Opioids

Episode 73: Oh No! Not Naltrexone! with Nancy Curran

Naltrexone, also known by its brand name, Vivitrol, is an opioid antagonist that kicks opioids off of opioid receptor in the brain, not unlike naloxone. But thanks to a combination of overprescription, unscrupulous marketing practices and ubiquitous use over more effective alternatives, naltrexone is a very controversial drug. In fact, a common reaction is Oh no! Not naltrexone!

Of course, naltrexone has some benefits and many people say their life has been saved by it. And at Narcotica, we don’t believe any drug is “bad” or “evil.” So where does this substance fit into the broader scheme of things? We’ve spoken about naltrexone many times on this show, but never this indepth before.

Narcotica co-hosts Zachary Siegel and Troy Farah speak with Nancy Curran, a nurse practitioner who has been practicing for 5 years in an OBOT clinic in the Lowell Massachusetts area, treating both opioid and alcohol use disorders. She prescribes buprenorphine (both Suboxone and Sublocade), as well as naltrexone (Vivitrol). She also treats patients who need Hep C treatment. Nancy is passionate about advocating for and educating her patients on their medication options, as well as their rights.

They discuss the history of hallucinogenic opioids, the shrewd and quasilegal marketing practices of Alkermes, Inc., how naltrexone stacks up against buprenorphine and methadone, why stigma persists against people who take certain opioid use disorder drugs but not others, the difference between addiction and dependency, some basic opioid receptor science, and much, much more.

Follow Nancy on Twitter at: @cashboygo

More background on naltrexone and the XBOT Studay can be found here and here. We also recommend reading Walter Sneader’s book: Drug Discovery, A History and also Nancy Campbell’s book OD: The Politics of Overdose.

You can read Zach’s article on Four Good Days and more here: https://www.nytimes.com/2021/05/11/magazine/addiction-movies.html

If you liked this episode, here are others you might enjoy:
Episode 19: Debunking Bupe Diversion Myths with Molly Doernberg
Episode 30: Getting Wrecked with Dr. Kim Sue
Episode 36: Moral Hazards and Naloxone, A Toxicologist’s Perspective with Ryan Marino

Follow Narcotica on Instagram, FacebookTwitter, YouTube and support us on Patreon. We just opened a shop where you can order Narcotica merch: narcocast.myshopify.com Help keep this podcast ad-free! Your support is appreciated! We’re on Spotify, iTunes, Stitcher and more. Tell your friends about us! Rate us! And thanks for your support!

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Aaron Ferguson
Music: Glass Boy / Nomad1
Intro voice: Jenny Schaye
Image: edit: Troy Farah

Episode 68: Is The Drug War Getting Better… Or Worse? with Zach Siegel, Chris Moraff and Troy Farah

On this episode, Narcotica co-hosts Zachary Siegel, Chris Moraff and Troy Farah interview each other, riffing on one question: Is the drug war getting better… Or worse? They cover everything from nitazenes, Dopesick, the Drug User’s Liberation Front, banning psychedelics like DiPT, benzo dope, West Virginia, buprenorphine, psychedelic exceptionalism, drug testing, crack pipes, supervised consumption sites in NYC and much, much, more.

Their conclusion? You’ll have to listen to find out. OK, not really: Like many things, it’s a mix of both progress and backsliding. Narcotica’s founders discuss their current frustrations and what’s giving them optimism in America’s longest running war, a conflict directed at people. Maybe the end is in sight after all.

Follow Chris Moraff on Twitter: @moraffreports
Follow Zach Siegel on Twitter: @ZachWritesStuff
Follow Troy Farah on Twitter: @filth_filler

If you liked this episode, here are others you might enjoy:
Episode 27: What’s the Most Dangerous Drug?
Episode 58: How Racism Fuels The Drug War with Kassandra Frederique
Episode 51: The Joy of Drug Use with Dr. Carl Hart

Follow Narcotica on Instagram, FacebookTwitter, YouTube and support us on Patreon. Help keep this podcast ad-free! Your support is appreciated! We’re on Spotify, iTunes, Stitcher and more. Tell your friends about us! Rate us! And thanks for your support!

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Garrett Farah / Troy Farah
Music: Glass Boy / Holly Mangler
Intro voice: Jenny Schaye
Image: Noun Project // edit: Troy Farah

Episode 67: Methadone in the Time of Covid with Danielle Russell

Harm reduction programs like syringe access, supervised consumption or even just handing out condoms on the street, can be some of the only access to healthcare some people encounter. Definitely not all, but some people who use drugs routinely shun going to the doctor—not because they don’t care about their health, but because our for-profit healthcare system treats almost everyone who uses an illicit substance like complete shit. And people who use drugs have been treated like pariahs long before the covid pandemic, but things got way worse once the virus came to town.

Previously on Narcotica, co-host Chris Moraff did an episode all about how doctors need to work harder to rebuild the patient-trust relationship. And many medical professionals are doing that work, which makes such a huge difference. It’s hard to understate how valuable it can be to receive nonjudgmental medical care that doesn’t hinge on absolute abstinence.

That episode, number 65, which we encourage you to listen to after this one, came from the perspective of two amazing doctors, Ashish Thakrar and Ben Cocchiario. However, on this episode, we want to talk to someone from the other side of the aisle to get a different viewpoint from someone with lived experience in this area.

Why would you go to a healthcare provider for an infection or injury if you’re going to be lectured about your drug use, even if it has nothing to do with why you’re there? Or you might be forced to hand over your urine or have your possessions rifled through by a nurse. Even for people that don’t use illegal substances, our healthcare system is a nightmare to try and navigate. It only gets worse if you happen to self-medicate or enjoy chemicals that aren’t sanctioned by the FDA.

Narcotica co-host Troy Farah speaks with Danielle Russell of Phoenix, Arizona, who is currently a justice and social inquiry PhD student at Arizona State University. She studies how the criminalization of substances used for personal pleasure has become a key issue and tool for social control, contributing to the ongoing legacy of racialized criminalization and mass incarceration in the U.S. Having personally experienced many of the harms that impact people who use illicit drugs, she is passionate about mutual aid and working to change the structures that impose harms on the bodies of drug users. Her research interests are oriented towards community-based participatory research.

Follow Danielle on Twitter @DopefiendPhD and you can read the study she co-authored here:
https://pubmed.ncbi.nlm.nih.gov/33461838/

If you liked this episode, here are others you might enjoy:
Episode 65: Restoring Trust in Doctors Amidst The Overdose Crisis with Dr. Ben Cocchiaro and Dr. Ashish Thakrar
Episode 48: Moms And Methadone with Elizabeth Brico
Episode 56: Drug Use During Disaster with Aaron Ferguson

Follow Narcotica on Instagram, FacebookTwitter, YouTube and support us on Patreon. Help keep this podcast ad-free! Your support is appreciated! We’re on Spotify, iTunes, Stitcher and more. Tell your friends about us! Rate us! And thanks for your support!

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Garrett Farah / Troy Farah
Music: Glass Boy / Holly Mangler
Intro voice: Jenny Schaye
Image: Noun Project // edit: Troy Farah