Bodybuilding & Nubain Drug Abuse: Real Issue of Addiction to Nubain

Mistaking Nubain for a wonder drug is just that, a mistake. Nubain is a drug all right but it's far from a wonder. A wonder has redeeming value. Nubain is a narcotic, and its only redeeming value aside from being a panacea for chronic pain in AIDS and cancer patients, migraine sufferers and mothers in labor is its ability to insidiously trap its regular users into addiction. Just because it's not injected with a dirty needle in some back alley doesn't mean it isn't every bit as life threatening and debilitating as its chemical counterpart, heroin. The real issue is the disease of addiction, not the name of the drug.

We often overlook addiction as the core issue and see only the drug or the use of the drug. That's why most people think the guy strung out in the alley, disheveled and clad in filthy, urine-stained clothes, is a loser, a man who has chosen humiliation as the price of continuing drug use. They distance themselves from the hardcore addict, confident they'll never be in that position themselves. After all, he uses heroin, and we all know what that makes him. But is he really any different from the pro bodybuilder you spot in the gym who's also regularly strung out on a narcotic?

Certainly the bodybuilder is more functional. His clothes are laundered more frequently. He has a big contract with a supplement company. He buys groceries without having to panhandle. He has a pretty girlfriend with a perfect body, and the world by the tail. What reason would he have to worry? He appears to have nothing whatsoever to worry about, but the truth just below the surface is that he's one flimsy generation removed from that filthy street urchin who leans against a soot-stained wall, begging for change behind heavy eyelids. Most of the distance between them is mere geography, for he's an addict too. There's just no mistaking that he's hooked on Nubain.

A second-string IFBB pro stands outside Gold's Gym in Venice. He's noticeably sleepy. His eyes are drooping and his speech is slightly slurred. Clearly he's not just another man in need of a caffeine boost. He's strung out on Nubain.

The picture is implausible. Why would a professional athlete be using a narcotic, destroying a body he's worked so hard to build? In fact this pro bodybuilder has just finished a heavy leg day. Literally minutes earlier he wrapped up sets of squats with 405,495 and 585. His thighs are swollen - an indication of how arduous the workout was-and he looks mildly ill. The cause of his distress, however, is not the severity of the workout. He worked his legs while in a state of euphoria. He may even have sustained new injuries that he's not aware of yet because his body is under the influence of Nubain.

Insiders will admit that bodybuilding has always been one part pseudopharmacology and one part insanity. It's never been an exact science. It's always been more of an "eye of newt" and "tail of rat" mentality. The small amount of information a bodybuilder does have access to through word of mouth can actually be hazardous. Yet mixing and matching chemicals is commonplace. Knowledge about drugs is typically firsthand, not gleaned from a textbook in med classes.

The human guinea pigs of the sport pride themselves on knowing how much is too much, and what's just sublime. But something has gone terribly wrong in the lab. The monster has awakened, and it's coming for its creator. The backlash has begun.

Who is the monster in this case? Nalbuphine, commonly known as Nubain, is a member of the opiate family of narcotics. (Yes, Nubain is a narcotic.) Nubain is a close relative of heroin, Detnerol and morphine. Like heroin, Nubain is a derivative of morphine. It is a painkiller which affects the brain's pain and pleasure systems, and interferes with the brain's ability to perceive anything but pleasure and relaxation. Sounds good, right? Well, initially it probably does feel good. But when the body begins to need more of the substance at more frequent intervals - because the narcotic has taken hold- it's far from pleasurable. It becomes a "have to;' and the perception of need is both physiological and psychological.

The question is, why are bodybuilders using it? Arguments for the use of steroids and growth hormone are plausible ones at least because they offer the opportunity to enhance athletic performance and promise to build muscle. But why are these men of muscle using a drug that is little or no help in the process of muscle hypertrophy? Pain relief is one answer. However, it isn't a viable one because drugs like Nubain are prescribed only for severe pain relief Steroidal and nonsteroidal anti-inflammatory drugs apply in the case of joint and soft-tissue injuries where indicated. Unless a bodybuilder is doubled over in pain, use of narcotic preparations is contraindicated.

Let's not mince words here. Most bodybuilders begin using Nubain for pleasure, relief of slight joint pain, or to kill the appetite. All of a sudden they discover they are no longer using it just for that purpose, but to maintain chemical dependence. The next most common reason bodybuilders use the drug is that they believe using Nubain will block the release of cortisol into the bloodstream. Cortisol is normally released in response to stress in the body, particularly during and after heavy workouts or periods of competition diet and training. So the general idea would be to find some substance to prohibit this release in order to optimize muscle-growth opportunities that follow resistance workouts.

The embarrassing fact about this theory that Nubain blocks the release of cortisol is that it's absolutely untrue. Even if it were true, the amount of cortisol released has never before appeared to prohibit bodybuilders even as recently as ten years ago from packing on mass. In truth, there is no empirical evidence to suggest Nubain is capable of doing this. A guy like Dan Duchaine may say so, but there's just no proof out there like that.

Dr. David Murphy, MD, director of the Exodus Recovery Center in southern California, and an expert in addiction medicine, states emphatically: "Saying that Nubain blocks cortisol release is just a smoke screen. There just isn't any conclusive evidence. Even if it did, using a narcotic to do it is a pretty far- reaching and severe method of blocking cortisol release, isn't it?"

