This Aug. 29 photo shows an arrangement of prescription Oxycodone pills in New York. Synthetic opioids have become increasingly common in the United States, especially on the East Coast. (Mark Lennihan, Associated Press)
Editor's note: This story pairs with 'Synthetic opioids abused from multiple sources'
Khalil Rafati first experienced addiction at 10 years old, messing around with pot and alcohol behind his school. As he got older, his life was a collection of oxycodone and acid, blackout episodes and raves.
Following a tooth extraction, he experienced 'the incredible effects' of popping a few Vicodin with wine or a beer. After that, he was hooked on synthetic opioids. Rafati's life quickly began to revolve around pain pills like oxycodone, Percocet and eventually, heroin.
Rafati tried to get healthy at 29 after being on opioids for two years, but found himself trapped in a cycle of addiction and synthetic opioids, which he would mix with coke, crack and alcohol. It all led to an eventual crash. He found himself, a high school dropout and felon, homeless on Skid Row in Los Angeles.
'After eight overdoses and a handful of seizures, nine hospitalizations, scabies, ringworm, teeth falling out of my head, I bottomed out,' Rafati said. 'I didn't have the strength to go on any longer.'
Rafati reached out for help and found himself at a treatment center, where he got on his knees and prayed to God for help.
'It wasn't a burning bush moment, but I felt a lightness to my spirit and my being. I believe that's ultimately why I'm alive 15 years later,' he said. 'I know there's a God, and every time I fell down I asked him to be with me. Never once did he let me down.'
After that, Rafati stayed strong. Prayer, meditation and a strong belief in a higher power encouraged him to turn his life around. He got a job, opened a checking account and got off welfare.
His self-confidence improved. He started a successful business, sold it and started another one, becoming more and more successful. He wrote a book, 'I Forgot to Die,' detailing his experience with overdose and rehabilitation.
Today, Rafati is clean. He owns and operates SunLife Organics, a growing chain of health food stores. His brand adopted the pink lotus, symbolizing growth from darkness.
'From the mud and the darkness grows a beautiful flower. That's why I chose the name SunLife. Life in the Sun,' his website reads.
A national crisis
Rafati's struggle is emblematic of what thousands of Americans face as opioids become more readily accessible and potent, according to the Centers for Disease Control and Prevention.
Synthetic opioids themselves are safe to take over a short time period when prescribed by a doctor, but abuse can lead to dependence, overdose and death, according to the National Institute on Drug Abuse.
According to the Centers for Disease Control and Prevention, synthetic opioids include oxycodone, fentanyl, carfentanil, furanylfentanyl and U-44700 (also known by the street name Pink). The most powerful synthetic opioid, Carfentanil, is 10,000 times more potent than morphine, while Pink is about eight times stronger than heroin.
According to Pat Bird, deputy director of operations at the Department of Drug and Alcohol Prevention and Treatment, synthetic drugs like fentanyl are stronger than natural opiates.
'Synthetic opioids have been chemically engineered to be more potent,' he said. 'They have different potencies and purities, which change the amount given.'
Opioid users often become dependent due to abusing a prescribed medication, which leads to addiction, according to Bird, and after a person crosses their 'trigger line,' it can be a lifelong battle to beat physical and mental addictions.
Synthetic opioid use has rapidly increased since 2013, according to the CDC. Fentanyl encounters, in particular, more than doubled from 5,343 in 2014 to 13,882 in 2015.
The CDC reports more than 19,000 deaths involving synthetic opioids in the United States in 2016. The largest increase in deaths occurred in males aged 25–44 east of the Mississippi River. New Hampshire, West Virginia and Massachusetts had the highest death rates in 2016, according to the CDC.
Emergency hospital visits due to opioid overdose have increased west of the Mississippi River from 2016-2017, according to the CDC. (Sam Bigelow)
Although synthetic opioid use is less common in the western U.S., notable cases have still reached Utah. In 2016, the Deseret News reported that two 13-year-old boys died from an overdose on Pink, which they had obtained from a 15-year-old female classmate, who was later arrested for ordering the drugs online from China.
