New drugs are emerging at an unprecedented rate as manufacturers of “legal high” products use new chemicals to replace those that are banned. These new chemicals take the place of heroin, morphine and amphetamines. These drugs are highly accessible, touted as legal and perceived as safe. However, despite the popularity in designer drugs and legal high products, the abuse of heroin and prescription painkiller medication is still trending throughout the country.
The introduction of the powerful new opioid painkiller Zohydro has spotlighted the nation’s growing prescription drug abuse problem. Opioids are the most commonly abused prescription medication. Drug companies are creating new synthetic chemical substances that act in the body in a way similar to the opiates, i.e., drugs derived from the opium plant, such as heroin, morphine and codeine.
Examples of opioids include fentanyl, oxycodone, methadone and hydrocodone. Codeine appears in dozens of different formulations, including cough syrup. Some users employ scams to obtain prescription strength cough syrups from doctors, others burglarize pharmacies and others purchase syrup that has been smuggled in from Mexico.
A powerful new prescription painkiller known as Zohydro ER hit the market in March 2014 amidst widespread concern that the drug could trigger a disastrous spike in overdoses and deaths. Zohydro is a potent extended-release formulation of hydrocodone without the additives of aspirin or acetaminophen and is intended to be taken every 12 hours. In early 2015, the FDA approved a reformulated version of Zohydro ER designed to be abuse resistant.
The effects of hydrocodone are similar to heroin, and Zohydro contains as much as 50mg of hydrocodone in a dose—10 times the amount found in other painkillers.
Zohydro belongs to the opioid family of medications, a highly addictive group of drugs that includes morphine, codeine, methadone and oxycodone. The FDA has stated the drug is safe if used correctly and is a necessary alternative for patients who have built up a tolerance to other opioids. However, with the deadly heroin and pain pill epidemic occurring throughout the United States, the potential for abuse is apparent.
Law enforcement fears that the medication will be diverted and fall into the wrong hands and that drug addicts will crush the capsules and consume the medicine at full strength rather than as it was intended.
Zohydro can be crushed, chewed, or mixed with alcohol and still retain full potency. Users can also simply separate the halves of the capsule and snort it or make it soluble with saline for injection. Consequently, the misuse of Zohydro ER has the potential of becoming the next major substance abuse epidemic. There will more than likely be an increase in pharmacy robberies, overdose patients and a need for addiction treatments.
Fentanyl is a prescription narcotic used to relieve severe or chronic pain and is commonly used for cancer patients or as a last-resort pain medication. It is available as a skin patch, lozenge, pill, shot and a dissolvable film strip. As a recreational street drug, fentanyl may be referred to as China White.
Fentanyl is now being concealed in non-injection drugs, including oxycodone and various “party drugs” in powder or pill form, as well as in marijuana. Some drug dealers are now selling pure fentanyl as heroin. Because of this new threat, all recreational drug users are urged to know their source.
Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities. There was even speculation that Philip Seymour Hoffman was killed by a similar blend when the actor was found dead in January 2014. The drug envelopes found in his apartment were marked Ace of Spades and Ace of Hearts.
Although mixing fentanyl with heroin isn’t new, the development of a synthetic fentanyl called Acetyl Fentanyl has just started to make headlines. Acetyl fentanyl is a relative of the powerful fentanyl and is five times more potent than heroin as a painkiller. The illegally produced compound may be secretly mixed with heroin to make it a more potent product or it may be sold in pills disguised as oxycodone. Overdose deaths have already been linked to acetyl fentanyl.
The prescription drug fentanyl is actually even more potent but is safe to use in pharmaceutically-controlled dosages. A specific antidote, naloxone, can be administered to block the effects of heroin, morphine, fentanyl and other opioids.
Acetyl fentanyl is difficult to detect and easy to miss in drug overdose cases. Other drugs were detected in most cases, including opioids, alcohol and benzodiazepines; however, one person died solely from acetyl fentanyl. In May 2015, acetyl fentanyl was temporarily identified as Schedule I under the Controlled Substance Act.
