REPORTED BY
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
BY
WALTER F. WRENN III., MD., NORMAN J CLEMENT RPH., DDS
THE BRAIN REWARD PATHWAY
Addiction is a complicated disease. Over the years the definition has changed but our understanding of this chronic disease remains stagnant. Today anything we do over and over again that is harmful is considered an addiction.
According to Richard Jerome, “The Agony Of Addiction,”
“…there is far from a universal agreement among experts about the meaning of addiction, which has come to be applied not only to intoxicants but also to a range of habitual behaviors including gambling, shopping, sex, gaming, and internet use. These and other activities can trigger heightened levels of the neurotransmitter dopamine, which lights up our brain’s reward system– and keeps us going back for more.”
What is drug addiction?
According to NIH, National Institute on Drug Abuse, Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.† It is considered a brain disorder because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.11
Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable. If left untreated, they can last a lifetime and may lead to death.
SUBSTANCE USE DISORDERS
But let us look at the substances that are usually discussed when we mention addiction. These substances other than alcohol and now marijuana is also illegal or if medication abused. They also are pharmacological different. They act on different parts of the body and brain.
Because individuals addicted to these substances are difficult to study in any clinical trial our conclusions are mostly speculative. Therein lies the problem.
How can we determine the problem when we can’t study the subject?
DIFFERENTIATING THERAPEUTIC USE AND RECREATIONAL ABUSE
Medical science has had to separate addiction based on the class of substances abused and the pharmacological action of the drug. No matter what substance we study we need to have a minimum of 2 years in order to validate the results.
The classes we are referring to are non-medical opioids and stimulants; Cocaine and amphetamines. These drugs lead to the majority of deaths from drug overdoses today.
Oftentimes, these classes are present together in those who die from a drug overdose. Since they don’t act synergistically determining the direct cause of death is impossible leaving us with “Accident” as the cause.
Today the chief opiate responsible for drug overdose deaths is by far fentanyl and non-medical heroin. Deaths from prescription medications have markedly declined.
What are the physiological actions of these classes of drugs and does that difference require a new definition of addiction?
Cocaine and amphetamines act like nerve endings. They cause a release of norepinephrine and trigger pleasure centers in the brain. Cocaines physiological action lasts for 7 minutes if inhaled or injected. It lasts for 20 minutes when ingested nasally.
In order to continue to experience the effects of cocaine repeated use is required. Once an individual stops using cocaine they return to normal function. No withdrawal. No cravings. After all, cocaine is really not a narcotic and shares the same class as novocaine a drug used every day in dental offices around the world. Amphetamines act the same way as cocaine but are long-acting.
However, individuals who use amphetamines develop paranoid symptoms sometimes becoming violent. Cocaine and amphetamines increase the heart rate and cause the coronary arteries to become deprived of blood leading to cardiac arrhythmia and death.
OPIATE NEUROSCIENCE
Opiates whether legal or illegal act differently. Opiates cause the heart rate to decrease causing respiratory arrest and death. When an opiate is taken they attach to opiate receptors in the brain and body.
The first opiate receptor discovered was the Mu receptor discovered in 1972 but largely ignored by the medical community. Since then Delta and Kappa receptors have been discovered. The action of these receptors has been reported but again ignored by the medical community.
The Mu receptor is responsible for euphoria and it is this action that leads to addiction. Why then is this ignored?
The answer is obvious. Pharmaceutical companies and physicians have been accused of fueling the opiate crisis in America by overprescribing and falsely advertising the benefits of opiate pain medication.
Addressing the physiological action of opiates and the action of opiate receptors would automatically discredit these previously accepted beliefs that something or someone was or is responsible for the opiate crisis in America.
The pharmaceutical companies and physicians accused of fueling this epidemic would be exonerated and released from jail. Lawsuits to recover lost assets and money would be filed all over America.
What then will be the medical community’s response to defining addiction?
How can the medical community undue the harm is done by the indifference to the physiological action of drugs?
Patients have died and continue to die by suicide and drug overdose from fentanyl.
What is the Truth?
CONGRESS: CLEAN UP THIS MESS
THE COMMITTEE ON GOVERNMENT OPERATION. 1990
“WHAT THEY FOUND ACROSS THE BOARD THE WAR ON DRUGS WAS HAVING A DISPROPORTION IMPACT ON BLACK PEOPLE”
https://www.c-span.org/video/?14263-1/jails-prisons-drugs
It is past time for Congress to correct the mess they have made of the regulation of opioid pain relievers. Here is contact information for your Senators, Representatives, and governor’ offices. Call them and demand that they:
- familiarize themselves with the problems they have created by reading this article in STAT news.
- begin work on legislation to force the repeal of the CDC Guidelines
- reign in regulators and drug enforcement authorities from their senseless and unfounded persecution of doctors.
FOR NOW, YOU ARE WITHIN
THE NORMS
