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Dr. Andre Waismann joined AM Tampa Bay to discuss that hehas identified the biological roots of opioid dependencyand has treated more than 24,000 people with opioid dependency.

He process he pioneered is called ANR, which stands for (Accelerated Neuro-Regulation).

ANR is an anesthesia-based approach to help people with opioid addictions deal with the adverse effects of withdrawal

He believes several factors are explaining the magnitude of the crisis, including the one here in the Tampa region:

• Care Isn’t In The Hands of Anesthesiologists
• The Wrong Mindset
• Doctors are mistreating patients
• Government Failure
  
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SUBSTANCE ABUSE unquestionably is a major health concern in the U.S. and the world, with annual treatment costs in the billions of dollars. The social impact in relation to crime, family life, and lost productivity is immeasurable. Diseases such as hepatitis C and AIDS have become common in many communities. Heroin, one of many opiate drugs, is the key player in this rapidly growing dilemma. Opiate-dependent babies have become an everyday reality in many cities, and heroin use among eighth-, lOth-, and 12th-graders has significantly increased over the last decade. Based on the most recently published statistics by the National Institute on Drug Abuse, 600,000 people in the U.S. are addicted to heroine.

Remedies in the past have included addictive opiate replacements and long-term isolation from society in centers outside general hospitals. Rehabilitation centers were developed to offer opiate dependents an array of alternatives, all of which involved suffering through long and tormenting withdrawal symptoms. Detoxification procedures often require lengthy and costly inpatient hospitalization, with dropout rates of 30 to 50% for inpatient and 70% for outpatient clinics. Despite these statistics, govemmental institutions continue to support centers for treatment of opiate-dependent patients outside general hospitals and outside the realm of mainstream medicine.

Methadone has become the treatment of choice and is widely endorsed by the scientific community as an effective remedy for heroin addiction. In fact, methadone masks the problem and simply replaces one dependency with another. Abstinence achieved by regular detoxification, psychotherapy, and methadone maintenance is not the solution.

Throughout the years, patients’ demands have been in direct opposition to the options for available treatment. Most patients desired freedom from the dependency, and tried abstinence without medical assistance. As a consequence, “cold turkey” became recognized as a valid treatment. When a no-treatment treatment became a workable idea, many experts were willing to apply therapeutic values to vomiting, pain, diarrhea, and other symptoms of withdrawal. Statements such as “no pain, no gain” became part of many physicians’ vocabularies. The scientific community continues to ignore the need to challenge the existing perceptions of opiate dependency and treatment.

Biotechnology has reached achievements in the clinical field of medicine unimaginable for a physician from the 1950s or 1960s. Yet, little has changed on the clinical level for an opiate-dependent patient. It is almost impossible to identify developments and improvements in the level of care, even in the most prestigious centers in the world, despite the incredible budgets for research invested in this subject. Opiate dependency seems to be perceived as an incurable condition. The scientific community has failed to challenge this concept, as well as the stereotypical view that dependent individuals have addictive or weak personalities.

For more than 30 years, opioid receptor management, through the use of agonists and antagonists, has become a standard technique used by anesthesiologists and other medical practitioners. However, all of the knowledge and techniques developed during those years in the medical field were not applied to the treatment of opiate dependency. The reason? Opiate dependency was not initially classified as a medical illness, but, rather, as a psychosocial condition. The scientific community has failed to challenge this classification.

Treatment today sees most opiate-dependent people being treated by ex-opiate-dependent individuals, social workers, psychologists, and psychiatrists. The treatment options include rehabilitation and/or detoxification centers, methadone clinics, hotel rooms, religious entities, and a few other alternatives. Despite the range of treatments available, patients are not afforded the common option offered to any other patient suffering from an illness – to go to a hospital and have the illness assessed in a professional environment with respect and dignity.

