Why do so many Alaskans switch from prescription opioids to heroin?

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ANCHORAGE (KTUU) - Politicians, health and social workers, and law enforcement agencies speak often about the alarming number of Alaskans who die by overdosing on heroin and prescription opioid painkillers.

Still, many struggle to understand how someone could switch to street drugs from pills that are marketed by pharmaceutical companies, handed out by trusted physicians, and regulated by federal agencies.

Channel 2 News posed that question to leaders from Akeela, the key organization that treats people battling addiction in Alaska.

Sen. Dan Sullivan on Monday spoke at an event at Bear Tooth Theater Pub and Grille that attempted to help people better understand the crisis.

Before that event, Channel 2 News asked the Republican senator about the role doctors play in getting people addicted.

Read excerpts of the interviews below, and watch in the video above:

Why are so many people here and around the country shifting from prescription painkillers to illegal drugs like heroin and fentanyl?

"The doctor has to satisfy a pain scale, so when you're in the physicians office, and they ask you if you have pain, then I need to write you a (prescription) if you tell me that your pain level is at an eight. I'm not always telling you or giving you the full breadth of information about the dangerousness of this opioid that I'm prescribing to you. I have legitimate pain, I came into see you, and my doctor -- a safe, trusted provider -- wrote me a prescription for these 15 opiates. Well, I come back in another two weeks, and my pain is still at this level, and I come back in another two weeks, but I'm short on my pills because I need more. And addiction happens just that quickly. Our bodies become dependent on the drug in a very short amount of time, and it differs for individuals. You will develop a dependency, and once you develop a dependency on a drug, your body starts reaching these set points of tolerance where you need more and more to achieve the same effect. So, my knee is still hurting, and I could take two oxies, but now I need three. Now my prescription is not lasting until the end of that 30 days, and my doctors redflag, 'OK, this is my third time the prescription has run out early.' And insurance is saying they're not going to pay for this anymore. So what am I going to do? I talk to my friend or family because, people think, 'I'm not a drug addict, I have legitimate pain.'

So now I have a friend that says, 'Hey, I know a guy.' And that's how it starts, just that quickly. 'Hey, I know a guy that can sell these to you.' Once you've reached that point where you don't have $600 a day to buy the amount of Vicodins you need, he says, 'I can give you heroin, and it does the same thing.' And you have people that say, 'No. I don't want to do that.' But the cost and the physical dependency that's happened in the body wants to be satisfied. Even though it's prescribed, it doesn't mean that wipes away the fact that you've become addicted to this. What a lot of individuals don't realize is that heroin and your Vicodin, Oxycodone, all of these other opioid derivatives are all in the same opioid drug category.

Think of the receptors in the brain almost like a parking garage where you've got the compact car slots and your regular slots, your heroin and your oxy are all opioids, so they're going to sit in that same compact car slot. They will fill that receptor site in the exact same way. The only thing is that your prescribed medications are going to have a longer effect, depending on how long you've been on the medication whereas heroin is going to have a shorter effect, and it's going to happen more quickly. But once that site is empty, you still need to park another car in there.

The brain doesn't care if it's a pill or if you're snorting or shooting up heroin: it wants that receptor site filled. So people kind of have a real misconception that in the early sixties, seventies, and into the eighties, they started with heroin. But we don't see that anymore. Individuals who are heroin addicts now generally started because of friends, family, or a personal prescription."

Federal and state governments have responded to the opioid crisis by pumping money into agencies that provide rehabilitation treatment services and other things like that. A new state law also requires pain management training for many health professionals, with the goal being to make it so more people understand how to avoid getting addicted.

One thing that has largely been ignored is making new laws that would enact harsher punishments for doctors that over-prescribe painkillers. What do you see as the next response needed to make it so less people are addicted?

"I really believe it's the prescriptions. I really believe that doctors are over-prescribing, that they're not educating the folks that they're prescribing: whether they're 12 years old coming from the dentist office or whatever the age is. It doesn't matter. Addiction doesn't see your age.

Doctors need to look at how they're educating folks, how they're writing prescriptions for folks. 30 Vicodin for a tooth extraction, that doesn't make sense.

Getting into the politics of that, what happens is, there's so much big money now that we're talking about it, but it stops there. The work stops. Until something else major happens, like somebody on Capitol Hill's child (overdoses) or gets caught up in the spiral of this addiction, again the lights get on.

We got the first step of that hitting the ground running, but there's more to be done. When's the next step? We started but it's got to keep going.

Doctors, the over-medication, that whole piece there, who's going to regulate that?"

Is it tough for politicians to go after doctors? They play a big role in people getting addicted to opioids and in the trend we see in Alaska and nationally, but you'd be going after people who hold respected places in the community and say, 'Hey, you're a big part of this problem.

Is that a difficult thing to do?

"It's really important to look at the origins of this problem. You have leaders of medical schools, federal officials in the 1990s saying ... (opioids) somehow, that they weren't addictive. Well, they are addictive. They've been addictive for thousands of years, so it's not going after doctors per se. It's going after the origins of the problem. And again, we've got to power through this crisis because it is heartbreaking. I know -- you and I talked about it before the show -- we see how many young Alaskans, young Americans, are being negatively impacted, and it cuts across all demographics, all parts of the state. It's something that we have to come together and work more on to go after the origins of the crisis and really address it."

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