buprenorphine

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

Episode 65: Restoring Trust in Doctors Amidst The Overdose Crisis with Dr. Ben Cocchiaro and Dr. Ashish Thakrar

Over the past two decades, as fatal drug overdoses have risen precipitously, few professions have been hit harder by the crisis than the medical community. Physicians in particular have found themselves in the no-win position of being both blamed for the overdose crisis, which claimed more than 100,000 American lives in the past 12 months, while being tasked with containing it.

According to one dominant narrative, it was cavalier doctors who sparked the crisis in the first place, by overprescribing habit forming narcotic painkillers to millions of Americans after being softened up at lavish dinners and then duped by nefarious pharmaceutical reps using fudged data.

But that’s overly simplistic. For starters, it ignores the fact that the greatest spike in drug deaths came when doctors reigned in opioid prescribing after authorities started targeting so-called pill mills. This left tens of thousands of pain patients stranded and paved the way for the introduction of illicitly made fentanyl into the U.S. to fill unmet demands.

Narcotica co-host Christopher Moraff delves into this topic, asking how the medical community can work to restore trust from their patients who are justifiably suspicious of the U.S. healthcare system, speaking with doctors Ashish Thakrar and Ben Cocchiario, who both work for the University of Pennsylvania medical system in Philadelphia, a focal point of the overdose crisis. They cover everything from methadone prescribing to overfunding the DEA, all of it underlining the importance of patient autonomy.

Follow Ben Cocchiaro at UPenn
Follow Ashish Thakrar on Twitter @especially_APT

If you liked this episode, here are others you might enjoy:
Episode 46: Behind The Pharmacists’ Counter with Jessica Moreno
Episode 36: Moral Hazards and Naloxone, A Toxicologist’s Perspective
Episode 30: Getting Wrecked with Dr. Kim Sue

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: Aaron Ferguson
Music: Glass Boy / Nomad1
Intro voice: Jenny Schaye
Image: Stockvault // edit: Troy Farah

Episode 56: Drug Use During Disaster with Aaron Ferguson

Our planet is in crisis, plagued by an increase in wildfires, floods, hurricanes, freak storms and outbreaks of disease. As a result, we’re seeing more and more people isolated, left to fend for themselves, as the cracks in public infrastructure only seem to widen.

To use one prominent example, the state of Texas has been slapped with recurrent cataclysms and catastrophes of late, most recently the February winter storm that crushed the power grid, leading to food and water shortages, which left at least 111 people dead.

At Narcotica, we always wonder about what happens to people who use drugs whenever ecological disaster strikes. Co-hosts Zachary Siegel and Troy Farah talk with Aaron Ferguson, who works as an outreach provider in Austin, Texas and is also on the leadership team of the National Drug Users Union. (Aaron was also a our co-producer on the show for about 20 episodes and volunteered to help with sound editing this one as well!)

We discuss everything from the evolving drug trade in Texas to the cult-like mentality that can sometimes manifest in the addiction recovery community and much more.

You can follow Aaron Ferguson on Twitter: @sciencenotheism and watch The Methadone Manifesto, a recent webinar hosted by the Urban Survivors Union. Aaron also co-authored a piece in the National Academy of Medicine discussing some of the public health challenges addiction treatment services faced during the recent Texas storm.

Follow Narcotica on FacebookTwitter and support us on Patreon. Your support is appreciated! We’re on Spotify, iTunes, YouTube, Stitcher and more. Tell your friends about us!

If you liked this episode, here are others you might enjoy:
Episode 51: The Joy of Drug Use with Dr. Carl Hart
Episode 18: Drug User Unions – The Rebirth of Harm Reduction with Jess Tilley and Albie Park
Episode 42: Supervised Consumption is an Essential Service

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

Episode 43: Russian Roulette—Life, Death and Getting High in Putin’s Backyard

The last place you’d want to be dependent on drugs, besides the Philippines, North Korea or the United States, is probably Russia. To give just one example, the Motherland has long banned the use of medication-assisted treatment, such as buprenorphine or methadone, which has made recovery next to impossible for many users. 

