alcohol and opioids.  If you don’t want to go to rehab you don’t have to, help exists in all kind of forms.

As for today, we can witness various addictions caused by the lack of information provided by healthcare professionals, alongside an augmentation of prescribed opioids such as Tramadol, which despite being effective, have caused addiction and entered the illegal market as recreational drugs. Such issues are accompanied by users being unable to continue taking their medication and finding alternatives on the streets, these alternatives are usually linked to cheaper compounds like Heroin that often are adulterated with substances from the Fentanyl family. 

Thus, it is quintessential to inform the patient about the addictive properties of opioid-based analgesics and antidepressants, as well as provide alternatives to the patient’s medication.

Recently Benzzzy was prescribed Buprenorphine to manage his addiction and is doing much better.

 

 

 

 

 

Calvin:

I am currently receiving my bachelors in Pharmacology as well as Molecular Biology. I actually went into pharmacology because during my active addiction years, I became interested in how these chemicals worked on a molecular level and what we could do to help people.

I was first introduced to opioids when I was probably 12 years old. My mother had a lot of pain pills lying around.
I was first introduced to psychedelics when I was about 16 years old.

My addiction started pretty young. I was addicted to a lot of substances over the years but first started drugs when I drank liquor at 8. I had a pretty bad home life and parents who really didn’t care. When I was a teen, I stopped just drinking alcohol and got into benzodiazepines. I spent over a year constantly barred out and sick with zero memory of anything happening. I remember waking up in public bathrooms without knowing how I even got there. Eventually, I realized I was going to die and managed to quit with rehab and tapering off. But then I met the worst drug of all opioids. I had taken them before when I was younger but never had access to a large supply at once so it was just a treat. I ended up becoming severely addicted to it for years. I was vomiting constantly, sick, my teeth were rotting, and my hair fell out. I was constantly constipated, lost a ton of weight, and had to plan my entire day around my fix. I still managed to work for a lot of the time I was using — especially toward the end when I had to constantly use so I could avoid just ending up in horrible withdrawals.

My biggest piece of advice depends on how long they’ve been in active addiction. If they’ve only been addicted for a few months or a year — PLEASE stop as soon as you can. One day the buzz is gone and instead you’re just flushing hundreds down the drain and using multiple times a day just so you’re not curled up on the floor going through the living hell of withdrawals.

If you’ve been in active addiction for a while — it’s never too late to stop. I was an addict for many years as a teen before I became an adult and finally really got serious about getting help. It does get easier to live life sober and recovery isn’t gonna be linear. You’ll probably relapse once or twice but it is so worth it to heal.

 

 

 

 

 

 

 

To understand more about these compounds and their alternatives we spoke to the research chemist and pharmacology student Anthony Furrule (@science_and_anonymous)

 

What do you think would be the correct medical approach when prescribing opioids?

Opioids and opiates are tremendously foundational drugs in medical practice, and to dismiss them as such would be irresponsible. Nonetheless, with their known efficacy it must also be acknowledged that μ-opioid receptor agonists in particular carry a great liability to both the patient and prescriber, being addictive and dose-dependently hazardous. The medical approach should be as such, and which most good doctors will follow, treat based on the severity. If the pain is minor, a weak analgesic like acetaminophen should be prescribed, if more serious, a stronger one administered. With due diligence, an opioid prescription carries no more risk than any other psychologically pleasurable drug, like that of muscle relaxants. Still, duration of use should be absolutely minimized to avoid tolerance, and the patient should be under strict supervision by a prescribing physician if longer term opioid use is needed. Every prescription of an opioid should be met with a naloxone kit, and if the patient refuses to follow the procedure, the patient will be denied a selective μ-opioid receptor agonist with the replacement of a κ opioid receptor agonist, which is less addictive and reinforcing/pleasurable, but holds analgesic potential.

 

Which compounds are available with analgesic/painkiller properties that could substitute opioids?

