Opioid Addiction is rare. Why?

Can we stop it with Substance Exposure Control?

Undating may 2020. this is our draft read it like you see a rehearsal of a play.

JATH Educational Consortium, LLC**

by Thomas Kline, MD, Carolyn Concia, NP, Erin O. LeBlanc.

The word “opioid misuse” is being misused. The term “misuse” was created by those wishing to promote unscientific, biased agendas. Those who say things like “overdose deaths”, leaving off the critical first word when the statement should be “street overdose deaths” 95% dying without medical care. What we are really afraid of is the creation of more dope fiends. The way to support that fear is to equate “overdose deaths” with the creation of more Heroin addicts. Look carefully. You have been tricked. There are no facts presented to indicate more receptor disease opiate addiction is occurring. In fact the 800,ooo addicts in the U.S. or less than 1% is exactly the same as in 1920. Numbers for other addictions, alcohol, cocaine, stimulants, bounce around from year to year dependent on supply and exposure. Heroin opiate addiction is an outlier in the addiction group being largely controlled by aberrant genes where the type 1 addiction less so (see ABC’s of Addiction in Medium).

In medicine when we see high variability in disease prevalenc and incidence we look for the environmental cause. High rates of alcoholism (a type 1 “substance exposure” addiction — more substance more addiction) lead to Prohibition which did reduce addiction to alcohol by some reports. This is not true for opiate addiction. There has never been a reduction in the numbers of Heroin addiction in the one trillion hundred year war on grubs according to a government report.

In medicine when we see no change in the prevalence of a particular disease we think of it as potentially genetic like Tay-Sacks disease, Sickle Cell Disease, hemophilia, and diabetes. Then we do genetic research and prove it.

This is the case for just Heroin addiction. The suspicion arose seeing the same numbers of opiate addiction rates over the years while other “soft wired” type 1 addictions varyin numbers

More concern Heroin addiction was fundamentally different has been the inability to change the rates of Heroin type or opiate (“opioid”) addiction even with intensive efforts over decades. (SAMHSA one of Federal abuse agencies declares “Opioid Use Disorder” has doubled to 2.3 million but the number of Heroin addicted people is the same at 800k. Do we have two types of “abuse”? No, we have chicanery at Substance Abuse ageny. SAMHSA did a shell and pea slight of hand. The psychiatrists get together every once in a while to try to put rhyme or reason to their fuzzy diagnoses and publish the Diagnostic and Statistic Manual now in the fifth edition or DSM5. SAMHSA took the official diagnostic new name for Heroin Addiction “Opioid Use Disorder” (OUD) and defined it’s as “taking opioates for non medical reasons” — not bad in our view. But for reasons they could not explain when JATH queried the Agency last year IN 199x. SAMHSA inexplicitly changed the definition of OUD to taking opioids in a manner not directed by the doctor or not on the prescription bottle. Since SAMSHA does household surveys we would imagine anyone who took a few less or a few more ( necessary for those with fluctuating pain ) wiuld now be counted as having OUD. In fact the Agency added another million to the rolls of OUD a term now used for Heroin Addiction in every thing you and we read. This is dishonest but seems to have made the Abuse Agency more relevant in these times of “increasing addiction rates” (some eg) fueling panic in turn fueling doctors being arrested to (wuote ag) distributors

The gene structure itself adds scientific proof is in hand with newer genetic tests showing a distinct abnormality in the gene

In addition

Only 500–1000 overdose. per year under a doctors care. What do suppose would happen if we moved all the receptor disease addicted patients into regular care? Unfortunately you cannot do that without a special DEA license.

Currently, the Substance Abuse and Mental Health Services Administration (SAMHSA) is using the terms abuse and misuse interchangeably in effort to convince us pain is not important enough to be treated with our drug of choice, opiates.

Misuse/Abuse is newly defined as “not taking the prescription exactly as the doctor prescribed it”. This is not the same as addiction. This Agency had no right to change the DSM5 definition which they did. This is something that’s dishonest and appears to be an attempt to make the problem look worse than it is, perhaps to increase funding.

