Black tar heroin – Pure Death

Back in the 70s, heroin was mostly filler, and the good stuff was 5% pure or so. Nowadays a new, more potent, version of the stuff is killing people all around the country with widely varying purities as high as 90%.

What makes black tar dangerous

When heroin was weak, shooting it was the best way to get high, which kept many people away from it. But this relatively new stuff (it’s been around California for a while), brought in from Mexico and known by the name Black Tar, is strong enough to make smoking, or snorting, it a viable option for a nice long high. It’s a much easier sell for the dealers too – no more ugly needles, they tell their customers you can “just smoke it like weed,” which is true until you get hooked.

Black Tar HeroinLike any other form of heroin, black tar will cause some serious changes in a user’s body and brain, messing with the body’s pain, digestion, and mood systems. The problem is that at these purity levels, the chance of a user overdosing are much higher too, and that’s where the body-count comes in.

The stuff is cheap, at least in relation to the old heroin that used to come in from the far-east, but the body count’s mounting and the problems only getting worse. Heroin overdose death rates have gone up at 20%-50% and they’re still going strong. Many of the people who are most concerned about this are hoping that heroin doesn’t bring about the same epidemic that crack did in the 80s.

Avoiding death by talking

As usual, I don’t believe in running away from a problem like this. Instead, this is exactly the kind of thing that education, information, and a good dose of harm reduction can fix. We need to make sure people know that the potency of this stuff can kill you. The only way to make sure that less people die from black-tar heroin is to let them know that they need to be careful with it because one mistake can mean death.

I’m hardly ever the “just say no” type and I think that in this situation, an approach like that will leave us in deeper and deeper trouble. The AP article I based this on talked about yearly seizures of heroin quadrupling to 86 kilograms across the U.S.-Mexico border last year. By comparison, cocaine seizures in 2008 totaled more than 8000 Kilos! I can tell you one thing, as someone with experience as a drug dealer, getting 86 kilos across the border isn’t that hard with the amount of Mexican corruption and “help” dealers can get. Where’s there’s money, there’s a way, and it seems that this heroin trend is offering up some money.

Calderon honoring dead in drug warIt’s that experience of mine that makes me believe we have to work towards understanding addiction and who develops it, and getting better at prevention, intervention, and treatment. Try as we might, solving this problem by the supply side isn’t going to work, I don’t care how hard Calderon is willing to fight.

80s style is back, cocaine use included!

Everyone knows that trends come back around, and with the resurgent popularity of gigantic sunglasses, eye-bleeding neon, electronic music and metallic spandex (or so we at A3 are told), it seems that the 1980’s have firmly replanted their flag in the public consciousness, down to a sequel to that seminal testament to 80’s excess, Wall Street, in theaters later this summer. Of course, as that film and many more were quick to point out, much of that characteristic 80’s exuberance was derived from an illicit, dangerous, source, and that too, it seems, is making something of a comeback.

Cocaine use is growing in Florida

A study of data collected at the University of Florida has shown that cocaine use in their area seems to have doubled since the beginning of 2000, according to a number of key measures used to assess drug use. The report notes that the number of cocaine deaths per capita in the first half of the decade almost doubled (from 150 per 100,000 in 2000 to nearly 300 in 2005). And the study is quick to point out that these cases are coming disproportionately from college-towns and opulent upper-class communities, evoking the very 80’s image of the white powder as an infamous vice of choice for the rich and privileged.  The phenomenon seems to be global, with law enforcement and public health officials from Sydney to Dublin sounding the alarm; here in the United States, a 2008 National Survey on Drug Use and Health said that approximately 36.8 million Americans, 14.7% of the population aged 12 and older, had tried cocaine at least once in their lifetimes.

Past effects of surges in cocaine use?

For many of these Americans, that “once” (or perhaps more) probably occurred in the early to mid 1980s, during the so-called “Cocaine Crisis.” During this period, rising rates of abuse (both of powder cocaine and crystallized/crack form), the subsequent surges in both crime and serious health complications and the related emerging research on real addictive and dangerous properties of the drug all combined to petrify the media, polarize the population and spur the government into aggressive, often misguided action to combat what was seen as a rapidly growing threat.

As several articles note, the cocaine-related deaths of high-profile celebrities such as John Belushi and basketball star Len Bias (whose death was of particular significance to the alarmists, as it was alleged that it was his very first time using the drug) shattered the previously widely held view of cocaine as a harmless and non-addictive substance. Despite the oft-repeated cliché that cocaine was once so commonplace that it was a Coca-Cola ingredient , it bears remembering that there were still grave misconceptions about its potency less than 30 years ago.

