I am going to delete some words to shorten this passage, taken from the essays Death: The Unintended Consequences of the War on Opioids, by Jeffrey A. Singer, and Drugs: The Systematic Prohibition of U.S. Drug Science, by Trevor Burrus, printed in the book Scienttocracy (page 125 et seq), edited by Patrick J. Michaels and Terrence Kealey. Stanley is a research fellow at the Cato Institute. He received his from Brooklyn College (CUNY) and his MD from New York Medical College. Burrus is also a research fellow, working in the Cato Institute’s Robert A. Levy Center for Constitutional Studies. He holds a BA in philosophy from the University of Colorado at Boulder and a JD from the University of Denver Sturm College of Law. All that follows until you run into the word “OK” is from Stanley and Burrus, thereafter from me.
“Diacetylmorphine, or dieamorphine, was first synthesized in 1874. It became popular only after re-synthesized by the Bayer pharmaceutical company in Germany in 1895. Bayer originally marketed it over-the-counter as what was thought to be a nonaddictive substitute for morphine, primarily for use as a cough suppressant. Its potency is 2 ½ times that of morphine. For this reason Bayer gave it the brand name Heroin, from the German word heroish, meaning “strong, heroic.”
Of the opioids commonly used today, methadone (Dolophine) also has 2 ½ times the potency of morphine. Hydromorphone (Dilaudid) is twice as potent as heroin and 6.6 times as potent as morphine. Fentanyl (Sublimaze, Duragesic) has 50 times the potency of morphine. Among the commonly prescribed oral opioids, hydrocodone (Vicodin) is roughly equivalent in potency to oral morphine, and oxycodone is roughly twice as potent. Oral codene has about 1/6 the potency of oral morphine.
The term “opiate” is used to describe alkaloids derived directly from the opium plant, such as morphine. Opioid refers to semi synthetic and synthetic opiates, such as oxycodone (invented in Germany in 1917), hydrocodone (invented in Germany in 1920), and fentanyl (invented in Belgium in the 1960s), as well as antagonist drugs such as naloxone, and Indo genus compounds such as endorphins.
Opiates combined with opiate receptor sites in the central nervous system to produce the effects of euphoria, analgesia, narcosis, and respiratory depression. 17 known receptors have been reported, but the principal ones are the mu, kappa, and delta receptors. They have subtypes, three of which are the mu receptors mu1, mu2, and mu3. Subtypes one and three produce analgesia, euphoria, vasodilation, and physical dependence. Subtype two produces respiratory depression and physical dependence, but no analgesia. The mu2 receptor is the only receptor that produces respiratory depression. All of the known receptors produce physical dependence – that is, chronic use requires larger doses to produce the desired effect, and abrupt withdrawal causes unpleasant symptoms. Opioid tolerance is associated with decreases in receptor sensitivity. The mu1 receptor develops tolerance more rapidly than the mu2 receptor. This likely explains why some physically dependent opioid users resort to higher and higher doses to achieve the desired effect and gradually succumb to asphyxiation from respiratory depression.
A January 2018 study from researchers at Harvard and Johns Hopkins universities reviewed over 568,000 patients in the Aetna Health Insurance database who received prescription opioids for acute postoperative pain between 2008 and 2016 and noted a total misuse rate using the range of misuse diagnostic codes of 0.6%.
Despite the hyperbolic press coverage surrounding the rising national opioid overdose rate, the evidence shows that opioids are safe and effective choice for severe and chronic pain, carrying little risk of physical harm, and a low risk for abuse, dependence, and overdose.”
First synthesized in 1912 and patented by Merck, 3, 4-Methylenedioxymethamphetamine, better known as MDMA or ecstasy, was a relatively obscure drug for much of its history. In the 1950s, the CIA dabbled in researching the drug for possible chemical warfare purposes. It wasn’t until the 1970s, however, when a group of psychiatrists began to use the drug to facilitate psychotherapy, that recreational use began to grow. Eventually, the drug showed up on the streets. Frightened of a new, unknown Street drug with the sexualized name of “ecstasy” that could be used by children, the DEA issued a notice of proposed rule making in July 1984, announcing the intent to classify MDMA as a Schedule I controlled substance.
In response to the DEA’s proposal, a group of physicians, researchers, and therapists hired DC attorney Richard Cotton to draft a letter to the DEA administrator requesting a hearing on whether and how MDMA should be scheduled. This letter seems to have surprised the DEA, which, according to the one DEA pharmacologist, “had no idea that psychiatrists were using it.” In fact, MDMA, initially called “Adam” within the therapeutic community (possibly either as a reference to Adam and Eve or as a pseudo-anagram of the letters MDMA), had flown under the radar of the DEA for years. Given that use was usually therapeutic, and that MDMA rarely causes an adverse reaction requiring either medical treatment or law enforcement assistance, it seemed that MDMA could have flown under the radar for years more had not hit the streets, been renamed ecstasy, and landed in the hands of teenagers. One distributor reveled in the DEA ignorance:
“One of the wonderful things is MDMA has been known as Adam and used therapeutically in thousands, tens of thousands of sessions for 10 years, since the early 1970s, when the DEA moved to make it illegal, they had never even heard the name Adam. It wasn’t listed at all. It was people who had learned of it from of therapeutic community, some of whom had gone on to mass market under the name of Ecstasy.” …
The DEA, fully ensconced in the drug warrior mentality of the 1980s, didn’t seem to care. In fact, the agency didn’t care that it couldn’t offer much evidence that MDMA was harmful or that it was being abused. Instead, the agency argued that actual harm need not be shown, just the potential for harm.