At the time, Pink was only regarded as a controlled substance in four states. According to the Drug Enforcement Administration, Pink was declared a Schedule 1 controlled substance on Nov. 14, 2016, banning it nationwide.
The Utah Department of Health also announced on Oct. 1 that the state has seen a decline in heroin overdoses for the first time in seven years. Deaths caused by prescription opioids are down for the third consecutive year, thanks to state government initiatives focused on fighting the opioid crisis.
Though opioid deaths in Utah are in decline by 19.8 percent from 2016 to 2017, Lt. Gov. Spencer Cox said during an Oct. 1 press event that 360 people died from an opioid overdose in 2017.
'While it's certainly encouraging to see these numbers headed in the right direction, the number of deaths associated with opioids and deaths of despair in our state is staggering,' Cox said. 'The sad fact that 360 families are struggling with the loss of a loved one due, at least in part, to opioids, is cause for all of us to remain committed to putting a stop to this terrible epidemic.'
Addiction and the human body
According to Kyle Bills, who works in the Scott Steffensen Neuroscience Lab at BYU, opioid addiction often results in users becoming more sensitive to pain, which leads them to pursue more potent substances, like heroin or stronger synthetic drugs.
Bills said opiate-based drugs target the central nervous system to increase the body's natural dopamine levels, which help manage sensitivity in the body's pain receptors. The more a person takes these drugs, the more they become desensitized to their body's natural dopamines.
'The first time someone takes an opiate, their dopamine levels are going to spike up pretty high. As they come down off of the opiate, their dopamine levels will drop again,' Bills said. 'Each subsequent time they take the drug, the release of dopamine is not quite as high. Afterward, the dopamine will drop below the baseline.'
As dopamine levels continue to drop below natural levels, those affected will begin to seek out more of the drug to feel normal, according to Bills. This can lead to hypersensitivity to pain, anxiety, depression and gastrointestinal issues.
Bills compared fighting an opioid addiction to having one's head held below water in a swimming pool. As the person underwater struggles to gain oxygen, they experience a moment of panic when they realize they can't get what they need to survive.
'When someone's dopamine levels drop below baseline, this sensation of drowning might be what they feel like,' he said. 'It can take weeks upon weeks for that sensation to go away.'
Robert Waldman, head of detox at the Cliffside Malibu treatment center in Los Angeles, said as a person uses opioids, they begin keeping secrets and lying to those around them, which robs them of their integrity.
'Deceitful, dishonest and secretive behavior is common to all addictions. That's the number one way addiction alters behavior,' Waldman said.
He also said pain pills and other synthetic opioids can often be viewed as less taboo than heroin, which can make them easier to abuse.
'When people discover they can get just as good a high from smoking or inhaling a pain pill, then it takes away the stigma of heroin because they don't have to inject it,' he said.
However, as prescription opioids become more difficult and expensive to obtain, addicts could end up switching to heroin, which is relatively cheaper than synthetic opioids, Waldman said.
He said although drugs like marijuana and cocaine can lead to psychological dependence, opioid addiction withdrawals can cause gastrointestinal issues, anxiety and depression. Opioid users will stop taking drugs recreationally and find the physical symptoms are too much to handle — turning themselves into what Waldman calls 'maintenance users.'
'When you stop using heroin, you get diarrhea, symptoms like the worst cold you've ever experienced and you get physically ill,' he said. 'Many other drugs don't have the same degree of physical dependence. You may want them and miss them, but you won't get the symptoms of an opiate withdrawal.'
Waldman also said maintenance users drink alcohol and abuse other substances to increase their high. Habitual users can also fall prey to stronger synthetic drugs, like fentanyl, which are being increasingly hidden in heroin or cocaine, according to Waldman. After taking what they think is their usual dose, users will occasionally end up overdosing due to the more potent drug.