The issue centers on just how common real Heroin addiction is, or at least what we are calling Addiction type 2*, those who are considered “junkies”, or “dope fiends”.

If opiate addiction (type 2*), is common, it supports the idea “misuse” of a prescription will lead to addiction, so you better not take it. Who wants to become a dumpster junkie?

If Addiction type 2 is indeed rare,and not changing in occurrence since the 1920’s, this supports a genetic theory (6) versus an environmental theory of “substance exposure”. The latter is the prevalent idea and drives the majority of the interventions currently in vogue. but failing miserably in some believe not only failing but making the problems worse.

Unfortunately governmental attempts to control addiction and “overdose deaths” (95% in the heroin community — not disclosed by CDC) have not worked. Why not? Because we are targeting the wrong problem. We are dealing with a bona fide genetic disease with real findings of abnormal function in the receptors in the brain. This is why it’s rare.

We just need get out in the streets and treat the genetic disease folks with opiate addiction who are not receiving medical care.

When you treat the disease medically with inexpensive medications all the crime stops, all the overdise deaths stop, people with illegal drug distribution systems not paying income tax will disappear and the problems will be over. It’s a simple solution. What is holding us back?

The Opioid crisis is defined by the number of overdose deaths. The overdose deaths are occurring only on heroin addicted people. Can we get our heads out of the sand and use some Eelementary logic?

Sadly people dying of the heroin overdose deaths are suffocating in the streets without even a $20 ambu bag to save their lives. No public health programs we have heard of that Jeff are in place to teach people with this terrible disease how not to die. They are making simple pharmacological mistakes which if they knew more information would be dying less.

Is this what we are really interested in preventing -more heroin overdose deaths? This clever shift by dropping the adjective heroin implies that people are dropping dead in communities which they are only very rarely but when it happens it makes everyone think that it’s very common.

When programs don’t work you need to stop doing them. Five drug wars beginning with President Eisenhower, have all failed and wasted one trillion dollars according to the Congressional Research Service all based on “substance exposure”

The Theory of “substance exposure” rests on the assumption that if you spread enough substance around the addiction rates will increase, and people will die as a result. This is correct for what we call the Type 1 addiction group: cocaine, marijuana, amphetamines and most overuse of alcholol.

This is not correct for Type 2 addiction, the opiate or heroin addiction which is multiple genetic errors in gene A118G which controls the mu receptor in the brain, peripheral nerves, and in inflammatory tissue. Addiction in opiate Type 2 patients with strong family history and abnormal genes is immediate on first exposure.

In speaking with multiple heroin addicts nearly all report an intense “moon shot” or “magic carpet ride” — on first exposure, not after a long “substance exposure, that is for type 1 addictions.

This is an important difference. To control type 2 opiate addiction one needs to ask patients “ever had a opiate?”. If you never have, then you will might be carrying the gene. “Here’s what you do. After the very first pill if you do not feel drowsy but feel energized or extremely happy, get back to the office — you have addiction disease.

But don’t worry we can treat that, like we treat other genetic disease. You will not die. You will not be shooting Heroin and living in dumpsters. You will live a normal life, but we need to be careful when prescribing you pain medicines, or you might want to twist my arm for more! There are other things we can do like substitution treatment but you are not at that point so, relax.

Remember this is genetic so we need to look at the rest of your genetic family. There will be a new genetic test soon. FDA has given it fast tract approval. If we catch everyone early, there need not be a single death”

If you can addict anyone, then the various wars on drugs (five in all, beginning with Eisenhower) should have been effective by now. By reading the newspapers this does not seem to be the case. Overdose deaths increase yearly, but looking carefully at the data and the expositions, none has been forthcoming showing increases in type 2 opiate addiction.

The tip off that Heroin addiction was not related to prolonged “substance exposure” was the numbers of Heroin addicts today compared with 1920. The percentage numbers are the same! Checking other years the same 0.5% keeps appearing. A steady prevalence of a disease suggests strongly a genetic cause.