Narcotica co-host Christopher Moraff takes a deep dive into Russian drug culture with Aleksey Lakhov, the deputy director of the charitable foundation Humanitarian Action in St. Petersburg. They discuss the culture of naloxone, synthetic drug use, heroin trends, the death penalty, legality of MAT and much more. Here’s the paper about HIV prevention mentioned in the interview and you can read more on this topic in Filter Magazine.

Follow Aleksey Lakhov on Twitter @Alexei_L

Follow Narcotica on Facebook, Twitter and support us on Patreon. Your support is appreciated! We’re on Spotify, iTunes, YouTube, Stitcher and more. Tell your friends about us!

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Garrett Farah
Music: Glass Boy / Poddington Bear
Image: Flickr / edit: Troy Farah

Episode 36: Moral Hazards and Naloxone, A Toxicologist’s Perspective with Ryan Marino

An opioid overdose can be a terrifying experience. When too much of a  drug like heroin or fentanyl floods the brain, it can cause your  breathing to stop. Sometimes you wake up, sometimes you don’t. But  there’s a miraculous drug called naloxone or brand name Narcan that can  reverse an opioid overdose and save your life.  

Today’s guest is Ryan Marino, an emergency room physician and medical  toxicologist at Cleveland University Hospitals. We discuss moral  hazards about naloxone, one of the most important drugs on the planet,  but also buprenorphine, competitive antagonists for benzos and  stimulants, and dispelling drug myths on social media. 

How to Get Naloxone by Zachary Siegel in VICE

Also visit: naloxoneforall.org

Follow Ryan on Twitter.

Follow Narcotica on Facebook, Twitter and support us on Patreon. Your support is appreciated! We’re on Spotify, iTunes, YouTube, Stitcher and more.
Tell your friends about us!


Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Garrett Farah
Music: Glass Boy / Min Y Llan

Photo: Naloxone via Wikipedia / Edit Troy Farah  

Episode 23: Bring Back Prescription Heroin! with Travis Lupick

With perhaps the exception of fentanyl, no drug is seen as more dangerous or controversial than heroin. But when you look at decades of medical literature, it’s clear that heroin, also known as diacetylmorphine, is just another opioid, and it has a place in medicine. On this episode, Troy Farah and Zachary Siegel discuss the controversial idea of prescription heroin with Canadian journalist Travis Lupick, author of Fighting for Space.

You can follow Travis Lupick @tlupick Twitter here.

Follow Narcotica on FacebookTwitter and support us on Patreon. Your support is appreciated! We’re on Spotify, iTunes, YouTube, Sticher and more. Tell your friends about us!

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-Producer: Aaron Ferguson
Music: Glass Boy and Aaron Ferguson
Image Credit: Wikipedia / Edit by Troy Farah

Episode 19: Debunking Bupe Diversion Myths with Molly Doernberg

If you ask many, many people whose lives have been upended by opioids, buprenorphine is a life saver. It can literally cut the risk of a fatal overdose by half or more in folks who have an opioid addiction. Also known as Subutex or Suboxone, buprenorphine is one of the three FDA approved medications to treat what’s formally known as opioid use disorder. It’s a partial agonist at opioid receptors, relieving cravings but with far less risk for overdose than other opioids like heroin, which are full agonists.

Zachary Siegel, Troy Farah and Christopher Moraff speak with Molly Doernberg, a grad student at Yale School of Public Health, who co-authored a recent paper called “Demystifying buprenorphine misuse: Has fear of diversion gotten in the way of addressing the opioid crisis?” which was published in the journal Substance Abuse last April. They discuss what buprenorphine is, why people take it, and why stigma and fears that buprenorphine may be used illicitly are actually contributing to more overdose deaths.



Follow Narcotica on FacebookTwitter and support us on Patreon. Your support is appreciated!

Read Doernberg’s paper here: https://doi.org/10.1080/08897077.2019.1572052 and follow her on Twitter.

Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-Producer: Aaron Ferguson
Music: Glass Boy and Aaron Ferguson
Image Credit: Chris Moraff / Edit by Troy Farah