Dr. Huerta talks about the dangers of using "rainbow fentanyl" 3:29
(CNN Spanish) --
In the late 1990s, the pharmaceutical company Purdue Pharma recommended the use of the drug known as OxyContin to doctors.
This is a powerful opioid prescribed to patients with chronic pain.
It took 18 years for the effects of this intense campaign to be seen in American society.
The use of opioids in the country has become a deadly and painful epidemic.
American society is currently facing another crisis: that of fentanyl.
In this episode, Dr. Elmer Huerta talks about opioids and fentanyl.
We also explore how the United States got into crisis over its excessive use of these drugs and why they are so deadly.
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You can listen to this episode on Spotify, our YouTube channel or your favorite podcast platform, or read the transcript below.
Hello, welcome to this new episode of In Consultation with Dr. Elmer Huerta, your favorite health podcast on CNN en Español.
Dr. Huerta greets you, I hope you are well.
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I'm sure in recent years you've heard about fentanyl, opioid addiction, and how deadly these drugs can be.
Well today we are going to talk about that topic.
We will see what is fentanyl and what are opioids.
We will analyze how millions of people have ended up being addicted to these drugs.
Also how can we avoid falling into that addiction that, let me tell you, is easier than you imagine.
opium
Since time immemorial, it has been known that if the capsule of the fruit of a plant called opium poppy, or royal poppy, is carefully cut, a latex or milky liquid is obtained that has numbing properties for those who consume it.
That latex is opium, a natural substance that was used by the Egyptians, Chinese, Indians, Greeks, and Romans as a medicine, mainly to soothe pain.
For the great doctors of antiquity, opium was a wonderful medicine.
It has been pointed out that the famous English doctor Thomas Sydenham came to say that: "Among all the remedies that Almighty God has deigned to give man to reduce his ills, none is as effective and universal as opium."
But that natural latex, opium, is made up of various alkaloids or natural chemicals called opiates.
Among these is morphine, isolated by the German pharmacist Friedrich Serturner in 1805. Also codeine, isolated from opium by the French chemist Pierre Robiquet in 1832.
Because of its wonderful analgesic properties, morphine not only became the medicine of choice for pain control during the 19th century.
But it is also used very widely today.
What are the derivatives of morphine?
The problem with using morphine as an analgesic was the difficulty of obtaining natural pure opium to obtain morphine and codeine.
Since the end of the 19th century and the beginning of the 20th century, pharmaceutical companies began to look for alternatives that would allow them to manufacture these substances in the laboratory.
In that search, chemists developed semi-synthetic and synthetic derivatives of morphine.
Synthetics are completely artificial substances, synthesized in the laboratory, while semi-synthetics are derived from known substances.
For example, the pharmaceutical company Bayer began marketing heroin in 1898, this being the first morphine-derived substance manufactured in the laboratory.
Thanks to that, heroin became a widely used medication to control pain.
The first clinical studies that were done with this substance were so promising that it was considered wonderful.
Unfortunately, it was soon discovered that patients using heroin developed a tolerance to the drug, requiring greater amounts of it, leading to severe addiction.
opioids
In the early 1910s, morphine addicts discovered that the euphoric properties of heroin were increased if the drug was injected into a vein.
This led to heroin becoming the most abused narcotic drug at the time.
That's why around 1920 the United States placed restrictions on the sale of opioids and narcotics, requiring formal medical prescriptions to be written to obtain them, and banning heroin.
In their search for less addictive alternatives during the first decades of the last century, laboratories began to manufacture dozens of artificial derivatives of morphine, substances that have been called
opioids
to differentiate them from natural opiates.
Because it is a very technical difference.
In everyday language, both names, opioids and opiates, are used interchangeably.
Some examples of opioids are oxycodone, hydrocodone, hydromorphone, oxymorphone, methadone, and the terrible fentanyl.
The effects of opioids
But what effects do morphine derivatives have?
Why are they used so much and what do people who get addicted to it look for?
Morphine derivatives cause marked euphoria, in addition to:
anxiety,
dizziness,
nausea,
vomiting,
profuse sweating,
constipation
and fatigue.
At high doses, these substances have a very serious side effect.
