A draft of this post has been awaiting my full attention all week. The death of Philip Seymour Hoffman opened discussions about heroin addiction, a subject that had been borderline on taboo and misunderstood in many ways. I’m sure my mum, who reads my blog, must have probably jumped in fright upon reading the title of this post, but I just wanted to add my personal views on the matter from my experiences in treating patients with heroin addiction when I used to work in pharmacies.
Beforehand, I want to mention that the last film I watched with Hoffman was a couple of months ago, called A Late Quartet. It was a movie about a string quartet, life, illness, love and human relations. As I adore classical music, I thought the move was beautiful, plus it couldn’t sound better to my ears. For me it turned out special that the last film I saw with him before his death was A Late Quartet. I shall choose to remember Hoffman for his talent and for the joy he brought to the world through his films.
At the beginning of my career I moved to England and worked as a pharmacist in community pharmacy. At that time the system to treat drug addiction was set up in a way that there were certain clinics with doctors that prescribed the treatment, social workers to help, and the treatment would be dispensed in a pharmacy. The pharmacy I was assigned to had to dispense treatment a number of heroin addicts, as in 30 each day. I had way more than 30 over the years because there was always turnaround: some dropped out and some died.
Working in a pharmacy like that was sort of like being thrown into the deep end. I came out of university full of molecular knowledge, but no subject had ever prepared me for the social skills needed to deal with this. Due to the fact that these patients saw me daily, they trusted me to tell me their life stories and daily struggles. There is a Spanish saying that goes la confianza da asco. It can roughly be translated into trust is disgusting. All this trust meant that if they were having an especially bad day, us pharmacy staff would probably be the ones they would strike out against. My staff did press the panic button under the counter a few times.
For anyone that has ever been affected through a family member or friend, please excuse me for writing all this so bluntly, it’s just that these things happened quite often.
They would come everyday for their dose of methadone or buprenorphine, which are supposed to help them get weaned off the addiction. Most of them had it prescribed under the supervised consumption regime, meaning they have to consume it there while being watched by a pharmacist. The main reasons for supervised consumption were so that it’s harder for them to sell it as soon as they walk out, and also because most had children, so it prevents the children from trying it at home. If they see Mummy have it everyday, it’s must be a normal thing to do.
Now I want to write about some of the pharmacological aspects of heroin and opiates. Heroin is an opiate. Opiates are narcotic opiod alkaloids derived from the plant Papaver somniferum, the species within the poppy flower family that produces opium.
I’ve heard strange things about heroin, opium, opiates, and morphine this week, as if they were all the same thing. Mumble jumble. Heroin is an opiate. Not all opiates are heroin. They are not all morphine. Many opiates are used in medicine. Am I confusing you even more?
If opiates are narcotic, why are they used in medicine?
The well known effects of opiates are, well, the narcotic ones, giving a high and with highly addictive effects. But they can also produce other effects such as pain relief, slowing peristalsis and respiratory depression. The molecules that are derived from opiates, whether naturally or modified semi-synthetically, can be used to treat certain conditions due to these other effects. Plus, some of them have lower addictive powers, so they are easier to use. I’ll explain with some examples from the three effects I mentioned just now.
Pain relief: the ones that relieve pain are usually the more addictive ones. Codeine relieves pain. It can be found frequently in some pain relievers, combined with other more “normal” pain relievers (like with paracetamol). Morphine relieves pain big time. It can also cause addiction big time. So morphine would only be used in extreme circumstances of enormous pain and in terminally ill patients. Its use should be very controlled by the doctor.
Slowing peristalsis: this means that it slows down the movement of the intestines, making it a great treatment for diarrhoea. Again, codeine can be used but that’s found in older types of formulas. Loperamide is more widely used for this purpose because it has way lesser narcotic effects.
Respiratory depression: this means that it slows down your breathing system, making it useful to stop coughs. Again, codeine can be used and is limited to older formulas. Dextromethorphan is the one very commonlly used for this. It can make you feel quite floaty.
I’m going to write about the side effects. They include making you sleepy. Though I hope all this pharmacology talk isn’t making you doze off…
So, if you are take an opiate to treat something, you can guess the common side effects due to these collateral effects: like making you sleepy, floaty and constipation. Naturally one must be very careful using these medicines as they can get you addicted. And with regards to slowing down breathing, here is where the greatest danger lies with any opiate drug: if there is an overdose, breathing stops. The person dies.
I’m making it pretty clear that we must be very careful whenever being treated with any opiate for any reason, so as to not overdose, and also to not get addicted.
How did my opiate addicted patients get into this tragic situation? Each and every case is unfortunate, bringing terrible despair to themselves and their families and friends. A minority began though medical treatment, maybe they had broken a leg or suffered a painful illness and were on morphine, then got addicted. Some people weren’t being treated for the addiction because they had not admitted it to themselves yet. But due to what they were buying, the pharmacy staff knew. Some had suffered tremendous problems in life, so began drug abuse in a desperate effort to forget. Unfortunately most had began out of sheer stupidity by trying heroin.
The thing that they all told me was that when it comes to heroin, it is extremely addictive. After trying it only once or twice, that was enough to get them totally addicted and ruin their lives. The one message they all wanted to get across is please never try heroin.
Thank you for reading!