Cocaine use, cocaine treatment, and the future

Clearly, the drug problem as it relates to America in particular has much to do with the political and criminal elements that complicate our own mission, which aligns more closely to the assessment and treatment of addicts in the manner best for their own health and the overall benefit of society. Even in a vacuum, however, cocaine is a highly addictive, extremely dangerous drug, and even if a relatively small percentage of those who try drugs end up categorically addicted to them, a doubling of use is a potential doubling of people addicted, which might be the most disturbing 80’s comeback not involving Boy George.

Brittany Murphy dead at 32 – Anemia, pneumonia, and yes, drugs…

Toxicology update

Well, it seems the toxicology reports are in and Brittany’s death was, at least partially, caused by her taking of multiple prescription drugs. Still, it seems that she was trying to medicate a host of conditions brought on by her underlying anemia and pneumonia. It’s sad to think that this death could have likely been prevented had she simply taken better care of herself and gone to seek emergency care rather than loading her body with those pills. Unfortunately, this seems to be another in a string of medically preventable deaths… Sad.

Original post:

Brittany Murphy, the actress from “Clueless,” and “8 Mile” died last night at Cedars-Sinai in Beverly Hills at the age of 32. Brittany has been rumored to be suffering from severe eating disorders, and recent pictures seem to support that notion. Given that she apparently died from cardiac arrest, I’m wondering if drugs (even prescription drugs) played a role in the death as well… I’ll keep updating the story as more becomes available.

My heart goes out to her family and friends. Certainly a loss suffered far too early.

UPDATE: According to the police report, a number of prescription drugs were discovered in Brittany’s bedroom including (read past the list for my take on this):

  1. Topamax –  While TMZ reported this drug to be used as anti-seizure medication, it is also used to reduce weight-gain associated with the use of many other prescription drugs on this list. Lastly, it is considered to be a mood stabilizer.
  2. Methylprednisolone – An anti-inflammatory that may be used to treat bronchial infections
  3. Prozac – A commonly prescribed SSRI anti-depression med.
  4. Klonopin – A benzodiazepine anti-anxiety prescription medication that is also used to help with insomnia. Like most benzos, the probability of overdose is low if used properly, but overdose would lead to cardiac arrest.
  5. Carbamazepine – Another anti-convulsant mood stabilizer often used to treat bipolar disorder. This prescription drug can be very dangerous when combined with other medications due to its actions on GABA and extensive alteration of Sodium channel activity. It is also a bipolar med.
  6. Ativan – Once again a benzodiazepine that is often used to treat anxiety and insomnia.
  7. Vicoprofen – A pain reliever that includes an opioid (it sounds like vicodin for a reason).
  8. Propranolol – Prescription med used to treat hypertension and as an alternative, less habit-forming anti-anxiety drug.
  9. Biaxin – An antibiotic.
  10. Hydrocodone – Same as Vicoprofen, an analgesic (pain reducing) prescription drug.

What do I think killed Brittany?

With 2 benzodiazepine medications, 2 opiates, and antidepressant, and a drug that is made to lower one’s heart pressure, it’s no wonder that Brittany was found not breathing. I’m going to wait until the final toxicology report to draw a definite conclusion, but from this list, it seems highly likely that a dangerous combination of these prescription drugs was taken, which resulted in Brittany’s heart stopping. Even when taken at their prescribed strengths, these medication, when combined, can form a lethal cocktail.

You should ALWAYS check with your doctor regarding interactions between different prescriptions you’re taking, especially when those medications haven’t all been prescribed by the same physician!

And the winner is… Cocaine: The US-Mexico drug war.

This post is based on an amazing broadcast I heard on KPCC, a local NPR radio-station; the story was part of Zocalo radio.

In the story, Dr. Josh Kun spoke about the struggles of the war on drugs and the recent massive casualties on the southern side of the border. I had talked about this violence in a past post, but hearing about it from the point of view of someone else made me realize all the more how desperate the situation is.

Drug smuggling, money, and reality

As Josh pointed out, drug-dealing and smuggling bring in so much money (billions of dollars annually) that it is at best naive, and at worse, stupid, to think that guns and enforcement are going to do the job. When there are tens of billions of dollars at stake in areas of the world that are deeply entrenched in severe poverty, the money is going to win.

I’ve had personal experience with this, with Mexican Federales bringing in cocaine in the tires of police cars. When faced with smuggling operations like that, all the sweeping governmental mandates won’t change a thing.

How do we fix the cocaine problem?

Given the fact that the US supplies the drug dealers not only with the money (we buy more than 50% of the world’s drugs), but also with the guns, it seems to me that there are only 2 ways to make a dent in the business:

1) We have to do a better job at treating, and preventing, the massive drug-abuse problem in this country. I’m working on this, and I haven’t failed at much in my life (yet), so hold on tight, I’m on it.

2) We have to do whatever we can to increase the standard of living in these places. That way, the deaths, the shootings, the violence, and the fear that permeate the border towns on both sides of the US-Mexican border affected by this are simply no longer worth it. If given a choice between starvation and a cocaine run, most of us would choose the cocaine; the choice is a lot simpler when there’s food on the table and soccer balls for the kids to play with.