Opioids depress the respiratory center in the brain and can cause death from respiratory arrest.
Why do so many people abuse the substance?
This is likely because opioids activate powerful reward centers in the brain.
This triggers the release of large amounts of endorphins, or natural human pleasure hormones.
Addicts say they feel good.
That their physical and emotional pain is softened and that they develop a particular sensation of pleasure.
This creates a very powerful, but temporary, feeling of physical and psychological well-being.
It is in this temporality of pleasure where the problem of addiction lies, because in order to feel pleasure again, the addict not only needs to take frequent doses of the drug, but also increasing amounts.
These drugs are so addictive that, when they are stopped, they cause a severe withdrawal syndrome, which is characterized by:
severe bouts of nausea
vomiting
panic attacks
great muscle pain
insomnia
high fever
America's deadly opioid epidemic
But knowing these details of the effect of opioids and their enormous addictive power does not fully explain how, over the past 30 years, a deadly epidemic of opioid abuse has unleashed in the United States, which authorities estimate has caused 932,000 deaths. since 1999. Incredible, almost a million deaths in just over 20 years...
Let's see in a simplified way what could have caused such a misfortune.
I clearly remember that during my medical studies in the 1970s we were very insistently taught that we had to be very careful with the addictive properties of morphine and its derivatives, so we had to be extremely careful when prescribing them.
That was the attitude of doctors, nurses and other health professionals: be very careful with morphine and its derivatives, they can cause severe addiction and should only be used when strictly necessary.
But, apparently, everything began to change in January 1980 with the publication of a letter of only 101 words in the prestigious New England Journal of Medicine, which stated that the addictive capacity of opium derivatives in hospitalized patients with no previous history of addiction was minimal.
Little by little, it seems, doctors began to lose their fear of using narcotics, and began to prescribe them more freely to their hospitalized patients.
In 1986, another American study was very influential in changing the perception of doctors.
The study suggested that narcotics could be used as a safe, healthy, and more humane maintenance therapy in patients with intractable non-cancerous pain and no history of drug abuse.
Thus, little by little, in the late 1980s and during the first half of the 1990s, doctors progressively prescribed narcotics to patients with all kinds of chronic pain, and the great epidemic of narcotic addiction began. .
The role of pharmaceuticals
Until in 1996 an event occurred that many experts believe was the trigger for the great epidemic of drug abuse and its great social impact in deaths: the Purdue Pharma laboratory put the drug oxycodone (trade name OxyContin) on sale for the pain management.
This fact marked the before and after the crisis, due to the aggressive marketing practices of that pharmaceutical company.
In 1998, for example, they created a video that was distributed to 15,000 doctors' offices in the United States that claimed that oxycodone was not addictive and encouraged doctors and patients to use the drug.
That combination of physicians losing their fear of prescribing narcotics and the aggressive marketing practices of the pharmaceutical company Purdue Pharma caused drug sales to soar in the United States.
In the early 1990s, for example, only 2 to 3 million oxycodone prescriptions were dispensed each year;
in 1997, that number rose to 8 million, and in 1999, a year after Purdue's video promotion, the number of oxycodone prescriptions rose to 11 million.
In the face of that sales success, Purdue launched a national advertising campaign in medical journals in 2000, and sales skyrocketed.
The beginnings of the epidemic
But in addition to the relaxation of physicians in prescribing narcotics and the intense and massive marketing campaigns of pharmaceutical companies, three events that occurred at the beginning of this century contributed to the epidemic of narcotic addiction.
In the first place, the Joint Commission, an organization that promotes the quality of medical services in American hospitals, proposed in 2001, with the endorsement of the now extinct American Pain Society, that in addition to pulse, temperature, respirations, and blood pressure, it should ask always to the patients if they suffered from any kind of pain.
This initiative was enthusiastically accepted by the country's medical system, despite the fact that the evaluation of this "fifth vital sign" —unlike the other four— was highly subjective, not measurable and, therefore, prone to be distorted.
Second, concerned about the dissatisfaction shown by many patients with the quality of the health services they received, administrators introduced the use of "patient satisfaction surveys" as a powerful instrument for measuring service quality.