Opiate dependency is a central nervous system disorder. The primary stage of the illness is withdrawal, and opiate craving is one of the secondary by-products. Therefore, detoxification procedures combined with any other counseling therapy caunot effectively access the Toot of the illness. Instead, neuroregulation should be the method of treatment, and this withdrawal management should be combined with craving relief. Without immediate and effective treatment, secondary social effects result. Social dysfunction and the need for social rehabilitation are often linked to the length of time and the severity of the illness endured by the dependent individual

A physician’s duty is to provide the patient at the onset of illness with an effective, safe, and humane treatment to reverse the condition.. I find that psychosocial side effects can be prevented at the first signs of the illness, when the patient has realized that he or she is hooked and needs to cope with the situation, going to a Methadone clinic or enduring a long and painful stay at a detoxification center is often not considered. The patient sees cold turkey as the only option. Most patients will try and try again, with no success. Throughot the Process, the patient may resort to lying, hiding, and hunting for self-healing. It becomes an everyday reality.

Each time a patient tries to overcome heroine dependency and fails, he or she becomes discouraged, often to the extent that dependency is more appealing than another attempt. This sequence of events cause the psychosocial side effects. Based on my professional experience, the psychosocial aspects of opiate dependency are not the cause of the illness, but, rather, the secondary effects of the untreated heroine dependency.

As with so many aspects of life, rules and regulations should follow the advancement of technology. The legal systems should adapt to a new paradigm where opiate craving is recognized as a biological condition. On this basis, punishment or imprisonment ate not adequate methods to prevent relapse. Instead. effective medical assessment and treatment should be utilized to achieve better outcomes.

If one were to measure, on a scale, the level of opiate cravings a patient has one month prior to the first withdrawal syndrome, it would be found to be very low. Immediately after the first withdrawal, the craving scale would rise to higher levels. Even if the patient were successfully to overcome the withdrawal, the cravings would be higher than they were prior to dependency. Additionally, the craving scale rises in direct proportion to the length of time of the dependency. In other words, the longer the patient remains dependent on heroine, the higher the craving scale would be, even after a successful withdrawal. For years, as with most aspects of opiate dependency, craving has been linked to the many psychosocial aspects associated with heroine dependency, with very few attempts to identify the neurological roots on the opioid receptor level.

In advanced medicine, doctors should recognize that any bodily dysfunction generates physical and psychological distress. On the clinical level, they cannot disregard either and, if possible, should intervene on both levels at once, taking into consideration the effects of one on the other. With the tools available today, it is necessary to take the focus off the methods that aren’t working and invest in altematives that do.

In the last decade, modern biotechnology has allowed physicians increasingly to understand the process of receptors within the brain that work to regulate opiates. Recognizing this opportunity, I developed a process called neuroregulation, which focuses on treating opiate dependency at the receptor level. This approach blocks the opiate receptors in the brain to precipitate the withdrawal syndrome, while, at the same time, controlling it. This is achieved through the use of medications, including anesthetic agents that allow opiate withdrawal to occur throughout the procedure while the patient is unconscious. Patients undergo a comprehensive psychological and medical examination prior to the commencement of the treatment conducted in a hospital intensive care unit. A patient can expect to be hospitalized for 24 to 36 hours, including the four-hour period allotted for the sedation process. Upon discharge, patients are prescribed a regimen of Naltrexone, a nonaddictive and non-mood-altering medication that ensures the patient will abstain from craving heroine.

Most patients will take a regular dose of Naltrexone for a year following the procedure. Naltrexone is FDA-approved, as are all the medications used in the procedure, and has been utilized for approximately 30 years in the medical field. No serious side effects have been associated with it. If properly prescribed, Naltrexone will effectively prevent and have a reversal effect on craving. The main reason for the maintenance dose is to keep the patient’s opiate receptors in the brain blocked against the impact of opiates in order to eliminate the cravings or the psychological need for them. Thereafter, the patient is able to resume a healthy and productive life.

In addition, this approach has opened the doors of pain-management treatment to patients who endure pain despite increased medication dosages. With increased dosages, patients can develop opiate dependency, leading to drug-tolerance levels so high no pain relief can be achieved. Remove the dependency, and patients can return to a more appropriate and effective, opiate-free, pain-management treatment program. Throughout the years, such treatments have effectively reversed opiate dependency in patients suffering from chronic pain caused by car accidents, war injuries, or illness and have assisted in improving their quality of life.

