CHARLESTON – A Charleston courtroom turned into a chemistry class on Tuesday as a witness in a landmark opioid crisis essay broke down opioids into their molecules and explained how use disorders opioids take hold of drug addicts.
Dr Corey Waller, a doctor specializing in drug addiction medicine, said opioids work by activating opioid receptors in a nerve. He said that when taking heroin, hydro- or oxycodone, dopamine levels in a body increase by 2150%, which permanently harms the body and leads to drug use disorders. substances and accompanying disruptive behavior.
The lawsuit is the result of a civil lawsuit filed by Huntington and Cabell County in 2017 accusing three opioid distributors of fueling the opioid crisis in the region after shipping more than 80 million opioid pills to the region. region over an eight-year period.
The “Big Three” defendants – AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp. – defended themselves on Tuesday by pointing to flaws in their relations with the Drug Enforcement Administration, arguing that they had not set supply quotas or prescribed the pills and once the pills were dispensed they were out of their control control. Beyond that, they had no control over or involvement in illicit drugs, which are the current cause of the crisis.
Governments claim that heroin, which has almost the same chemical makeup as oxy- and hydrocodone, is cheaper and easier to access when the number of pill distributors sent to the region dramatically decreased there about 10 years ago.
Governments want to pay for the costs associated with past and future efforts to eliminate the hazard, arguing that wholesalers have failed to meet an obligation under federal law to monitor, detect, investigate, deny and report suspicious orders from prescription opiates in the county.
The case is the first to go to trial among hundreds of people alleging the same. This is a bench trial, which means the outcome will be decided by Charleston-based U.S. District Judge David A. Faber.
While questioned by Cabell County attorney Paul T. Farrell Jr., Waller said the body produces its own natural opiates, like endorphins, in opioid receptors on a nerve. When endorphins bind to receptors, dopamine – known as the pleasure hormone – is released.
When artificial opioids enter the body, they attach to these receptors more tightly than endorphins.
Natural opioid drugs, such as morphine and codeine, are extracted from poppy plants or other sources. The semi-synthetic opioids – oxycodone or hydrocodone – also come from the poppy, but are improved in the laboratory. Synthetic opioids, like fentanyl, are made entirely in the lab.
The molecular structure of semisynthetic opioids is nowhere near the structure of naturally produced endorphin, Waller said, and heroin, oxycodone, and hydrocodone all have the same core molecule.
Waller compared the body’s natural opiate system to a soundboard with dozens of knobs and knobs, in which you have full control and can make subtle changes to find the perfect sound. Ultimately all you have to do is turn it off and you won’t see any effect.
On the other hand, the opioid drugs introduced into the system are like a volume knob. There’s no subtlety or control, just a button up or down, which can often be like an explosion that leaves damage, Waller said. The fentanyl raises the receptor as high as possible, he said.
Waller said the center of substance use disorder is dopamine, a natural hormone in humans that creates happiness and motivation. When disturbed, the brain and the body fail.
Dopamine levels on a normal day would be around 50 nanograms per deciliter and on a bad day would drop to 40, making it difficult for someone to be motivated. On a good day it could be around 100. The higher the level, the more invincible a person feels, including less pain or fear.
Dopamine levels on semi-synthetic opioids, like heroin, oxy-, and hydrocodone, rise to 900 because the opioids cling to and not release the receptor.
“When we disrupt that part of the brain, we really disrupt all aspects of… how we react,” he said.
After the first use, Waller said, the body won’t want to push you that high again, resulting in a higher tolerance and forcing the user to need more to feel that level again.
“The brain doesn’t like being told what to do, so it starts to regulate the system,” he says.
The body will reduce the amount of natural dopamine levels because of the confusion of unnatural opioids introduced into the body. The effect leaves dopamine levels far below a human’s worst day. As a result, users are often left chasing that peak and happiness for years to come.
Waller said he would not define prescription drugs as an introductory drug because they have the same effect on receptors. The body cannot tell the difference.
“No, he has no idea,” he said. “The brain doesn’t know what medicine you just gave it. He just knows what reaction he had.
Alcohol has less of an impact than opioids and is more predictable, but can still be harmful, he said.
When questioning Jennifer Wicht, an attorney for Cardinal Health, Waller said things like genetics and adverse childhood experiences play a role in whether or not a person suffers from a related disorder. use of opioids. Wicht said studies show that up to 50% of people are at risk for addiction.
Wicht said hydro- and oxycodone are legally prescribed drugs, approved by the Food and Drug Administration, and highly regulated. The defendants argued that it was not their duty to control the quantity of pills. The DEA, the West Virginia Board of Medicine and others pushed for higher pills and fulfilled the orders, they said.
When asked if he thought there were any patients with a legitimate need for hydro- and oxycodone, Waller said yes, at the lowest possible dose for a short period of time. If they need it for more than a week, they should be under surveillance, in his opinion.
Nonetheless, Wicht said the wholesaler does not collaborate with doctors to write prescriptions and does not have any interaction with patients. The government controls the quantity of pills distributed.
The parties selected several publications, indicating the elements that supported their position.
Timothy Hester, an attorney for McKesson, referred to several articles, newsletters and the like from the 1980s that said no patient should have to endure severe pain and encouraged higher distribution of opioids.
In questioning Farrell, Waller said that the change in opioid prescribing dates back to the 1980s and it was decades before the distribution of opioids skyrocketed.
Hester also pointed out several writings, according to which the current drug problem is caused by illegal or fake opioid pills or drugs shipped to the Mountain State by illegal dealers. Waller said it would be difficult to tell the counterfeit pills apart from a legitimate pill, and the former could be fatal.
The trial is scheduled to continue on Wednesday with testimony from former West Virginia health commissioner Rahul Gutpa.