Special Report: As opioid overdose deaths skyrocket, local research leads to important discovery

Special Report: Kicking the heroin habit
Published: May. 23, 2016 at 3:03 PM CDT|Updated: May. 24, 2016 at 9:50 PM CDT
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NEW ORLEANS (WVUE) - Living with chronic pain is not easy, but medical professionals say overuse of painkillers leads to overdoses, and some people who start out on opioid pain medicine transition to heroin.

Local researchers have developed a painkiller that is as strong as one widely used opioid drug, but is not likely addictive.

"It stopped me from getting a lot of things I want out of life," said a heroin addict living in New Orleans.

He's an admitted 20-year heroin user and says a "living hell" sums up his struggle. He is not oblivious to the fact that the drug his body signals it cannot do without also possesses the claws of death.

"I overdosed once. Every time you take a chance you could overdose, every time you get high you could overdose you take a chance of overdosing," he told FOX 8 News.

Recently there has been increased media attention on overdose deaths following the April 21 death of musical giant Prince. Investigators continue to probe whether prescription drugs played a role in Prince taking his last breath inside his Paisley Park Estate outside of Minneapolis.

But long before the questions swirling around Prince's death, America faced up to a rock-solid reality: Overdose deaths are an epidemic.

The Centers for Disease Control says from 2000 to 2014, nearly a half-million people died from drug overdoses. More than six out of 10 overdose deaths involve an opioid.

"There are 70 people dying a day from this problem, not intentional, not necessarily heroin addiction, but pain pills, prescription pain pills are a huge part of the problem," said Dr. Arwen Podesta, a psychiatrist and addiction specialist based in New Orleans.

Opioids can not only reduce one's perception of pain, but in some people the drugs can induce feelings of euphoria.

"An opioid is anything that hits your natural opioid receptors in the brain. It can be a synthetic opiate, or a natural opiate," Podesta said.

"When you're overdoing on opiates, first it affects the mind, offers euphoria or a pleasant feeling, and then it suppresses, or decreases respiratory drive, both the number of respirations as well as the depth of respirations, and so what eventually happens is carbon dioxide rises and oxygen levels plummet and then the patient eventually develops injury to the brain, and then injury to the heart, and death," said UMC Chief Medical Officer Dr. Peter DeBlieux.

Pain management for many involves powerful opioids that are prescribed by medical professionals.

"There are oral medicines, things like Percocet, Percodan, Tylenol Number 3, all of those agents, as well as injection agents Dilaudid, Fentanyl, Demerol, that does as well, as well as patches of Fentanyl as well as Methadone as well," DeBlieux said.

Podesta said some take the drugs for legitimate reasons, unaware of what could possibly be in the offing later.

"About 10 to 15 percent are going to have a genetic and biological preponderance for being hooked, whether it's being addicted, or building dependence easily," she said.

DeBlieux said it does not take long to get into trouble with opioid drugs.

"The evidence shows that three-day usage of opiates seems to be the cutoff point for which you begin to develop tolerance, and beyond tolerance is then dependence," DeBlieux said.

"I found that was so interesting when I started in this field, that the gateway drug was not marijuana, the gateway drug was surgery, or it was a doctor's visit," Podesta said.

She said the thought of enduring withdrawal symptoms is too much for some.

"People say it feels like they're dying. They're not going to die from the withdrawal," she said.

Still, obtaining prescriptions for opioids to feed over-dependence can dry up, leaving opioid addicts trying to find the drugs or a substitute high on the streets.

"And they are unable to get those medications, those drugs on the street, and they're driven towards heroin," DeBlieux said.

But when it comes to street drugs, you never know what you're getting.

"Street drugs have no quality control, so when you're purchasing heroin from somebody, no one's really done quality control and we can't compare one dose to another dose," DeBlieux said.

And because potent pain killers can serve as a gateway to heroin use, ground-breaking research takes place at Tulane University's School of Medicine.

"We made a discovery of a peptide, that's a small string of amino acids in the brain that is very selective for the receptor that morphine uses to kill pain. It's called a mu-opioid receptor," said Dr. James Zadina, a VA Senior Research Career Scientist and professor of medicine, pharmacology, and neuroscience at Tulane School of Medicine.

Zadina served as lead investigator as researchers at Tulane and the Veterans Healthcare System worked to develop a painkiller as strong as morphine, but without the addictive side efforts. For Dr. Zadina it has been a 20-year process to get to this point.

"The analgesia is at least as good, and in many cases, longer acting than morphine, but it doesn't have multiple side effects, the abuse liability, the respiratory depression. Tolerance is a big problem where you have to keep escalating the dose to get the same effect, and then that makes it more likely that you're going to get addicted. With ours, it doesn't escalate nearly as fast as morphine does," he said.

The drug is called 853.

Dr. Zadina spoke of training lab rates using both the highly addictive opioid morphine and the compound developed through exhaustive research.

"So for instance if you train them to press a lever to get a drug infusion, IV drug infusion, pretty much like an addict would take heroin, or morphine, you can train an animal to do that, he'll press the bar if he likes it, if it's morphine, he'll start pressing pretty hard for that and you start upping the ante, you make him press five times instead of the one time for every time he gets an infusion. So with this abuse potential test we found that you do them side-by-side, the morphine they'll work very hard pressing that bar to get morphine than they would with ours," he said.

The new drug's structure is very different from opium. Heroin is an opioid that is synthesized from morphine, which is a naturally occurring substance taken from the opium poppy plant, according to the National Institute of Drug Abuse.

"Eventually we got to the point where we had many compounds, all of which were pretty good analgesics, but our real interest is getting around the side effects. So we would take those that are good at breaking and killing pain, and then test them in other tests to see if we could get around things like respiratory depression, which is what kills you if you overdose and most important is abuse potential," said Dr. Zadina.

Clinical trials in humans for the opium-free drug could be one to two years away.

"Still have to do animal studies for toxicology and make sure it's safe. We have to figure out from animal studies what doses would be good to start with in humans," Zadina said.

Meanwhile, the so-called "save" drug, Naloxone, is becoming easier to get.

"This is pre-packaged, it's packaged like this and it's filled with the medication inside, and you simply stick it into the nostril of the patient and squirt and it delivers the medicine in the nasal passages where they are absorbed and you can have a reversal from an opiate intoxication," Dr. DeBlieux said as he demonstrated how it is used while standing in a vacant trauma room at the new UMC.

Naloxone is not addictive. Because of the overdose problem locally, in January city officials worked with UMC to make Naloxone available without a prescription at the hospital's on-site pharmacy.

"So really no side effects to this drug, no addiction level for this drug, this reversal agent," said Dr. DeBlieux.

As for the heroin addict interviewed for this story, he said people hooked on opioids should seek help because turning to heroin would be a life-altering mistake.

"Makes life real hard," he said. "It's nothing like pain pills at all, it's way worse."

Podesta says dependence on opioids can be overcome and said she works with patients and the doctors treating their pain to come up with a regimen to reduce their use of opioids.

"Including psycho-social treatment, and also treating the stress that comes with pain. I think we can be more rational prescribers. A lot of other countries don't prescribe like we do, and they don't tend to have this huge opioid overdose problem," she said.

"Some of the questions we should be asking, right, as lay people out there, number one are their alternatives? How long should I be taking it, and then the most important question, if I have extra, is how should I dispense with them?" DeBlieux said.

Dr. Zadina relishes the research and drug development he is a part of.

"It's 20 years of work that is going to do some good for people, and especially in this kind of crisis situation," he said.

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