Patients with diabetes, chronic heart conditions, and AIDS, among other illnesses, are now able to receive safe treatment. Until recently, such individuals often were left to live with their dependency, due to the high risk involved in treating patients with these conditions or their inability to endure the pain associated with withdrawal symptoms. Neuroregulation offers these patients a safe and humane alternative to their suffering and a treatment enabling them to get beyond addiction.

In 1997, I reversed opiate dependency in a six-year-old child who was hooked on morphine for five years following surgery and a pain-management program that used opiates. It is time to shift the treatment of “heroin babies” and replace the long, painful, and sometimes damaging current approaches with a timely, humane, and effective technique.

Neuroregulation reduces the risks of anesthesia-related complications and has proven to ensure positive outcomes. Future practices must focus on giving patients precise and scientific information regarding opiate dependency. The goal is to offer an effective way of overcoming withdrawal and managing cravings with medicinal tools. The idea is to free patients from misguided theories and provide them with the knowledge and treatment they deserve.

The neuroregulation approach has changed the direction of opiate dependency treatment and brings about a new understanding of what was once perceived as addiction and is now recognized as neuroadaptation. The breakthroughs in changing the direction of treating opiate dependency assist in continually elevating the standard of care and research work necessary in meeting these ideologies in healing. Opiate addiction is a disorder of the central nervous system that can be reversed with appropriate medical treatment.

The challenge remains to release heroine-dependent patients from all the misguided theories they were made to believe for so long, providing them with the knowledge and treatment they deserve and the freedom of choice they are entitled to. Regardless of patients’ decisions and their overall outcome, the physician’s role is not to confront and judge them, but to treat them with all of the knowledge and technology available to assess their needs. This is part of a very old oath undertaken by the scientific community that has unfortunately been forgotten by many.

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Published: July 23, 2019

The opioid dependency epidemic is not a plague or virus from outer space. Rather, the crisis is a result of relying on theories that are built on ignorance and moral prejudice. For too long, this approach has left patients defined by their behavior, when their actions were dictated by a basic untreated medical condition.

And the biological roots of this dependency were totally disregarded, with all efforts and resources wrongly focused on the secondary effects of the untreated primary illness.

New findings  from the Commonwealth Fund show that deaths by drug overdose hit an all-time high in 2017, thanks to the rapid growth in opioid deaths. Still, there is hope. Modern biotechnology allows us to comprehend the chemical and morphological changes that serve as the source of the dependency itself. Consequently, we can now recognize the biological roots of the illness and develop effective therapeutic ways to reverse it.

Opioid dependency is a curable central nervous system disorder. It is not a chronic illness; it only became chronic due to the lack of useful remedies. Opioid-dependent patients can be cured and stabilized.

Policymakers should allow opioid-dependent patients to enjoy the benefits of modern medicine. If we fail to do so, we are simply feeding the existing, ineffective structure that has led us to our current chaotic situation.

Modern science indicates that opioid dependency is a direct consequence of the distortion of the natural endorphin receptor levels in our brains, triggered by heavy opioid abuse. We must address the fundamental neurophysiological derangement and provide addicts with sustaining relief. The goal should be to bring normal endorphin receptors back to equilibrium.

Today, we can eliminate the length of time and suffering associated with traditional treatment programs by transferring treatment back to general hospital care. We must correct the misjudgments of the past and welcome our patients back into the true halls of modern medicine. This will allow withdrawal to be managed in a critical care setting, where patients will be treated in a safe and humane way. Most importantly, post-detox cravings will no longer affect the recovery period.

We must usher the treatment of opioid addiction into a new era. This crisis can be resigned to the past, and we can move on to the new challenges ahead.

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Heroin was first derived from the opium poppy flower in the late 19th century by drug manufacturer Bayer. The same company later distributed the drug as a cough suppressant and pain reliever. In 1914, the federal government put the first heroin restrictions in place that limited the distribution of the drug. Nowadays, state laws vary in the severity of sentencing depending on state legislation. In 1986 lawmakers did enact a mandatory minimum sentencing guideline for drug offenses in an effort to crackdown on organized illegal distributors. Many states such as Kentucky have adopted some of these methods of harsh drug sentencing and carry some of the most extreme consequences. States like California, on the other hand, have some of the most lenient sentencing which focuses more on small fines and shorter jail time for drug possession to emphasize rehabilitation.