And third, during those years, huge amounts of very cheap heroin and powerful synthetic opioids from Mexican and Chinese drug traffickers invaded the streets of the cities.
The perfect storm of an addiction
So let's see how those factors lined up for the perfect storm of addiction in the population:
Health personnel incessantly asking patients if they were in pain.
Patients complaining in satisfaction surveys that their pain was not adequately treated.
Administrators—concerned by these responses—asking doctors and nurses to do their best to soothe their patients' pain.
Physicians with less fear of prescribing narcotics.
Pharmaceutical companies actively pushing their products, assuring doctors and patients that they were not addictive.
A huge supply of cheap heroin and narcotics on the streets.
The result: doctors who began prescribing narcotics left and right to millions of people.
The vast majority of these addicted to narcotics, many of whom died from overdoses.
When addicts could no longer get formal opiate prescriptions from their doctors, they searched the streets for heroin and other narcotics at very cheap prices, also finding death while consuming them, because drug dealers, in their eagerness to get more clients for their products, they mixed them with fentanyl, an opioid 100 times more powerful than morphine, capable of causing death by respiratory arrest.
The result of this entire chain of tragic events is that, as we mentioned, more than 932,000 people have died since 1999.
The response of American society
American society reacted late to the ravages of narcotic addiction.
The photo of an unconscious couple in their truck with a 4-year-old boy in the back seat, released by Ohio Police in late 2016, went viral, showing the horror of the problem for the first time.
As recently as 2018, the United States Senate passed a bill to alleviate the epidemic, giving access to effective addiction treatments, expanding alternative non-opioid pain control options, reducing overprescribing, and educating patients.
And just in March 2022, after a long legal battle, a judge in the United States approved an agreement whereby the Purdue Pharma company and its owners, the Sackler family, must pay up to US$6 billion to affected states and individuals. for their illegal pain pill marketing practices.
On the other hand, dozens of doctors—as the CNN documentary “American Pain” recently showed—are in jail for indiscriminately dispensing narcotic prescriptions.
While it is true that many people start their addiction using the heroin they get on the black drug market, it is estimated that 80 percent of addicts started with an opiate, such as codeine or oxycodone.
Why is rainbow fentanyl so dangerous?
1:02
The fentanyl epidemic in the US
In the last two or three years, in addition to the reported abuse of pain pills such as hydrocodone, the epidemic of narcotic use is radically changing in the United States with the use of fentanyl by drug dealers.
That makes us look at how that drug, which has become the deadliest of all the drugs currently circulating in the United States, is being used.
Fentanyl is a drug that can be made anywhere, without requiring sophisticated laboratories to synthesize it.
It is also very cheap.
From one kilogram of the precursor chemical, 800 grams of fentanyl can be obtained.
This yields to manufacture half a million pills at a very cheap cost.
Fentanyl is a very powerful drug.
More than two milligrams of that substance can kill a person by respiratory arrest.
Two milligrams is a minimum amount that can fit on the head of a medium-sized pin.
What drug traffickers do today is contaminate a series of drugs and pills that are sold on the street with fentanyl.
For example, fentanyl can be in heroin and cocaine.
But also in pills for anxiety, pain, and even attention deficit disorder.
The result is that many adolescents and young people who buy pills on the street can become intoxicated and die from fentanyl.
In a recent CNN report, authorities from the United States Drug Enforcement Administration stated that their analyzes reveal that 99% of the pills bought on the street are contaminated with fentanyl.
This is a direct message to parents.
Their children may be unknowingly taking fentanyl-contaminated pills and dying as a result.
The conclusions of Dr. Huerta
It is important to say that there is no doubt that the use of opioid medications in a patient with severe pain is an absolute necessity.
What must be avoided is that, due to unnecessary and uncontrolled use, innocent people develop a serious addiction.
In the history of medicine, the opium drug addiction crisis in the United States will be an example of a human-caused misfortune.
The collaboration of medical societies, corrupt doctors, perverse economic incentives designed by greedy pharmaceutical companies, and currently the criminal attitude of drug traffickers, have contributed to causing this public health disgrace.
Do you have questions for Dr. Huerta?
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You can find me at @DrHuerta.
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