Synthetic Opioids Flooding Into US Via Postal Service
According to U.S. Deputy Attorney General Rod Rosenstein, drug overdoses are now the leading cause of death among Americans under the age of 50.1 Preliminary data for 2016 reveals the death toll from drug overdoses may be as high as 65,000,2 a 19 percent increase since the year before, and the largest annual increase of drug overdose deaths in U.S. history. Data from the National Institute on Drug Abuse suggests over 202,600 Americans died from opioids between 2002 and 2015.3
Opioid abuse has also been identified as a significant factor in rising unemployment among men. A 2016 paper4 found nearly half of all unemployed men between the ages of 25 and 54 are using opioids on a daily basis. Two-thirds of them, about 2 million, are on prescription opioids. A follow-up study5 looking at the opioid epidemic’s impact on the American labor force suggests chronic opioid use accounted for 20 percent of the increase in male unemployment between 1999 and 2015.
Synthetic Opioid Use Is on the Rise
The most common drugs involved in prescription opioid overdose deaths include6 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®). Tragically, synthetic opioids like fentanyl are also being abused by a rising number of people. Deadly overdoses involving fentanyl rose by 50 percent between 2013 and 2014, and another 72 percent between 2014 and 2015. Over 20,000 of the drug overdose deaths in 2016 were attributed to fentanyl and/or other synthetic opioids.7
With a potency nearly 1,000 percent greater than morphine, synthetic opioids like fentanyl are very easy to distribute via mail. A single standard envelope can hold enough fentanyl to get 50,000 people high. Last summer, The New York Times8 reported the deaths of two 13-year-old boys who died after taking the synthetic opioid U-47700, also known as “pinky.” They got the drug from a friend who bought it on the dark web using bitcoin.
Fentanyl Flooding Into US Via Regular Mail
As recently reported by STAT News9 and ABC News,10 Chinese drug sellers are exploiting the federal government’s inability to track and identify shipments of illicit drugs sent via international mail.
They’re simply shipping fentanyl to the U.S. via the U.S. Postal Service, as this is a “virtually guaranteed route to not get caught” — this despite a 375 percent increase in international mail seizures between 2016 and 2017. (Interception and seizure of domestic packages containing opioids increased by 880 percent.) As explained by STAT News:11
“Part of the reason for this confidence has to do with differences in how well Customs and Border Protection [CBP] can track packages from the various carriers … Much of CBP’s tracking is done using advanced electronic data — basic shipping information required on FedEx and other delivery services packages, but not required for USPS shipments. Only about 36 percent of USPS shipments have the advanced data, a fact which complicates CBP’s tracking efforts.
CBP flags potentially problematic shipments to the carriers, which find and turn over the packages for inspection. CBP can also ask USPS to monitor all packages from a specific country, but has struggled to address the large volume of shipments from China. Some sellers also routed their packages through other countries to avoid that detection.”
Federal Report Calls for Improvements to Identify and Track Illicit Drug Shipments
The potency of fentanyl makes exposure to even minuscule amounts an extreme hazard. As reported by CBS News in May 2017,12 a police officer nearly died after being exposed to fentanyl dust during a routine traffic stop. Fortunately, he survived, but needed no less than four doses of naloxone. Drug-sniffing dogs are also at risk, as inhaling just a few flakes of the drug can be lethal. It stands to reason the drug may also pose a risk to mail and customs workers, should the package rupture during transit or handling.
Disturbingly, a report by the Senate subcommittee on investigations suggests hundreds of millions of dollars of fentanyl are entering the U.S. via the Postal Service, as the federal government is simply not equipped to track or prevent it. A majority of these drugs are coming from China. Of six online sellers offering fentanyl, five are located in China while the location of the sixth is as yet unknown.
According to the report, more than 300 individuals based in the U.S. have received shipments from these vendors, and more than 500 Western Union transactions totaling $230,000 have been identified. While buyers were found in 43 states, Florida, Ohio and Pennsylvania received the greatest number of shipments.
The street value of these orders is estimated to be around $766 million. The investigation also concluded that at least seven individuals have died from overdosing after receiving a shipment of fentanyl from these vendors.
