Breaking the dragon

July 24, 2018

This morning I came across a disturbing headline while drafting Labline, MLO’s daily e-newsletter: “Increasingly popular practice of inhaling heroin linked to severe brain damage.” I grimaced at the thought. What kind of skills and resources do laboratorians need to deal with this somber problem?

Flashback to 1994. Myself, along with everyone else in the movie theater, simultaneously gasped in horror as Uma Thurman’s character in Pulp Fiction discovers a baggie filled with what she thinks is cocaine, and continues to snort mass amounts, only to realize that something is very wrong—she has inhaled morphine—and falls into a violent coma. Mass confusion ensues and the audience is paralyzed in fear. Of course, in Hollywood, the pretty wife of a renowned mobster miraculously recovers with an emergency shot of adrenaline directly to the heart and she lives, with, we assume, no brain damage.

In reality, not so much.

Morphine and heroin are both well-known narcotic drugs. They are similar substances, with enough overlap in molecular structure, mechanism of action, and range of effects to blur the distinction between the two. Both are opioids, which reduce pain perception in the brain. Inhaled heroin use now represents a global phenomenon and is approaching epidemic levels east of the Mississippi River as well as among urban youth. Chasing the dragon (CTD), as it is called, is the process of heating heroin and inhaling its fumes. This method of heroin use has greater availability, greater ease of administration, and an impressive high compared to sniffing or snorting. Although it has a safer infectious profile compared to heroin injection, it often has catastrophic brain complications.

Three out of four heroin users start off abusing prescription opioids. Today’s typical heroin addict starts using around age 23, is more likely to live in affluent suburbs, and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor. According to the CDC, the number of overdose deaths related to heroin increased by 533% between 2002 and 2016, from an estimated 2,089 in 2002 to 13,219 in 2016.

In terms of regulation and funding, the 21st Century Cures Act, passed in 2016, allocated $1 billion over two years in opioid crisis grants to states, providing funding for expanded treatment and prevention programs. In April 2017, Health and Human Services announced the distribution of the first round of $485 million in grants to all 50 states and U.S. territories. In August 2017, the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice was opened. State legislatures are introducing measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense. As recently as last month, the White House announced a new multimillion dollar public awareness advertising campaign to combat opioid addiction. The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to get a hold of the powerful drugs.

The government appears to be trying, and the long-term horizon sounds somewhat promising, but what can be done now? What, if anything, can medical laboratorians do to assist in the dire issue of chemical addiction and its disabling, and often deadly, effect on the human race?

Aptly, this year’s AACC president’s session at the 70th AACC Annual Scientific Meeting & Clinical Lab Expo in Chicago will explore the role of clinical labs in solving the opioid epidemic in the United States, and what strategies are underway to combat the misuse of these drugs.

I, for one, will be in attendance. I’ll save you a seat.