Beating the habit
The first step in fighting substance abuse and the stigma surrounding those affected is understanding proper terminology, according to Bird.
He said using negative terminology for beating an addiction like 'dirty' or 'getting clean' can cause those struggling with an addiction to avoid getting help. Instead, Bird stressed the need for substance abusers to 'get healthy.'
Many people facing so-called 'addiction' are actually facing a drug dependence, according to Bird. Dependence is a state in which a person feels like they need a substance to survive, and often results in mild side effects and withdrawals.
In comparison, addiction is an advanced state of dependence that changes brain chemistry, resulting in actual brain disease and chronic relapses. Addicts will also change their lifestyle to accommodate their addiction, Bird said.
'A person can't stop and often makes adjustments in their life to attempt to stop or seek the substance,' he said.
Anything that can form habitual dependence should be seen as equally harmful, according to Bird, and therapists and clients often view any abused substance harmful to 'individuals, family and communities' as a direct substance disorder.
'If a drug impacts a person's life, we shouldn't consider it 'harder.' That substance could be alcohol, which is a legal drug,' he said. 'It doesn't matter if the drug is illicit or legal. Some have higher abuse rates and are scheduled by the DEA (Drug Enforcement Administration) accordingly.'
Early prevention also plays an important role in halting opioid abuse. By preventing a person from forming an addiction at a young age through education and intervention, they become less susceptible to substance disorders, Bird said.
Waldman also said a teenager's stronger, healthier body will often be easier to treat for substance abuse. However, older patients often neglect their personal hygiene and medical well-being, which leads to difficulties treating both an addiction and physical afflictions.
'When you treat someone in their 40s or 60s, you have to worry about high blood pressure, diabetes, arthritis and heart disease,' he said. 'It takes a lot more skill and understanding to treat someone with multiple problems rather than just one.'
Bird said if someone is addicted to any substance they need to be 'up front with their doctor' when initiating recovery.
Waldman also said controlled substances and prescription profiles are monitored by pharmacists, which helps prevent opioid users from abusing their prescription or obtaining prescriptions from multiple doctors.
Communities nationwide are also making efforts to save opioid users from overdoses. Those suffering from substance addiction can call the National Drug Abuse Hotline to receive rehabilitation information. According to the website, all calls are anonymous and callers will not be 'scolded, judged or reprimanded for drug use.'
The U.S. Senate recently passed a bipartisan opioid package, according to the Washington Post. The legislative package requires the Postal Service to screen overseas packages for fentanyl and other synthetic opioids and will increase access to medication-assisted treatment and comprehensive recovery centers.
The California legislature also passed a bill allowing for safe, supervised injection sites, which San Fransisco Mayor London Breed said can help prevent overdoses and connect people to treatment, according to Curbed. However, California Gov. Jerry Brown vetoed the bill, stating he doesn't believe 'enabling illegal drug use in government-sponsored injection centers ... will reduce drug addiction.'
Utah is home to approximately 62 Narcotics Anonymous meetings and 33 long-term drug rehabilitation facilities. The Utah Department of Health has also received a $3.2 million grant from the CDC to establish 'near real-time monitoring and reporting of opioid overdose events' to help communities accurately address opioid addiction, according to an Oct. 1 press release.
Additionally, the Utah Department of Human Services has provided grants to communities to train and provide first responders with naloxone, a drug that can reverse an opioid overdose, according to NIH.
Rafati said adopting the philosophy behind rehabilitation programs — and a belief in a higher power — can help others get healthy, as it did for him.
'Surrender and find and build a relationship with God. Hang on like a drowning man with a life preserver and you'll be OK,' he said. 'Anyone can make it through one day without drinking and drugging. If you throw God and grace into that, then you'll have an amazing life.'
https://soundcloud.com/samholden95/dr-kyle-bills-on-opiates
Kyle Bills discusses how opioids affect the human body. Bills works in the Scott Steffensen Neuroscience Lab at BYU and specializes in the science behind addiction. (Sam Bigelow)