Diversion of prescription medications for illicit use is a major law enforcement and public health problem. Diversion refers to prescribed medications that are stolen from the rightful holder of the prescription or the sale of the medication by the holder of the prescription, or theft of prescriptions from pharmacies, hospitals, and doctor’s offices. There is a thriving illicit market for prescription medications that can be abused for their psychoactive effects, or to manage the side effects of withdrawal symptoms from use of other illicit drugs.
The two most common types of medications targeted for diversion are:
What are Opiates?
Opiates are medication made from or derived from opium. Opium is a naturally occurring narcotic substance from the opium poppy, a red to pink flower which grows primarily in Afghanistan, India, China, Laos, Burma, Cambodia, Vietnam, and Mexico. The sap of the poppy bulbs is raw opium, from which morphine is extracted, and converted to diacetyl morphine aka heroin. Because the cultivation and harvesting of opium from opium poppies is a labor intensive and expensive process, pharmaceutical companies have made synthetic copies of the opium molecule. There are numerous opiates, all of which require a prescription in the United States. The differences between the types are mainly the potency, or strength, and how long they last.
Common opiates are:
- Hydrocodone (weak synthetic, always mixed w/ another analgesic)
- Vicodin (Hydrocodone and Acetaminophen)
- Percocet (oxycodone and acetaminophen)
- Roxicet (oxycodone and acetaminophen)
- Lorcet (oxycodone and acetaminophen)
- Oxycodone (strong, long acting synthetic)
- Oxycontin (time released oxycodone)
- Dilaudid (hydromorphone) (strong short duration synthetic)
- Demerol (Meperidine) (strong synthetic)
- Fentanyl (strong opiate admin TD)
- Opana (oxymorphone)
- Fiorcet (Codeine, barb, and acetaminophen),
- Subutex-Buprenorphine (buprenex)
- Suboxone (buprenorphine w/ naloxone)
- Methadone (dolophine) strong long acting synthetic)
The primary use of opiates is management of chronic or severe pain. The opiates on the list above are mostly pills or capsules. When swallowed as intended, our stomachs will dissolve them in a bath of hydrochloric acid, and they will continue to pass through our digestive track and be further broken down at the molecular level with enzymes from our liver and finally infiltrate into our circulatory system, or bloodstream. Every beat of our heart will carry the medication upstairs to our brain, where they will exert their psychoactive and analgesic effects. Opiates work by attaching to receptor sites in the brain and spinal cord. The primary receptor they attach to are called mu-opiate receptors. Opiates agonize, or increase the action of these receptors. When mu-opiate receptors are agonized the following effects are experienced by the user:
- Analgesia, or pain relief
- A pleasant drowsy feeling
- Warm feeling and flushing
- Dry mouth
- Nausea and vomiting
- Itching, described as “all the way to the bone”
- Constricted pupils
- Respiratory depression
- Bradycardia or slowed heart rate
- Inability to ejaculate and lowered sex drive
When swallowed, the effects set in gradually over an hour or two. The effects are typically not even felt for the first 30 or 45 minutes, and are not that intense. Some also have time release mechanism, such as a coating that slows digestion so the medication is gradually released over many hours. However these medications are not taken orally by people who want to abuse them. The capsules are penned, or the pills crushed, and snorted up a nostril. The crushed or powdered medication can also be mixed with water and injected. Either snorting or injecting will greatly speed up the onset of the effects, and make the effects much more intense. Over time, the individual will develop tolerance. Their body will adapt to the presence of the substance, and require larger and larger doses or more potent versions of the drug in order to get the same effect.
Opiates produce a characteristic withdrawal symptom when they are used for a long time, then suddenly stopped. People typically stop using opiates suddenly because their source has been exhausted. The physician they have deceived into writing them prescription because of the fabricated pain they report recognizes them as a drug seeker and cuts them off. The dealer who moves diverted prescriptions gets arrested or their money runs out, and there are lines they are not ready to cross yet to get more funds. Stopping opiates suddenly is the neurological equivalent of stopping a car suddenly by smashing into a cement wall. It is not going to feel good. The withdrawal symptoms will begin about 12 to 18 hours after the last dose of opiates, depending on the types used, peak at about 26 hours, and persist from 72 hours to two weeks. This will include most or all of the following:
- Watery, tearing eyes
- Runny nose
- Nausea, vomiting and stomach cramps
- Muscle cramps
- Joint and bone aches
- Profuse sweating
What are Benzodiazepines?
Benzodiazepines are tranquilizing medications. They are used for many legitimate purposes, including managing anxiety and insomnia, sedation during dental or minor surgical procedures, and for emergency management of a seizure. Like opiates, when they are swallowed as prescribed, the effects are more gradual. When the pill form of benzodiazepines is crushed, they can be snorted or mixed with water and injected. This will provide a faster effect and a high that users seek. Benzodiazepines can also be mixed with a weak opiate, such as Vicodin, to intensify the high. This is not a recommended course of action, as this can lead to coma, respiratory shutdown, and death. People, who abuse CNS (Central Nervous system) stimulants such as cocaine, crack, or methamphetamine will use benzodiazepines to come down, or abruptly diminish the high. This can be a soft landing, or a fiery crash into the ground metaphorically speaking. There are many variables at work such as the dose and potency that will determine this, which are too complex for an untrained person to manage, especially when they are already altered from other substances.
Benzodiazepines are all similar in their effects. The main differences are how potent they are, and how long they last. Common benzodiazepines are:
- Valium (Diazepam) / Long acting / low potency / 24 hours
- Klonopin (Clonazepam) / Intermediate acting / high potency / 18 hours
- Ativan (Lorazepam) / Intermediate acting / high potency / 10 hours
- Xanax (Alprazolam) / Short acting / high potency / 6 hours
- Versed (midazolam) / ultra-short acting / high potency / 1-2 hours
Benzodiazepines are highly physically addictive. This means that although the user may not crave them and desire with the intensity that opiates are desired, our bodies will adapt to the presence of the benzodiazepines. If they are suddenly taken away, there will be withdrawal; symptoms that can be life threatening. One way to look at this is that our levels of bodily functions are under pressure. Benzodiazepines will force the levels of bodily function down, but when removed the levels will rebound, rising higher than normal. This will be expressed by:
- Rambling speech
- Fast gulping choking breaths
- Respiratory failure
Opiates and benzodiazepines are prescribed for a reason. They are not meant for recreational purposes. Diverting them for profit has developed into a pressing national concern, which is costing people’s lives and ruining the quality of life for themselves, their families, and the community.