Did you know the “Hill Tribes” as they are called in the Golden Triangle in Southeast Asia, famous for cultivation of the poppy plant and opium production were found in a 1978 study to have an opiate type 2 addiction rate of hold your breath — 0.5%! The opium is just lying around, available to everyone, but only less than 1% of people whether Asian or American can addict.

The 99.5% without the gene, can never addict. Substance control has cost the taxpapers 600 billion dollars and has not worked. We have the same number of opiate addicts as always.

The solution is simple. Type 2 Heroin and opiate addiction is real disease, need to treat it as such. Type 1 addiction disorders are more psychosocial disease and do not respond to medicines as with Type 2 addiction.

Without MAT or medication substitution for Heroin addicts in “rehab” fail 90% of the time.

This is not true for the more dangerous addictions: cocaine, amphetamines and alcohol. Here typical non medical rehab has a higher success rate.

The rarity of heroin addiction type 2 has been challenged vigorously (why dost thou protest so) as it spoils the “substance control” theorem which is totally ineffective. The following studies show that opiate addiction is consistently rare.

A 1982 study of 145 burn treatment centers representing 20,000 burn patients found after prolonged parental (injections) opiate treatment only 22 people became addicted (1). In 2010, the Cochrane Collaborative (a highly regarded reviewing agency in the UK) reviewed 26 long term opiate use studies and concluded: “serious adverse events, including iatrogenic (caused by the treatment) opioid addiction, were rare”(2). A recent study at Loyola showed only one person addicted out of 1100 cases given postoperative opiates (3)

A carefully designed epidemiological study studying occurrence rates of addiction was conducted by the respected epidemiologist Lee Robins at Washington University in 1977 She studied 700 soldiers returning from Vietnam on high dose, pure, I.V. heroin.(4) Expecting nearly 100% addiction, she was “surprised” to find though most had withdrawal symptoms confirming the habituation most all get taking medicinal or street opiates, or antidepressants for that matter. Why was she surprised — only 2% became addicted. Jim Mintz studied smaller cohort of Vietnam heroin users in 1979 at the Brentwood VA and replicated the findings of Robins. It is hard to generate any other explanation other than genetic triggering, odd as it may sound it explains the consistent failure of 100 years of government “substance control” failures.

Population statistics also support the rarity of addiction. The rate of addiction in 1915 when the Harrison Act was passed was 3/1000 or less than 1%. NIH figures nlshow a similar rate of addiction today of 4/1000 or less than 1%, unchanged in 100 years. Think about it. Why has it not increased on a per person basis in 100 yrs. (shhhhh, it’s genetic)

Neuroscience research at NIH, Montreal, Bonn, and Sydney to name a few, show consistent evidence that true addiction is a genetic mu opioid receptor polymorphism (variance) running strongly in families.

Opposing views such as the CDC Guidelines of March 15, 2016 and groups opposed to the notion of rarity of addiction (5) were jointly reviewed but they did not cite data to support their position, rendering the positions null.

The studies above as well as epidemiological data show that less than 1% of people will become addicted after exposure to opioids, including those with prolonged exposure to high dose IV heroin (4). Based on our experience, along with the experience of pain management physicians, once exposed to an opiate without addiction further exposure does not lead to Diamorphine addiction.

The length of time taken, the type of agent, the background of the individual matter not. No genes, no addiction, thus the rarity.

Using the confirmed government figure of 2 million people with Opioid Use Disorder (OUD), even if a created government disease made up by SAMHSA still comes in at 1 %. — rare.

The low rate of addiction appears real and constant over time irrespective of opiate dosage equivalence. Given the rarity of addiction, 99% of the American population is currently being taken their prescription pain medications for no reason. This has created the worst health care disaster in modern times.

If you do not have the genetic propensity even IV Heroin will not addict you (Robbins study above)

The highly regarded brain researcher and Director of NIH Drug Abuse (NIDA) Nora Volkow, MD said in a 2016 New England Journal of Medicine article, “Unlike tolerance and physical dependence, addiction (opiate type) is a not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities” (6)

To answer the question, “can we stop opiate addiction with substance exposure control” — the answer is no. It is scientifically impossible. Yes you can reduce the other addictions with substance control and worth doing since the type 1 addictions are more dangerous crime wise.