Simple and Construction Possession

“Possession” is defined as having, owning, or controlling a thing, or in this case, a substance. Simple possession is a case in which a person knowingly has illicit opiates under his or her control. It might be stored somewhere on their person or belongings, but the person must be aware that they are in possession of the substance and that it is in fact illegal. If the individual receives a bag or jacket from a friend for example, and they are unaware that the drug is located on their person, they may avoid penalty. Constructive possession is the charge that’s applied against more broad instances. If the individual charged had possession or control over the substances at any time, even if the opiates are far from the individual in a suitcase, dresser drawer, or hotel room, warehouse, or other remote location. As long as the individual did at one point in time have possession and dominion over the substance, they can be charged with one or multiple counts of constructive possession.

Federal vs. State Offenses

When an illicit opiate possession case is brought to federal court (for example, heroin) an individual who has no prior record or convictions of narcotics can be sentenced for no more than 1 year in prison and/or up-to a minimum amount of $1,000. If the defendant has prior heroin convictions a prison sentence may range anywhere from 15 days to 2 years and penalties can be applied anywhere in excess of $2,500. If the case involves a defendant who was in possession of heroin with the intent to sell them greatly increases the time of incarceration and fines.

States differ individually when sentencing for possession of heroin according to specific state law. The costs incurred to the criminal justice system of each state due to the opioid epidemic can be steep. This just one part of the compound issue that’s currently putting pressure on government officials and lawmakers around the country. In Pennsylvania, the cost to the state as it relates to opioid-related arrests, court costs, and incarcerations have totaled $526 million over the course of 9 years. The calculation that determined this estimate involves data collected from the National Survey on Drug Use and Health, Treatment Episode Data Sets, and the Drug Abuse Warning Network. The number is reached by multiplying the number of opioid abuse cases based on national averages by the average per-person cost within the state criminal justice system. As the number of opioid arrests increases and incarceration times remain stagnant that estimated cost with undoubtedly grow as the problem remains unsolved. The exponential cost of inmates incarcerated on opioid-related charges means that the total cost on the state level will continue to climb.

Today, Americans are becoming addicted to both heroin and legal prescription opiates at alarming rates. The consequences of this epidemic are far-reaching and incalculable when it comes to governmental cost as well as the cost of lives and turmoil. Even as the opioid epidemic wrestles the problem by curbing the prescription of legal opiates, illegal synthetic opioids, such as fentanyl, and hard drugs like heroin, are estimated to continue to increase. As new mandates have been put in place limiting the prescription of legal opiates the legal system seems to be unsuccessful at making an impact on the issue. Instead, new forms of treatment may be viable to help curb the issue at its root.

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Our brains naturally produce endorphins that play a part in moderating levels of pain throughout the body. However, when the pain becomes too severe and our brain doesn’t produce enough endorphins for relief then we turn towards opiates in order to block the pain messages. But, alongside the use of these powerful pain relievers patients will always run the risk of dependency. 

If the medication is taken outside of normal instructed use or more often then as suggested, a dependency on opiates can be more easily established and it becomes easier for things to spiral out of control. As their body builds a tolerance to the drug, patients must take higher doses in order to feel the same amount of relief as before. Patients may end up down the path of a continuous search for relief and fall into the use of more easily obtainable drugs, like heroin, in order to relieve their pains and symptoms of withdrawal. 

 Opioids such as morphine, tramadol, oxycodone, and methadone all have the potential to cause substance dependence along with other synthetic opioids such as heroin and fentanyl. This can show in various ways including impaired control over opioid use, persistent opioid use despite harmful consequences, increased tolerance, loss of interest in other activities or obligations, and physical withdrawal symptoms once opioid use has discontinued. During a period of withdrawal is the time when many opioid users can fall victim to an opioid overdose as they may seek drugs again in order to avoid the difficulty of the withdrawal symptoms. It is important to know the signs and symptoms of an overdose and make sure that you stay in touch with the opioid-dependent person and offer support during this part of their journey to seeking help towards treatment. 

During an opioid overdose, a person’s breathing may slow or stop completely due to the drugs effect on the part of the brain that regulates respiratory depression. It may sometimes be difficult to tell whether or not a person is just experiencing a very strong high or is suffering from an overdose so be aware and alert of any of these signs in order to respond accordingly.