Tramadol is an opioid analgesic, similar to codeine, approved by the FDA for the management of moderate to moderately severe acute or chronic pain in adults. Although tramadol offers important medical benefits when used appropriately, it can have serious health consequences when taken without medical supervision, in larger amounts than prescribed or in combination with illicit drugs, alcohol or other prescription or over-the-counter (OTC) medications.
Recreational use of tramadol can be dangerous due to the possibility of convulsions with higher doses. When taken orally, rather than injected, tramadol produces opiate-like effects similar to oxycodone. Adverse effects include dizziness, nausea, constipation, vertigo, headache and vomiting. In extreme cases it may cause hypertension, hallucinations, tremors, respiratory depression, blurred vision, liver swelling and speech disorders. In 2011, the drug was linked to over 21,000 emergency room visits throughout the country. Prescriptions for tramadol increased 88 percent from 23.3 million in 2008 to 43.8 million in 2013. In Florida, there were 379 overdose deaths from Tramadol in 2011. In most of the cases, tramadol was combined with other drugs or alcohol. Also in 2011, 2.6 million people ages 12 and older used tramadol for nonmedical purposes. Tramadol misuse or abuse may be contributing to the overall problem of narcotic pain reliever misuse or abuse among older adults.
Federal drug policies were implemented in July 2014 to control the manufacture, importation, possession and use of tramadol, an action indicating that tramadol has potential for abuse.
More than 15,500 people die every year of prescription drug overdoses, and nearly one-third of those overdoses involve methadone. Methadone has been used for decades to treat drug addiction, but in recent years, it has been prescribed to relieve pain. Methadone is available as a low-cost generic drug.
The synthetic opiate is taking a toll in Northern Kentucky and other parts of the country, as heroin addicts try to detox themselves, self-dosing with methadone and overdosing. Methadone is also used for a heroin fix. Since 2005, prescriptions written for methadone have decreased; however, most users are finding their methadone on the street. With the surge in popularity for methadone, pharmacy burglaries have increased in some areas.
Taking methadone improperly can slow breathing. Death could occur if the breathing becomes too weak. It can also increase the negative effects of alcohol.
A drug increasingly being used to treat opioid addiction may be fueling a new epidemic of diversion, overdose, addiction and death in the United States. Similar to methadone, Suboxone is used to treat drug addiction and is sometimes prescribed for chronic pain management. In 2012, Suboxone generated $1.55 billion in sales in the United States, surpassing well-known medications like Viagra and Adderall. Its success was partly fueled by the nationwide opioid-abuse epidemic.
The lack of understanding about the dangers of this drug is especially worrisome. Although people may think of Suboxone as a safer alternative to opiates due to its legal status, it is actually an opioid itself. Buprenorphine, an opioid in Suboxone, can produce euphoria and cause dependency. Its effects are milder than methadone, making overdose deaths less likely. Side effects include slow breathing, dizziness, liver problems, nausea, sweating, stomach pain and constipation.
Purple Drank, or Lean, a mixture of Sprite, Jolly Ranchers, and codeine, is generally consumed by teenagers and young adults. If prescription codeine is unavailable, DM cough syrup is often substituted. Purple drank originated in the Southern hip hop community, specifically Texas. Other names include sizzurp, syrup, drank, barre, purple jelly, Texas tea and Tsikuni.
Cough syrup containing promethazine and codeine are usually purple in color, but there are other colors of cough syrup that work the same way, including a golden-colored hydrocodone-based syrup. The prescription-only cough syrup is a controlled substance with widespread recreational use. It is not unusual to see large quantities of the substance being sold and transported. It is usually obtained by doctor shopping, forged prescriptions and pharmacy theft.
Demand for the syrup has sent its price soaring on the streets. Syrup that typically costs $12 per pint is sold for $300 per pint to street dealers who in turn sell it by the ounce for $40-$80. The drink produces euphoria and causes motor skill impairment that make users move slowly or lean over. Overdosing on the syrup is potentially fatal. Too much codeine, which is produced from morphine, can depress the central nervous system and stop the heart and lungs.