The bipartisan report is now calling for a number of improvements within the federal government, including advanced electronic data for all international mail. It also urges CBP to increase inspections of packages to identify shipments of illicit drugs, and to automate processing of packages from targeted locations.
Doctors Receive Kickbacks for Prescribing Opioids, Including Fentanyl
Another factor that contributes to rising opioid addiction is kickbacks to doctors for prescribing them. According to a study13 published in August 2017, between August 2013 and December 2015, more than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling more than $46 million. This means 1 in 12 U.S. physicians is collecting kickbacks from drug companies producing prescription opioids.
The top 1 percent of physicians received nearly 83 percent of the payments, and fentanyl prescriptions was associated with the highest payments. Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were also those showing the most opioid-related payments to physicians. In other words, there’s a direct link between doctors’ kickbacks and patient addiction rates and deaths.
While back pain has been cited as one of the most common reasons for opioid use, a significant number of people get their first opioid prescription from their dentist.14 This is particularly true for teenagers and young adults.15 Half of all opioids are also prescribed to people with mental health problems such as anxiety.16
What these statistics are telling us is that doctors really need to take greater responsibility for their prescribing habits, and be far more prudent when it comes to handing out prescriptions for opioids. In many cases, an over-the-counter pain reliever may be just as effective, and far safer.
Opioids, Not Cannabis, Are a Priority, Federal Prosecutor Says
While many U.S. states have legalized marijuana either for medicinal and/or recreational use, on January 4, the White House administration rescinded the federal government’s policy to limit enforcement against marijuana sale in states where it is legal under state law.
This creates a convoluted and complex situation for vendors, as they may still face federal prosecution. U.S. federal prosecutor for Massachusetts, Andrew Lelling, recently clarified his stance on marijuana prosecutions in the state, saying “The No. 1 enforcement priority for my office is the opioid crisis … 2,100 people in Massachusetts were killed by opioid overdoses last year, not marijuana overdoses.” As noted by Reuters:17
“The new policy gave U.S. attorney’s offices discretion in how they enforced the law. Lelling, a Trump nominee who took office in December, said on Jan. 8 he would not promise to refrain from prosecuting state-sanctioned marijuana businesses.
Those remarks worried advocates for Massachusetts’ nascent marijuana industry. Lelling said on Wednesday people ‘have lost sight a little bit of the prior statements of the office.’ He said the 14 prosecutors he oversees devoted to drug cases were focused on fentanyl and heroin traffickers. ‘That is where my resources are going right now,’ Lelling said. He also said he was open to pursuing cases over corporations’ roles in the opioid epidemic.”
Indeed, it is virtually impossible to die from an overdose of marijuana, and the idea that legal vendors of medical marijuana (meaning those operating in states where the sale of marijuana has been legalized) can still be prosecuted under federal law seems like an incredible overreach of power. Medical marijuana, if anything, may actually be part of the answer to the opioid crisis, as it can effectively treat many different kinds of pain, but without the lethal side effects associated with opioids.
Feds Cracking Down on Supplements Claiming to Treat Opioid Addiction
Federal regulators are also cracking down on “illegal and unapproved” products claiming to treat or cure opioid addiction and withdrawal, The Washington Post reports.18 So far, about a dozen products, mostly dietary supplements, along with two homeopathic remedies, have been targeted by the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC).
Eleven companies19 have received warning letters stating that claiming to ease or cure a disease (in this case drug addiction) makes the product subject to FDA authority, and failing to obtain FDA approval means they’re marketing an unapproved drug.
While FDA Commissioner Scott Gottlieb has called for increased availability and use of medication designed to treat drug addiction,20 he warns that “phony remedies could divert people from getting the right treatment.” In a statement, the FTC echoed Gottlieb’s sentiments, saying “Health fraud scams like these can pose serious health risks. These products have not been demonstrated to be safe or effective and may keep some patients from seeking appropriate, FDA-approved therapies.”
Opioids Have Never Been Proven Safe or Effective Beyond Six Weeks of Treatment
It’s rather ironic, but not unexpected, that the opioid crisis has led to the proliferation of costly drugs to treat opioid addiction. NPR recently reported how Alkermes, a company that makes the anti-addiction medication Vivitrol — a monthly injection that costs about $1,000 per shot — is trying to weasel its drug into state laws, making it the sole treatment recommended for opioid addiction.21
What really needs to happen is for the drug industry to be held responsible for creating this situation in the first place, rather than allowing it to profit handsomely a second time. As discussed in several previous articles, the opioid addiction epidemic was no fluke.
