THE ANATOMY OF AN ADDICTION

It's not hard to understand how something that reduces pain, induces
euphoria and reinforces its own consumption could be addicting.

And that's just the problem with opiates, a group of drugs that
convert into morphine in the brain and attach to receptors
controlling those three very basic sensations.

"I don't know of any other drug that can do that," said Dr. Joan
Coffin, a King's College psychology professor and neuroscientist.
"People experience a dreamlike state. That's why a person who is
addicted to an opiate is unaware of the horrendous surroundings they
find themselves in."

There are many opiates, natural and synthetic, and many of them are
used legally every day. Aside from legal status, the group is mainly
differentiated by efficacy, or potency, which ranges from low, such
as codeine, to medium, such as OxyContin, to high, including pure
morphine and heroin.

Fentanyl, an extremely high-efficacy opiate linked to more than 100
deaths in the country in the past several months, has been estimated
at roughly 100 times more potent than morphine.

"If you want to encourage someone to be a regular user (of a drug),
throw a little of this in," Coffin said.

That's exactly what heroin producers are doing, cutting amounts of
clandestinely made fentanyl into batches of the yellowish, powdery,
illegal drug. However, dealers aren't telling users how much was
added, or even that any was added, and it's that lack of
communication that's killing their customers.

An amount of fentanyl equal to five or six grains of salt can cause a
fatal reaction in an adult by depressing the breathing center in the
brain's medulla and creating a breathing suppression that leads to
asphyxiation. Since both heroin and fentanyl convert to morphine in
the brain, a user's regular dose intrinsically becomes an overdose.

"Heroin use has always been there, but people who use it know how to
manage it, unless somebody changes the concentrations and composition
of the drug," said Luzerne County Coroner Dr. John Consalvo, who has
become alarmed by a recent rash of overdose deaths linked to the
fentanyl/heroin blend.

"I don't know that people who are buying really know that this is
going to happen to you," Coffin said, adding she has heard stories of
users dying from a fentanyl overdose before the next addict was able
to shoot up.

It's improbable that addicts will snap out of the addiction on their
own, either. The drugs create such illogical reasoning in the minds
of users that they often flock to highly potent batches of drugs
rather than avoiding them, in hopes of achieving a high so effective
it borders on death.

"We're talking about ... drugs that reward down on the level where
the brain simply has the purpose of survival," said Ed Pane, the
president and chief executive officer of Serento Gardens, a Hazleton
drug and alcohol rehabilitation center. "Without external
intervention, (rehabilitation) ain't gonna happen."