We have been wrong for more than 100 years and thrown away 600 billion dollars trying to control opiate or Heroin type addiction due to ignorance of medical facts.

A medical understanding of this very real genetic opiate disease would have saved enough money build 30,000 large public high schools instead. Maybe well intentioned efforts over 100 years but it has never worked and never will.

Meantime patients with this horrible genetic opiate addiction disease and their doctors end up in prisons with the government trying to contain the supposed “evil” a term used when Steven Henson MD was sentenced to life by his federal court judge for failing to recognize his patients were selling his medications.

Thomas F. Kline, M.D, Raleigh NC
Carolyn Concia, NP, Portland Oregon
Erin O. LeBlanc, Editorial assistance, Raleigh NC

Corresponding author: thomasklinemd@gmail.com

*See medium essay “ABC’s of Addiction” The word “addiction” is too broad and is too confusing. This essay defines for the first time two sub groups of addiction: psychosocial addiction, and hardwired brain addiction.

1. Perry S, Heidrich G. Management of pain during debridement: a survey of U.S. burn units. Pain 1982;13:267–80

2. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM. Long-term opioid management for chronic noncancer pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006605.

3. Shah, AS, et al. Rates and Risk Factors for Opioid Dependence and Overdose after Urological Surgery. Journal of Urology 2017; May 12, PMID: 28506855 (ahead of print)

4. Robins, LN. Vietnam Veterans Three Years after Vietnam: How Our Study Changed Our View of Heroin. Problems of Drug Dependence 2010;19:203–211 (reprinted exactly from 1997 Proceedings of the Thirty-Ninth Scientific Meeting of the Committee on Problems of Drug Dependence)

5. Leung, PTM, MacDonald, EM,Juurlink, DN. 1980 Letter on the Risk of Opioid Addiction.” New England Journal of Medicine 2017;376:2194–2195.

6. Volkow, N and McLellan,A. Opioid use in chronic pain — misconceptions and mitigation strategies. New England Journal of Medicine 2016;374:1253–63

Addiction References:

  1. Nora Volkow, MD, Director of national institute of drug abuse “Addiction is not an predicable result of opioid prescription. Addiction in only a small percentage of persons who are exposed to opioids- even among those…even those with another type of substance abuse disorder,” NEJM XXXXX
  2. CDC 1%
  3. Silva S. Martins, MD, PhD, Colombian university, heroin use disorder 0.7%
  4. BMJ Jan 2018 665000 post-surgical patient addict rate 0.6% not correlated with dose (compared with CDC)
  5. SAMHSA : “only 2% of those using prescription or illegal opioid developed opioid addiction”
  6. Cochran review less than 1%
  7. NEJM, 2016 “careful diagnosed addict mediation,” TBC
  8. Dickinson, et all, Western journal of medicine, 2000, 172: 107 “Addiction occurs infrequently in patient without history of substance abuse.”
  9. NY Times, May 15, 1956, “addicts in the U.S., 60000, in the population of 160 million, is equal to 0.03%
  10. Kaiser Ed news, Jan 16 2016, Shelia Luthra “Although the majority of current heroin users report having used prescription opioid non-meditation before they initialized heroin use, heroin use among people who use prescription op for non-med reasons is rare, and the transition to heroin use appears to occur at a low rate”
  11. Ballantyne, JC, Pain, 2007, 129: 235 “ opioid treatment of severe and short term pain, addiction arises only rarely”
  12. Shatterproof.org scientific research a 75% chance that a person will develop addict comes from genetics or a person in their family.

**JATH Educational Consortium LLC is a recently incorporated group of writers, researchers, doctors and people with chronic painful diseases searching for the truth to share with anyone. The group has no financial or competing interests. We are not policy body but the information can assist with policy as well as with clinical medical practice and as information for patients.



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Thomas Kline, MD, PhD

Thomas Kline, MD, PhD

42 years varied primary care • former Chief, Hospital in Home Service @harvardmed • formerly: @UofMaryland, @StanfordDeptMed, @uoregon • nationalpaincouncil.org