• Constricted pin-point pupils
• Falling asleep or loss of consciousness
• Shallow breathing
• Limp body
• Unresponsive to outside stimulus
• Choking or gurgling sounds
• Pale, blue or cold skin

When people survive an overdose, it is because someone is there to respond. Stay vigilant and try and be present for those in our lives who may fall victim to an overdose.

There are also certain things that can factor into the likelihood of someone falling victim to a drug overdose including: 

• Taking high daily doses of prescription drugs
• Taking more opioids than prescribed
• Combining opioids with alcohol or other drugs
• Taking illicit drugs such as heroin or fentanyl
• History of sleep apnea, or reduced kidney or liver function
• If you are older than 65

A combination of sedatives, alcohol, and opioids are often found in fatal drug overdoses as this combination can increase the chances of respiratory depression and chances of death. However, it’s important to remember that overdoses can be prevented and that our communities can change to help reduce both the risk and the chances of fatal overdoses. 

It is important to note that effective treatment is available for opioid dependence yet only 10% of people who need it can access it. Also, the majority of people who were dependent on opioids were using illicitly manufactured drugs such as heroin and synthetic opioids such as fentanyl. However, it is becoming increasingly more common for prescription opioids to be abused as the opioid epidemic continues to grow across the nation. 

By increasing the availability of treatment that approaches opioid addiction from a modern medical standpoint we can help give those who are dependent on opioids a better chance at recovery.  This includes creating facilities in areas that are hit harder uch as rural communities that already have a hard time in terms of access to appropriate medical care.

 It is also important that we change the viewpoint that our nation and the medical community currently has about opioid addiction. Rather than treating it as a “chronic relapsing illness”, doctors should approach it from the angle of a disease in order to be able to open their minds to the possibility of treating it at the root cause rather than only it’s symptoms. By doing so we can move forward towards an age where treatment is no longer the same unsuccessful methods from 30 years ago but rather a more beneficial and humane treatment for patients of opioid addiction.

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Opioid addiction is a crisis that affects millions of Americans from all demographics as its effects continue to spread across the country with no clear end in sight. This epidemic has had an enormous impact on people from all walks of life; Its victims come from all age groups, orientations, ethnicities, genders, professions, and classes. 

115 Americans die every day due to opioid-related causes and 7,000 are treated every day for opioid-related complications. Unless there is a serious change in the way that we think about opioid addiction and its treatments then the spread of this illness in our country will not stop until we modernize both our thinking and our treatment around opioids.

Veterans 

When we first think of just who might be affected by the opioid epidemic our minds would first think of veterans. Veterans have often been prescribed opioids in order to relieve post-combat injuries and are more susceptible to addiction as they are one of the groups more vulnerable to chronic pain. Things like mental health problems and PTSD can also lead veterans down a path of self-medicating in order to relieve their symptoms and slowly end up falling into addiction with opioids, heroin, and alcohol. 

LGBTQ+

Addiction to opioids is also prevalent within the LGBTQ community as a way to relieve psychological distress that they may experience regularly as a person that society at large still often discriminates against. As a whole, the LGBTQ community has higher rates of substance abuse due in part by the fact that there are societal imposed obstacles that they often face on a daily basis. Self-medication and addiction are common in this group.

College Students

College students are another group affected by the opioid epidemic as they can find themselves pressured into drug use at parties or turn towards opioids in order to sedate anxiety. Young adults between the ages of 18-25 are some of the most vulnerable to opioid abuse as illicit drug experimentation may begin in their teens and continue or worsen as they progress into college through the normalization of their substance abuse. Once a tolerance or dependence on the substance happens then addiction is likely to follow in later years. 

Senior-Citizens

Opioid use in elderly populations is very common as they can easily access pain medication because of medical disorders and pains naturally associated with the aging process. The risk of side effects and negative drug interactions are also increased for seniors using prescription opioids as they may be taking multiple medications for several health problems. 

