What has been called America’s greatest drug crisis — the opioid epidemic — has some people longing for the bygone days of cocaine.
At the July meeting of the Bladen County forum on opioid abuse, one participant voiced the following: “Even crack is better, because it’s illegal across the board. If someone has it, they’re breaking the law. That’s not true with opioids.”
While crack may have been preferable because of its comparative ease of enforcement, opioids are proving a dangerous foe in more areas than just the legal or criminal justice fields. One of the greatest threats from opioids comes from the unknown impact on the body. Drugs like cocaine and methamphetamines basically affect everyone the same way, but the opposite is true of opioids.
“I might be able to take 30mg of one drug, and it doesn’t affect me at all, beyond just relieving pain,” said David Chestnutt, who, in his role as director of Carolina Crossroads, sees many men addicted to opioids. “You could take 5mg of the same drug and experience euphoria. Doctors have no way of knowing who it will produce euphoria in.”
Clarkton Drug owner John Stoll agreed and said further complicating matters are studies showing addiction as having a link with biology.
“Scientists have isolated the genes that make some people more prone to addiction than others,” Stoll explained. “If you have that ‘addiction gene,’ you’re more likely to become addicted if you’re prescribed an opioid.”
Stoll added that the genetic tests to determine propensity to addiction are cost prohibitive, so, again, providers have no way of knowing in whom the drugs may lead to abuse.
“Once they experience that euphoria, they’re continually chasing it,” he explained.
The euphoric effect is a just one of the possible side effects of the class of drugs. Opioids is a term that refers to a synthetic group of drugs. Frequently, however, the word is used in a broader sense to refer to all pain medications that act on opioid receptors, including opiates — drugs naturally derived from the opium poppy. Opioids work by binding to mu-opioid receptors on the nerve cells in the brain and body to reduce pain and suppress coughs when used legitimately.
Opioids can be procured three ways: over the counter, by prescription, or illegally. In the first category are substances like codeine, found in many over-the-counter cough medicines. America’s drug problem, however, centers primarily on the second two categories. Available only by prescription are drugs like oxycodone and morphine, Schedule II drugs that relieve pain. Opioids that are illegal to purchase or possess include heroin and most fentanyl.
Many of the drugs, especially those in the second or third categories, produce the euphoric effect users are seeking. Gavin Kersey, resident at Carolina Crossroads and in the program for his addiction to opioids, has experienced the high. He says though opioids act as depressants in some people, meaning they slow down the nervous system, for him, they do the opposite — give him energy.
“It’s not the same as cocaine, but it’s definitely euphoric. I feel like I could run through this wall,” he explained of the high. “I feel like I’m on top of the world, and nothing can go wrong.”
Things do eventually begin to go wrong, however — tolerance develops. According to the National Institute for Drug Abuse, the binding of opioids to opiate receptors in the body triggers the inhibition of an enzyme that results in the firing of impulses, or the “high” experienced by users. After repeated activation, the enzyme adapts so the drug no longer causes changes in cell firing, a process known as tolerance. Similar to how people become accustomed to alcohol, tolerance means drug users are constantly needing more and more of the drug to produce the high they are chasing.
“That’s the thing these kids don’t understand about opioids,” said Doyle Owen, a White Oak resident and District 13 leader for Parents Coalition for C.H.A.N.G.E. “It’s never going to be enough.”
Kersey, who has been in and out of rehabilitation centers for 11 years, said not only does tolerance build up over each on-again, off-again drug cycle, but his body never forgets what it’s done.
As an example, the 32-year-old said he had once come clean from opioids. During the period of sobriety and while at work one day, he experienced a pinched nerve that resulted in a later surgery. The hospital prescribed Percocet for his post-operative pain, and the former drug addict left the Chapel Hill hospital with 60 pills in hand. By the time he arrived at his home in Clinton, he had 24 pills left.
“It’s a wonder that didn’t kill me, ” he said. “That’s what people don’t understand — I can stop, and then within a week (of using again), I’ll be back to what I was on before.”
Since euphoria can be accentuated by rapid delivery to the brain, users may begin snorting or injecting crushed prescription pills.
At this point in the downward spiral of use lies another danger of opioids — their use as gateway drugs.
Defined as a drug that is commonly thought to open the door to harder drugs, the gateway drugs of choice for decades have been understood to be marijuana or alcohol, which sometimes led to cocaine. Some drug users, however, may have been reluctant to go from a “recreational” drug marijuana to a “serious” drug like cocaine.
With opioids, on the other hand, users see the gap between what they’re using and the harder drug as a smaller one. Drugs like morphine and heroin are in the same family of pharmaceuticals, morphine being the substance to which heroin metabolizes. Convincing someone to make the switch may be as simple as reasoning with them that they’re close to heroin anyway, and the high is more intense.
For other users, it just makes financial sense to cross the threshold from prescription pills to heroin.
Owen, whose son died in February from an overdose, said his son eventually turned to heroin because of tolerance and money.
“It got to where Opanas were $60 apiece, and it was just cheaper to do heroin,” Owen explained.
The transition to opioids like heroin and fentanyl is creating an unprecedented hunger across the country, something not seen with earlier drugs like crack. At a September 22 conference, U.S. Attorney General Jeff Sessions spoke to law enforcement about the increasing strength of drugs on the street.
“Drug dealers across America are profiting off of this crisis,” Sessions remarked. “They are making the drugs stronger and more deadly by lacing fentanyl — a drug 30 to 50 times more powerful than heroin — and carfentanyl, a synthetic opioid 100 times more potent than that. As a result, drugs on the streets today are more powerful, more addictive, and more dangerous than ever.”
The opioid fentanyl has the power to kill with the ingestion, inhalation, or skin absorption of just two milligrams, or just a few granules. By comparison, a sweetener packet found on a restaurant tabletop generally contains 1,000 milligrams.
An Ohio police officer knows all too well the potency of the new obsession. In May, 2017, East Liverpool officer Chris Green, while wearing gloves, searched a car and found fentanyl. Later in the day, he brushed with his bare hands a white powder off his uniform and had to be rushed to the hospital, diagnosed with a drug overdose.
The lethal drugs aren’t just in other states, however. The lacing of heroin with fentanyl was, in fact, the very thing that killed Brandon Owen.
“These kids … don’t know what these dealers are really selling them,” Owen lamented, adding his son’s drug dealer had purportedly been bragging about the death of his son.
The use of these deadly opioids — heroin, fentanyl, and carfentanyl — are what leaders around the country are scrambling to keep in check. In Bladen County, the opioid forum meetings have produced the general sentiment that heroin isn’t a problem in the Mother County — yet. But with the preponderance of people nationwide turning from prescription pills to heroin — overdoses of the latter have increased 244 percent nationwide from 2007 to 2014 — leaders fear Bladen County’s prescription pill crisis could turn into a heroin or fentanyl epidemic.
“If we ever get into heroin, we’ll be in a bind,” said Richard Allen, narcotics investigator with the Bladen County Sheriff’s Office.
Chrysta Carroll can be reached by calling 910-862-4163 or emailing firstname.lastname@example.org.