Evidence suggests opioid makers such as Purdue Pharma, owned by the Sackler family, knew exactly what they were doing when they claimed opioids — which are chemically very similar to heroin — have an exceptionally low addiction rate when taken by people with pain. In fact, the massive increase in opioid sales has been traced back to an orchestrated marketing plan aimed at misinforming doctors about the drug’s addictive potential.
The drugs’ general effectiveness against pain has also been vastly exaggerated. In April 2016, the U.S. Centers for Disease Control and Prevention published a paper in which it noted that:22
“Most placebo-controlled, randomized trials of opioids have lasted six weeks or less, and we are aware of no study that has compared opioid therapy with other treatments in terms of long-term (more than 1 year) outcomes related to pain, function, or quality of life.
The few randomized trials to evaluate opioid efficacy for longer than six weeks had consistently poor results. In fact, several studies have showed that use of opioids for chronic pain may actually worsen pain and functioning, possibly by potentiating pain perception …”
Addicted? Seek Help!
Some marketing materials for opioids still claim the drug will not cause addiction “except in very rare cases,” describing the adverse effects patients experience when quitting the drug as a “benign state” and not a sign of addiction. This simply isn’t true. Panic is one psychological side effect commonly experienced when quitting these drugs, and this can easily fuel a psychological as well as physical dependence on the drug.
It’s important to recognize the signs of addiction, and to seek help. If you’ve been on an opioid for more than two months, or if you find yourself taking higher dosages, or taking the drug more often, you’re likely already addicted and are advised to seek help from someone other than your prescribing doctor. Resources where you can find help include:
Your workplace Employee Assistance Program
The Substance Abuse Mental Health Service Administration23 (SAMHSA) can be contacted 24 hours a day at 1-800-622-HELP
Treating Your Pain Without Drugs
With all the health risks associated with opioid painkillers, I strongly urge you to exhaust other options before resorting to these drugs. The good news is there are many natural alternatives to treating pain. Following is information about nondrug remedies, dietary changes and bodywork interventions that can help you safely manage your pain.
Medical marijuana has a long history as a natural analgesic and is now legal in 28 states. You can learn more about the laws in your state on medicalmarijuana.procon.org.24
Kratom (Mitragyna speciose) is a plant remedy that has become a popular opioid substitute.25 In August 2016, the DEA issued a notice saying it was planning to ban kratom, listing it as Schedule 1 controlled substance. However, following massive outrage from kratom users who say opioids are their only alternative, the agency reversed its decision.26
Kratom is safer than an opioid for someone in serious and chronic pain. However, it’s important to recognize that it is a psychoactive substance and should be used with great care. There’s very little research showing how to use it safely and effectively, and it may have a very different effect from one person to the next. The other issue to address is that there are a number of different strains available with different effects.
Also, while it may be useful for weaning people off opioids, kratom is in itself addictive. So, while it appears to be a far safer alternative to opioids, it’s still a powerful and potentially addictive substance. So please, do your own research before trying it.
Low-Dose Naltrexone (LDN)
Naltrexone is an opiate antagonist, originally developed in the early 1960s for the treatment of opioid addiction. When taken at very low doses (LDN, available only by prescription), it triggers endorphin production, which can boost your immune function and ease pain.
A primary therapeutic compound identified in the spice turmeric, curcumin has been shown in more than 50 clinical studies to have potent anti-inflammatory activity. Curcumin is hard to absorb, so best results are achieved with preparations designed to improve absorption. It is very safe and you can take two to three every hour if you need to.
One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required for pain relief, and you may need 8 milligrams or more per day to achieve results.
Also known as boswellin or “Indian frankincense,” this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites, as it worked well for many of my former rheumatoid arthritis patients.
This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind most of the bromelain is found within the core of the pineapple, so consider eating some of the pulpy core when you consume the fruit.
Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting your body’s supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.
Cetyl myristoleate (CMO)
This oil, found in dairy butter and fish, acts as a joint lubricant and anti-inflammatory. I have used a topical preparation of CMO to relieve ganglion cysts and a mild case of carpal tunnel syndrome.