Young Children and Adolescents

Despite what one may think, children and adolescents are not immune to dependency or addiction to opioids. The risk of addiction to opioids is heightened for children whose parents were addicted. Not only that, but pregnant mothers who are addicted to opioids can also pass their addiction onto their unborn babies as the chemicals from the opioids will pass from the mother’s bloodstream into the child’s.  When this happens, babies can be born with neonatal abstinence syndrome. Neonatal abstinence syndrome is when a baby is born showing the signs and symptoms of opioid withdrawal as well as low birth weight and a number of other birth defects. Alongside the misuse of opioids, neonatal abstinence syndrome has drastically risen making children the youngest casualties of this opioid epidemic.

Foster care placement has also risen along with the rates of misuse of opioids and opioid-related deaths as many children are losing parents and guardians to the effects of drug abuse and addiction every year. Even children who do not use drugs can be affected by parents who abuse opioids as they miss out on parental bonding, child development, forming emotional connections and nurturing moments with their parent or parents. Unintentional neglect of the child may also occur resulting in child services removing the child from the custody of their parents.  

Rural Communities

The opioid crisis is also prevalent in economically disadvantaged and rural communities. Opioid prescriptions are given out in higher rates in rural communities and health access tends to be limited with fewer treatment programs available for opioid addiction.  Up until recently, opioid-related deaths in rural areas had outpaced those in urban areas. However, due to the flow of synthetic opioids making its way into urban communities that it is no longer the case. 

We as a society cannot allow this epidemic to continue any longer and must come together to find a modern solution to the evolving opioid crisis.  Families from all walks of life are being affected as lives are being thrown into chaos in a system that fails to acknowledge that opioid addiction is not a human failing, but a chronic illness and must be treated as such for us to move forward. It is only when we come together that we can make significant changes by joining our hands and hearts towards finding a modern medical solution to the nationwide opioid epidemic. 

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With increasingly more dangerous concoctions of drugs being sold on the streets it’s clear why opioid addiction has not only become a compounded problem but deadlier as well. One of the biggest silent killers within the opioid crisis as a whole are accidental deaths that occur when illicit or prescription opiates are mixed with benzodiazepines (of which anxiety and sleep medications are comprised) with opioids of any kind. Of all forms of opioid use, heroin is by far the deadliest and most highly addictive. It can be sniffed, smoked, and snorted depending on the preference of the addict and purity of the drug.

Heroin is normally the end-point for an opioid user and oftentimes is the last drug in a series that an individual addicted to opiates will begin using. Codeine, hydrocodone, and oxycodone are all common gateway drugs that lay the path towards deadly heroin addiction. For an opioid addict, the wide availability and cheap cost compared to prescription drugs are what makes heroin so dangerous. Those who are already hooked on opioids require daily use or else the body experiences harsh withdrawal symptoms. The longer an opioid addict has been using heroin, the more severe withdrawal symptoms become, feeding the cycle of addiction. Heroin can go by a number of street names, but the scientific name of the substance from which heroine is derived is diacetylmorphine. Morphine naturally occurs in a resinous sap found within the seeds of opium poppy plants. Some street names for Heroin to be aware of are as follows:

• Smack
• Big H
• Horse
• Hell Dust
• Boy
• Tar
• Dope
• Chiba
• Brown Sugar
• Mud
• Brown Crystal
• Snow
• Snowball
• Thunder

Forms of Usage

There are a few different ways that heroin users enter the drug into their bloodstream. Smoking, injecting, or snorting are all methods commonly used by addicts due the decreased time it takes for the drug to enter their bloodstream and reach the pleasure centers of their brain. If a user were to ingest the drug, for example, only a part of the dose would reach their neuro receptors. This is why vein collapse, liver failure, kidney failure, and respiratory failure are all-to common deadly aspects of a heroin overdoses. New users may only seek out the highest purity heroin which can be snorted or smoke in a glass pipe or in a cigarette form. Once a user becomes accustomed to lower purity forms of heroin, such as black tar heroin, that is the usually the point at which an addict will become accustomed to or resort to injecting the drug into their bloodstream. The fact that injection users gain a tolerance to the drug exponentially faster also adds a layer of complication to heroin addiction.