There are a host of analgesics, both prescribed or over-the-counter, that have similar pain relief to opioids. Most notably, NSAID drugs have been very influential in the treatment of pain, and should always be a first line treatment for pain unless it is severe. Second line treatment, if the patient declines opioids or cannot use them, should be ketamine. Ketamine is a potent analgesic that has minimal side effects in medical settings. For short term treatment in a hospital setting, low dose to higher dose ketamine can be very effective. Stepping away from drugs, breathing exercises can be tremendously beneficial for pain, as can mild movement when possible.

 

If the patient does not wish to use either ketamine, or cannot use an NSAID drug, and for some reason also cannot have acetaminophen, local analgesics are very effective in some cases, as are some nerve blockers in severe cases. IM lidocaine for instance can treat a variety of peripheral pains related to muscular issues, and with back pain, nerve blockers can reduce some pain, but in most cases these two procedure are invasive and the least invasive options are always chosen.

Opioids simply are the best our society has developed as of yet for the treatment of moderate to severe pain for a moderate to longer period of time, and it comes at the cost of the patient becoming reliant on the medication. Keep in mind, the drug is not the problem, it’s the system which fails to help those who have developed the addiction which is the problem.

 

What is your opinion towards Opioid-Based antidepressants? Alternatives of non-Opioid antidepressants.

 Opioids in general do not act as very effective anti-depressant drugs. Although classically some μ-opioid receptor agonists have been used for depression, the fact of the matter is that they treat depression on a symptomatic level, and not certainly on a psychological or biochemical level. μ-opioid agonists are very effective at causing stimulation in key reward pathway areas of the brain, such as the ventral tegmental area (VTA) and nucleus accumbens. These areas are strongly associated with pleasure and dopamine release, and opioids activate them strongly. μ-opioid activation also signals a decrease in neurotrophic factors such as BDNF, which impairs cognitive functioning, learning, and is pro-depressive. The fact of the matter is that μ-opioid agonists are not effective for long term treatment of depression.

 

However, there is clinical evidence κ-opioid receptor agonists, most famously Salvanorin A present in “Salvia Divinorum” is antidepressants, and its analogs hold great promise in the treatment of depression on a biochemical level. The sigma-1 receptor also is highly implicated with mood and behavior, and agonists of this site show antidepressive behavior, of which is significant. Thus, widening our view of the whole opioid class, we can make adept improvements in drug discovery and treatments for depression.

 

What is your advice to someone who’s currently fighting an addiction? Do you believe in the treatment of addiction via compounds such as Ibogaine?

I absolutely agree Ibogaine has insurmountable potential, however Ibogaine will not be the drug that I personally see being used to treat addiction worldwide, rather an analog of it.

 

Ibogaine is highly anti addictive when coupled with adequate therapy, but it should be known Ibogaine is a very promiscuous drug unlike many of the other classical tryptamine psychedelics. Ibogaine not only has activity on serotonin sites, but also cholinergic, opioid, glutamatergic, monoamine uptake proteins, and sigma sites. It has affinity for the 5HT2B receptor subtype, and thus can cause cardiovascular harm (as some other psychedelics target this site, but not with such affinity). The drug has already had replacements formulated, which allegedly have less side effects, don’t target 5HT2B sites, and have the same efficacy, but we shall see what the future holds.

Ketamine and psilocybin seem to have fantastic efficacy with alcoholism, and thus the transfer to opioid abuse shouldn’t be that far of a stretch. Addiction is 70% psychological and 30% biochemical. Allowing the individual to be helped on a psychiatric level is far more important than getting them off the drug. One follows the other, and drug abuse, not use, stems from a psychological perspective of self-treatment.

 

Recently there was a buzz about Narcan-resistant fentanyl. What is your take on that?

There is no such thing as treatment resistant fentanyl, however, there is fentanyl laced with drugs than Narcan (Naloxone) can not revert the overdose of. In most cases, Xylazine, which is an adrenergic type 2 receptor agonist (not an opioid), and thus an opioid antagonist like Narcan cannot reverse it. In the case where Xylazine is the culprit of overdose, Narcan may help to establish a possible baseline, if you’re lucky, but in most cases a hospital visit is necessary to save the persons life. There is no antidote to Xylazine, but in a hospital setting there are drugs to help with the symptoms, or in severe cases, dialysis to remove the drug from the blood stream.

(Read more on the subject at Anthony’s Instagram)