That’s it, that’s our goal. This is how we make the world of drug abuse, smuggling, brain-damage, imprisonment, and death, better. We don’t do it with guns; instead we used common sense, we use our heads. We can’t beat out poverty with bullets, the human will to survive and thrive will keep producing soldiers.

Alcohol, benzos, and opiates – Withdrawal that might kill you

Along with teaching and telling stories, part of my goal here at All About Addiction is to get important information out to those who can benefit from it.

Most drug users who quit drug use “cold turkey” have to go through withdrawal of some sort. Withdrawal is never comfortable, but sometimes it can actually be dangerous. The list below outlines some drugs that should NEVER be quit suddenly without medical supervision. This is the reason why some rehab treatment is preceded by a medical detox period lasting anywhere from 2 days to a week or more.

Which withdrawals can actually kill?

  1. Alcohol – Yes, after long term use, withdrawal from alcohol can kill. Alcohol withdrawal syndrome can take on mild, moderate, or severe forms. If while withdrawing from alcohol a person develops a fever, extreme nausea, diarrhea, or DT (delirium tremens), they need to be rushed to see a doctor as soon as possible. In fact, alcohol withdrawal after heavy, chronic use is best managed under the care of a doctor or a professional medical detox unit. By using medications that relieve withdrawal symptoms, these professionals can essentially eliminate any of these risks.
  2. Benzodiazepines – Benzos were introduced as a replacement to barbiturates that were causing common overdose cases, many of which resulted in death. Nevertheless, withdrawal from extended use of benzodiaepines can kill. Whether Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam) or other variations, long term use of Benzodiazepines requires medical supervision to be completed successfully with minimal side-effects and risk to the patient. Normally, the withdrawal process is managed by slowly reducing the dose and transferring the patient from a slow acting, to a long acting, form of the drug. Still, full resolution of benzodiazepine withdrawal syndrome can take up to 6 months (or even longer).
  3. Opiates – Many people are surprised to learn that in most cases, withdrawal from many opiates is not deadly. Still there are some very important exceptions. Methadone, a long-acting opiate often prescribed as a replacement for heroin can cause death during withdrawal if it’s consumed in high enough doses for a long enough period. The debate of whether the state should be prescribing something like this should be saved for a later date. It is one of the better ways of getting people off of heroin, though obviously, all it does is replace dependence on one substance with another, more manageable one. Also, some of the recently popular methods of rapid-detox from heroin addiction can themselves cause death, and many other negative side-effects. Overall, I would recommend checking in with a physician and conducting opiate withdrawal in a controlled setting. Withdrawal under Suboxone or Subutex can be far less horrific.

Much of the danger in withdrawal from all of these drugs has to do with the body’s response to the extreme changes in the chemical processes going on in the brain and the rest of the body. Alcohol, Benzos, and Opiates interference with the GABA system, the body’s most common downregulator.

Withdrawal from these drugs is like trying to turn the heat up in a cold house with a broken thermostat and an out of control heater – It won’t always lead to disaster, but it’s a bad idea.

The withdrawal danger summary

That’s pretty much it. “Cold Turkey” withdrawal from cocaine, marijuana, crystal meth, ecstasy, GHB (never mix GHB with alcohol though!!!), and many other recreationally used drugs will not lead to death in the vast majority of cases. While it may make you uncomfortable, and you may feel moody, constipated, dehydrated, hungry or nauseous, and a whole slew of other symptoms, the chances of someone actually dying from withdrawal are very small.

If you have any more specific questions regarding your case though, don’t shy from asking me!

About addiction – Len Bias, the war on drugs, addiction statistics, and anonymity

Here are some good links from the recent past. I know I haven’t done this in a while, and it’s not because of a lack of good stuff out there about addiction. I’ve been busy/lazy, so sorry.

Addiction tomorrow: An article about the effect of Len Bias’s death in 1986 on the war on drugs.

Addiction recovery basics: Statistics on addiction treatment.

The gentle path: A good article about sex addiction (and recovery in general) and anonymity.

Small town heroin addicts – When drug use and overdose hit smalltown USA

We’ve already talked (see here) about the fact that well-off teens are in no way protected from the damages of drug abuse. We’ve even published a story by a reader who became addicted to heroin after another friend introduced her to snorting oxycontin pills. This recent article, published in the Washington Post, tells the story of a small Virginia town recently hit with their own small heroin epidemic.

cooking heroinWhen all was said and done, the residents of Centreville, VA would be left with 4 deaths and 16 convictions, a sad memory of the quiet town they thought they were living in.

This story is nothing if not a sad reminder that addiction doesn’t discriminate based on any factors we’re familiar with – race, money, age, or political leaning…

Click HERE for a link for some information on what to do in case someone you know is going through a heroin overdose