Mainlining heroin, also known as shooting heroin, can become a ritualistic aspect of the user’s life. Just like a nicotine smoker will carry a pack of cigarettes and a lighter, the paraphernalia used to heat and inject the drug are almost always carried on the person. Just like smoking a cigarette daily, so too does heroin become a ritualistic part of a user’s daily routine or lack thereof. Normally, heroin is placed in a spoon along with citric acid and water and is heated from the underside using a lighter until it becomes liquid. So too does the process of laying out the items used in the injection of heroin become a process and a habit. A cotton swab or cigarette filter is commonly placed on the edge of the hot spoon to draw up the liquid. Subsequently, the user draws up the liquid with the syringe through the filter in order to get rid of any impurities. Most commonly a user will tie a shoelace or belt around their upper arm like a tourniquet. Doing so causes their veins to bulge and makes the injection process easier. New users usually start with their arms for ease of access, but after repeated use veins may collapse and become unusable for drug injection. Signs of an overdose include a lowered heart rate, shallow breathing, and unconsciousness.

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Point of Entry for Opioid Abuse

In addition to coming in tablet form, codeine is also the main active ingredient in cough syrup and cough suppressants. Codeine addiction usually begins with the abuse of prescription grade cough syrup as its not perceived to be as dangerous as other commonly abused drugs such as morphine. Overall, it’s less regulated and easier to obtain than other opiate alternatives. When taken in large quantities codeine has some of the same effects of a low dosage of morphine within the body and has a similar chemical makeup to hydrocodone. For reference, codeine is converted to morphine in the body and this form is around 8-12% as potent as pure morphine. Because codeine tolerance is developed quickly, it’s common for a prescription user to require more of it over time. This the point at which a dependence can develop as a legitimate user may turn to the drug to cope with either occasional pain, chronic pain, or eventually emotional pain. Even though many see codeine as being harmless when compared to  harder forms of opiates like heroin or oxycontin, at high enough doses codeine can lead to a coma, respiratory failure, and even death by overdose or mixture with other with other drugs. Some street names to look out for when referring to codeine are:

• Cody
• Captain Cody
• Schoolboy
• Syrup
• Purple Drank
• Doors
• Fours
• Lean
• Loads

When codeine addiction starts, users usually don’t stop opiate use with codeine. As the body develops a higher tolerance and seeks higher forms of euphoria, an abuser may begin to mix codeine with other substances such as alcohol or turn to an alternative form of opiates. Commonly an abuser will turn to oxycodone or morphine as to supplement their addiction. In 2008 a survey was conducted that showed that 4.7 million Americans reported using pain relievers for non-medical purposes. This statistic includes codeine among other highly abused opiates.

Serotonin Syndrome

Seratonin syndrome is a condition that occurs when the levels of chemical serotonin are dangerously elevated in the body. It can occur with high doses of codeine as well as instances where codeine is abused in conjunction with another drug. Side effects of the state can range from mild like shivering or diarrhea to sever such as fever, seizures, or even death. Serotonin is a chemical your body needs to normal nerve and brain cell functions but at elevated levels it starts to become an extreme risk. Less serious forms of serotonin syndrome have the possibility of going away in under 24 hours, but regardless it’s crucial to seek help if experiencing any of the symptoms. A doctor may also prescribe a drug that blocks serotonin for immediate treatment. Onset of serotonin syndrome usually starts within several hours of abusing the drug in question and can be brought on by such opiate drugs as fentanyl, oxycodone, tramadol, and codeine in addition to antibiotics, lithium, antidepressants, and tobacco addiction medications. Herbal supplements to watch out for in conjunctive use of opiates are ginseng, nutmeg, and St. John’s wort.

Codeine In Popular Culture

Codeine abuse in the form of cough syrup is widely referenced in popular culture from all ranges of public figures such as musicians, athletes, and celebrities. The preferred method of ingestion of codeine is a drink normally comprised of cough syrup, alcohol, and sprite referred to as ‘lean’ or ‘purple drank’. In March 2013 celebrity rapper Lil’ Wayne was admitted under intensive care after a codeine overdose signaled by seizures and unconsciousness. Although he survived the ordeal he had to have his stomach pumped three times in an attempt to clear his system of the drugs. Afterwards, he became outspoken about the dangers of codeine abuse and helped to raise awareness around both around codeine and the normative effect that culture has had on its use.

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