Even though board certified psychiatrist explained that MDMA had an “accepted medical use” in practices, the DEA insisted that the FDA should decide what belongs in that category. They argued that the agency “need only ask the FDA whether the drug or substance in question has received FDA approval under the FDCA [Food, Drug, and Cosmetic Act of 1938] in order to ascertain the existence, vel non, of ‘accepted medical use.’
In a carefully reasoned 90-page opinion, Judge [Francis I.] Young concluded that MDMA should be placed on Schedule III, not Schedule I. Young disposed of the DEA’s argument that “accepted medical use” was synonymous with FDA approval. “Congress could easily have linked the phrase ‘accepted medical use in treatment’ in the CSA to some provision of the FDCA, and FDA’s authority thereunder, had it desired to do so. It did not do so.” Rather than being determined by the FDA, accepted medical use is determined by “what is actually going on within the healthcare community.
Young reviewed “testimony in this record from reputable physicians, i.e., responsible medical authorities who constitute a respectable minority, that the use of MDMA is acceptable in the treatment of certain kinds of patients.” Furthermore, the drug, although it can be abuse, does not have a high potential for abuse. Finally, reasoned young, there are accepted safety standards for use under medical supervision, therefore, MDMA should be a Schedule III drug. …
[Note: The DEA arbitrarily classified it as Class I.]
… In the limited research that has been done, however, MDMA has continually surprised researchers with its efficacy to treat certain psychological problems, particularly PTSD. In one small study of those with treatment-resistant PTSD, 80% of MDMA-treated patients reported benefits from the treatment; only 20% of the placebo group did so. The one year later, the majority of those treated with MDMA reported continual beneficial effects, whereas none of the placebo group did. In another small study of those suffering chronic PTSD, 10/12 subjects were determined to be cured after two MDMA -assisted psychotherapy sessions. …
… If we wanted to invent a drug especially designed to help enhance trauma-focused therapies, it would have the following qualities:
- Be short-acting enough for a single session of therapy.
- Have no significant dependency issues.
- Be non-toxic at therapeutic doses.
- Reduce feelings of depression that accompany PTSD.
- Increase feelings of closeness between the patient and the therapist.
- Raise arousal to enhance motivation for therapy.
- Paradoxically, increase relaxation and reduce hypervigilance.
- Stimulate new ways of thinking to explore entrenched problems.
Ecstasy has all these qualities when used in a clinical setting and is extremely effective. (David Nutt, British pharmacologist.) …
The growing acceptance of research into MDMA has also helped resuscitate research into other psychedelics that were hastily banned and given a bad reputation before any meaningful scientific research could be done, particularly LSD and psilocybin. Psilocybin has been used to combat smoking addiction in small, FDA-approved studies with shocking results. In a study with 15 participants, “12 subjects, all of whom had tried to quit multiple times, using various methods, were verified as abstinent six months after treatment, the success rate of 80%.” Before it was stamped with the label “hippie drug” and associated with anecdotal stories of “bad trips,” LSD was used to successfully treat alcoholics. But getting into the story behind psilocybin and LSD is beyond the scope of this essay. Suffice it to say that the story is largely the same for MDMA, a fearful government, goaded on by hyperbolic media reports and frightened parents, and something before we knew much about it. As a result, science was retarded, and those who could have benefited were forced to languish with her possibly curable disorders.
OK, virtually everything above is taken from the Burrus texts, and the brief passages below are mine. I watch more TV than I would admit to without embarrassment. Some shows, like Bosch Legacy, starring Titus Welliver, I find compelling. Author Michael Connolly supplies both riveting plot and complex characters. Another series, Ozark, features Jason Bateman, and while I watched the first season, I lost interest and have not returned to it. It was not believable.
Despite my willing suspension of disbelief with Bosch Legacy, it gnaws at me that he is fighting the Russian Mafia. With Ozark, the US government is fighting Mexican drug Cartels. I don’t think either exist, but these series and many others push this mythology. This has always bugged, me, and then to come across a straightforward treatment of opioid abuse as set out above suggests to me that screen writers are given certain subject and told that they have to include them in the shows. Of the scores of things they use to control us, fear of Russians (going way back) and fear of Mexican drug lords (and the associated fear of addiction to narcotics) are near the top, maybe just below viruses and Greta Thunberg and Climate Change.
Another series we are watching is called Lincoln Lawyer, starring Manuel Garcia-Rulfo, who replaced Michael McConaughey, the one who starred in the movies. It’s a Michael Connally piece too. In this plot line we learn that Mickey Haller had a surfing accident, and during his long recovery became addicted to opioids. That’s a different twist on the same plot line.
I’ve had two surgeries in past months, and as a result was prescribed opioids. We still have them. One morning I took a pill before going to the gym, as my operated hand hurt. I then drove the seven miles and noticed that I was a little bit high, and so had to be very careful. That effect wore off quickly, but it did help with the pain. I had no desire to take another pill, as the minor high I experienced was not pleasant. Only the pain relief was, and I was able to manage the pain without drugs thereafter. It lingers to this day.
The chances of my becoming addicted to opioids was practically nil, .6% if you read Burrus above. But they push that so hard. PTSD was a very big deal during the Iraqi and Afghanistan attacks, and if these young men and women could be helped by taking ecstasy, then do it! It seems that the people at the top are reminiscent of the 1936 movie Reefer Madness, which demonized marijuana. I don’t claim that it makes us smarter or more ambitious. (I don’t use it myself, but did once or twice in the past. I did not find the high to be a pleasant thing.) Marijuana is doing little more than pacifying people who should be more on top of things. I suspect in the beginning they needed a reason to throw Mexicans in US jails, which is what led to prohibition. When it came into widespread use in the white population, it became legal.
Enough of being afraid all the time of every damned thing they throw our way! Opioids are not the vast menace they claim them to be. Ecstasy and LSD have legitimate medical uses.