Evening primrose, black currant and borage oils
These oils contain the fatty acid gamma-linolenic acid, which is useful for treating arthritic pain.
This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea, or incorporated into fresh vegetable juice.
Dietary Changes to Fight Inflammation and Manage Your Pain
Unfortunately, physicians often fall short when attempting to effectively treat chronic pain, resorting to the only treatment they know: prescription drugs. While these drugs may bring some temporary relief, they will do nothing to resolve the underlying causes of your pain. If you suffer from chronic pain, making the following changes to your diet may bring you some relief.
Consume more animal-based omega-3 fats. Similar to the effects of anti-inflammatory pharmaceutical drugs, omega-3 fats from fish and fish oils work to directly or indirectly modulate a number of cellular activities associated with inflammation. While drugs have a powerful ability to inhibit your body’s pain signals, omega-3s cause a gentle shift in cell signaling to bring about a lessened reactivity to pain.
Eating healthy seafood like anchovies or sardines, which are low in environmental toxins, or taking a high-quality supplement such as krill oil are your best options for obtaining omega-3s. DHA and EPA, the omega-3 oils contained in krill oil, have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
Radically reduce your intake of processed foods. Processed foods not only contain chemical additives and excessive amounts of sugar, but also are loaded with damaging omega-6 fats. By eating these foods, especially fried foods, you upset your body’s ratio of omega-3 to omega-6 fatty-acids, which triggers inflammation. Inflammation is a key factor in most pain.
Eliminate or radically reduce your consumption of grains and sugars. Avoiding grains and sugars, especially fructose, will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production, which contributes to pain.
While healthy individuals are advised to keep their daily fructose consumption below 25 grams from all sources, you’ll want to limit your intake to 15 grams per day until your pain is reduced. Eating sugar increases your uric acid levels, which leads to chronic, low-level inflammation.
Optimize your production of vitamin D. As much as possible, regulate your vitamin D levels by regularly exposing large amounts of your skin to sunshine. If you cannot get sufficient sun exposure, taking an oral vitamin D3 supplement, along with vitamin K2 and magnesium, is highly advisable. Get your blood level tested to be sure you’re within the therapeutic range of 60 to 80 ng/mL year-round.
Bodywork Methods That Reduce Pain
The following bodywork methods have also demonstrated effectiveness for pain relief and pain management.
- Acupuncture: According to The New York Times,27 an estimated 3 million American adults receive acupuncture annually, most often for the treatment of chronic pain. A study28 published in the Archives of Internal Medicine concluded acupuncture has a definite effect in reducing back and neck pain, chronic headache, osteoarthritis and shoulder pain — more so than standard pain treatment.
- Chiropractic adjustments: While previously used most often to treat back pain, chiropractic treatment addresses many other problems — including asthma, carpal tunnel syndrome, fibromyalgia, headaches, migraines, musculoskeletal pain, neck pain and whiplash. According to a study29 published in the Annals of Internal Medicine, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks compared to those who took medication.
- Massage therapy: Massage releases endorphins, which help induce relaxation, relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline. A systematic review and meta-analysis30 published in the journal Pain Medicine, included 60 high-quality and seven low-quality studies that looked into the use of massage for various types of pain, including bone and muscle, fibromyalgia, headache and spinal-cord pain.
The study revealed massage therapy relieves pain better than getting no treatment at all. When compared to other pain treatments like acupuncture and physical therapy, massage therapy still proved beneficial and had few side effects. In addition to relieving pain, massage therapy also improved anxiety and health-related quality of life.
- Emotional Freedom Techniques (EFT): EFT continues to be one of the easiest and most effective ways to deal with acute and chronic pain. The technique is simple and can be applied in mere minutes. A study31 published in Energy Psychology examined the levels of pain in a group of 50 people attending a three-day EFT workshop, and found their pain dropped by 43 percent during the workshop.
Six weeks later, their pain levels were reported to be 42 percent lower than before the workshop. As a result of applying EFT, participants felt they had an improved sense of control and ability to cope with their chronic pain. In the video below, EFT expert Julie Schiffman, teaches you how to use EFT to address chronic pain.
Health and Wellness Associates
Dr J Jaranson