DEA chief: Synthetic drugs pose alarming US overdose risk

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Prince's Death Highlights Overdose Antidote Quandary

WASHINGTON, June 7 (Reuters) - Synthetic designer drugs, especially synthetic opioids like fentanyl implicated in the death of pop star Prince, pose an "unprecedented" threat for U.S. overdoses and deaths, especially among youth, the country's top anti-drug official said on Tuesday.

The U.S. Drug Enforcement Administration has been cracking down on synthetic drugs since they began gaining popularity in 2010. But because each newly designed drug needs to be separately banned through a "clunky and cumbersome" process, the problem continues to spiral, DEA head Chuck Rosenberg told a U.S. Senate committee.

SEE ALSO: Prince died of an opioid overdose

"For every one substance we've controlled, legislatively or administratively, there are 11 more out there that are uncontrolled," Rosenberg said.

"We're playing catch-up, and we need your help."

Among commonly used designer drugs in the United States are synthetic cannabinoids that mimic marijuana, so-called bath salts that have effects similar to cocaine and methamphetamine and synthetic opioids including counterfeit painkillers.

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DEA chief: Synthetic drugs pose alarming US overdose risk

Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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Democratic Senator Dianne Feinstein suggested creating a committee to decide how to classify new synthetic drugs as they appear on the market.

"To me, it's like Zika, and there's a lot of effort going on now to speed up research. Here, we've got to speed up the ability to enforce," Feinstein said at Tuesday's hearing.

Rosenberg testified that the DEA has seen a particularly alarming rise in illicit use of the fentanyl, which a medical examiner recently identified as the drug that killed Prince.

More than 11 million people illegally consume prescription painkillers for non-medical purposes each year, and overdoses are likely to increase as fentanyl is introduced to that market, according to Rosenberg.

U.S. President Barack Obama earlier this year asked Congress for $1.1 billion in new funding over two years to expand treatment for users of heroin and prescription pain killers.

Fentanyl users typically first develop an addiction to prescription drugs, and then turn to fentanyl because it is cheaper, although fentanyl has a much higher potential for abuse and overdose.

Some illicit fentanyl distributors disguise the opiate as a prescription drug, said Michael Botticelli, the Obama administration's top drug policy adviser, at Tuesday's hearing.

Botticelli said the administration supports legislation that would broaden prosecutors' ability to cite sales strategies as evidence when prosecuting synthetic drug manufacturers, especially manufacturers who claim their drugs are not intended for human consumption but clearly market them as such.

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DEA chief: Synthetic drugs pose alarming US overdose risk
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