The relief for pain, with a catch

Illustration+by+Skye+McEowen%C2%A0

Illustration by Skye McEowen 

Skye McEowen

Ohio has witnessed a dramatic change in the heroin crisis, touching directly or indirectly almost every life, and the problem has seemed to balloon over the past several years.

In 2014, Ohio saw 503 accidental fentanyl-related deaths, and in 2015, the number of accidental deaths spiked to 1,155, according to the Ohio Department of Health. As a response when the problem began to grow out of control, clinics, advisory boards and government initiatives began to tackle the heroin crisis. However, they’re all tackling a crisis that extends centuries and even millennia.

How did heroin get to Ohio?

The Governor’s Cabinet Opiate Action Team (GCOAT) falls under the Department of Mental Health and Addiction Services. Andrea Boxill is the deputy director for GCOAT, created in 2011 by Gov. John Kasich, which meets monthly to review specific strategies to put into place. Recently, they completed an opiate toolkit and prescribed protocols that physicians can follow.

Gerald Craig, executive director for the Alcohol, Drug Addiction and Mental Health Recovery Board of Summit County, works among over 50 other boards in Ohio to assess community needs and contract agencies to provide necessary services. One example of this is the board focusing on treatment and prevention, including teaching people how to minimizing the diversion of drugs.

Both Boxill and Craig said a portion of incoming heroin comes from Mexican cartels. How heroin reaches Ohio is unknown, but one conjecture is the interstate system that runs through the state — making it a hotspot between major cities.

“We have 77 and 71 that goes north and south, we have 76 and 80 that go east and west, then it’s really a main thoroughfare to get from here to Chicago, or to New York or the other places,” Craig said. “We’re just really ripe for the trafficking to come through our state.”

Craig said drug dealers often look for those in suburbs with expendable income and cell phones. Dealers carry drugs in small amounts and focus intensely on customer service to keep clients, Craig added.

Furthermore, Boxill and Craig discussed the heroin epidemic not only existing in Ohio, but in the entire nation at one point or another.

“It’s not specific to just Ohio. Everyone in this nation is dealing with this epidemic,” Boxill said. “Ohio … seems to be one of the major epicenters, but the reality is every state in dealing with it. Every state historically has dealt with it.”

From fields to shelves, the origin of heroin is straightforward, yet its roots go back even further to the world’s first civilizations in Mesopotamia, around 3,400 B.C.E.

Grown and cultivated from the opium poppy, the use of opium spread throughout the continent, growing with world history. Its spread to China expedited the Opium Wars in the mid-19th century. Eventually, as the fairly new U.S. grew in immigrant population, the popularity of opium spread.

Heroin falls within the same family and extensive history of opiates.

In the late-19th century, a British chemist named C. R. Alder Wright faced a problem: How can morphine, generally used to alleviate pain, be less addictive? His answer was to combine the drug with other chemical groups (acetyl), producing diamorphine.

In 1874, heroin had been synthesized for the first time. From there, a German chemist named Felix Hoffmann synthesized heroin independently, but this time for the Bayer Company in 1898.

Heroin was widely advertised and sold throughout other companies in order to suppress coughs and relieve pain, but government officials effectively banned the drug a few decades later due to its highly addictive nature.

The fifth vital sign

Though heroin had been taken off the shelves for the public and outlawed in 1924, other opiates still made their way to pharmacies, as doctors prescribed them to patients with pain.

Boxill said opiates have been used frequently throughout American history. There were opium dens when railroads were being built, and people used opiates during movements like the Harlem Renaissance. Even during the Vietnam War, the drugs were present.

According to Boxill, many heroin addictions start from prescriptions of opiates.

“The overwhelming majority — data statistics shows us — are receiving prescriptions from doctors,” Boxill said. “When you combine those situations of injury, medication, trauma history, it’s the perfect storm for the disease of addiction to prosper, and that’s exactly what happens with many of these individuals.”

Craig said that at one point, clinics began to look at the physical pain as another vital sign in patients. According to the Johns Hopkins School of Medicine, the initial four vital signs include body temperature, pulse rate, respiration rate and blood pressure.

“(In) the ’80s (and) ’90s there was this notion that studies had showed that pain was under-treated in medical clinics,” Craig said. “One of the things that happened is that physicians in training began to be taught pain as the fifth vital sign.”

According to Craig, this eventually led to an increased pressure for physicians to make sure patients weren’t being “mistreated” for pain. To avoid patient dissatisfaction with treatment, Craig said, insurance companies and accreditation bodies created an incentive to overprescribe.

“The perfect storm”

The opiates prescribed to patients cover them as far as pain tolerance, but more deeply-suited issues and the danger of over-prescribing opiates lead to — what Boxill and Craig describe as — the “perfect storm” for addiction.

If patients begin to rely heavily on prescribed opiates and can no longer get a prescription for them, they could possibly take pills prescribed to their family members or friends, Boxill said.

From there, Craig added, an addict could turn to buying opiates like Oxycontin from the streets, which gets expensive. He said with the withdrawals having the potential to get worse, heroin becomes the cheaper option if someone is driven that far.

Joel Mowrey, executive director for the Mental Health and Recovery Board of Portage County, said while patients rely on the opiates they were prescribed, the next steps they take can be far more dangerous.

“With (patients) trying to find other pain medication … (they) unfortunately often wind up finding something on the street … which could be heroin or any number of substances,” Mowrey said. “The problem is with street drugs. You don’t know what you’re getting.”

According to Craig, some substances may not exactly lead as much a risk in getting addicted, like with alcohol. Though one still could develop an addiction, Craig said alcohol would be like riding a bicycle toward it.

“With heroin,” he said, “you’re driving a Maserati toward addiction.”

Skye McEowen is the print managing editor, contact her at [email protected]