He goes onto explain why bodybuilders have made the connection in the first place. "When Nubain is injected, a general relaxation and stress-release action occurs. Without stress little cortisol is released. In that sense Nubain may reduce cortisol, but it isn't an actual blocker itself. The issue isn't about whether it does or doesn't. The issue is about addiction and using an illegal substance that is potentially very harmful. Is the prevention of cortisol worth that? It's like having a skinned knee and instead of using Bactine, you inject yourself with heroin to kill the sting. Nubain - just doesn't make any sense!"

If the parameters for stress-induced cortisol release are present throughout the entire year-during heavy workouts, intensified rapid workouts and precontest diets-when would Nubain not be used? Therein lies the trap. The use of Nubain rarely ends once it starts. When it does end, it usually ends with serious consequences.

THE HOOK

Nubain isn't a drug a person can jump on and off at will. It's a narcotic with as much abuse potential as any other narcotic despite the light warning it may have received in the PDR (Physician's Desk Reference). Make no mistake. It's a member of the opiate family of drugs, just as heroin and morphine are, and it is almost always addictive.

THE THREE TYPES OF OPIATES

Opiates come from the poppy plant, and are harvested from the seeds in the stamen of the flower. There are three different types of opiates: opiate agonists (such as heroin, morphine, Demerol), opiate agonists/antagonists (Nubain, Naltrexone) and opiate antagonists (Methadone). Agonists such as heroin bind to different receptor sites than antagonists or the combinative agonist/antagonist opiate narcotics, just as the other two groups bind with their respective receptors.

THE OPOID RECEPTOR SITES

The receptor sites commonly associated with opiates are mu, sigma and kappa. These sites are like antennae that pick up the presence of whatever substance they resonate with and grab onto it. It's like fitting an electrical plug into a wall. A three- pronged plug would never fit into a two-pronged outlet. Since a set of Nubain receptor sites has both opiate agonist and opiate antagonist information, if heroin were to be introduced, it would bind to only half of the receptors since heroin is only an agonist. Further, it would block the action of the heroin in some of the receptors because half of its action is antagonistic to opiates. Methadone, on the other hand, being a full antagonist, would antagonize the action of heroin, thereby blocking its narcotic effect in the opiate agonist receptors.

Confused? Whether agonist, antagonist or a combination of both, all are still narcotics. That means they all have the potential for addiction, but to some extent are lesser evils of the same theme.

Mixing agonists and combinative types (agonist/antagonist) or mixing antagonists and combinative types can lead to immediate death-a case of too much overkill in one receptor type or the other.

WITHDRAWALS

Bodybuilders often don't want to stop taking a certain drug for fear its absence will be too painful. This process is called withdrawal. Psychological withdrawals often occur with steroids. Narcotics produce physical withdrawals which are difficult to bear.

Staff at the Exodus Recovery Facility in the Brotman Medical Center in Culver City, California, treat much of the general public. They also see many bodybuilders for steroid abuse, diuretic abuse, recreational drugs and narcotic painkillers such as Nubain. Dr. Murphy, director of the center, advocates getting off narcotics at all costs. That may mean incredibly uncomfortable withdrawal symptoms, but Murphy is quick to dispute the many myths about withdrawal from Nubain that bodybuilders perpetuate. "I've heard a lot of them say they didn't want to get off Nubain because they thought the withdrawal would be too severe. Well, it's no walk in the park, but it's also a necessary evil, especially at an early stage when withdrawal isn't going to be as painful?'

A patient can expect to experience flu like symptoms such as nausea, vomiting, fever and gooseflesh when ceasing to use Nubain. Murphy promptly reassures, however, that there is "very little risk of seizure associated with Nubain withdrawal. We see many more seizures from the beam group (benzodiazapines such as Valium and Librium). Alcoholics even seize way more often than narcotics addicts ever do?'

Believe it or not, that's the good news. Now here's the bad.

ADDICTION AND THE ADDICTION CYCLE

Talk to any persons in Narcotics Anonymous or Alcoholics Anonymous, and they'll tell you not everyone who drinks alcohol or takes drugs is an addict. Addiction, or the lack thereof is a very thorny subject, one that is highly charged in some circles. To some, everyone who uses a chemical is an addict. To others, like Dr. Murphy and other medical personnel associated with drug rehab programs, many more variables need to be present to determine whether a patient is an addict or not.

What is an addict? Generally an addict is a person who cannot live without a particular substance and will sacrifice many other core aspects of his life to procure and continue using that substance. The drug of choice doesn't necessarily need to be present every day for a person to be diagnosed as an addict, however. In fact, many addicts fool themselves for years by simply abstaining for periods of time, or by skipping addictions so that no one substance can be singled out as problematic. With a drug such as Nubain, or any other narcotic, that dodge becomes a bit more difficult. If an addict's narcotic use were mapped on a grid using frequency vs. amount, the graph would take a much sharper upturn than one showing the same criteria for marijuana use.

ABSTINENCE / RELAPSE

Abstinence is key, especially for a person who has used narcotics or other drugs (including alcohol) over the course of his or her life. Some people who have maintained abstinence have then returned to drug use very abruptly in a relapse after many years on hiatus from its use. What becomes of this type of user? Dr. Murphy says this situation can potentially be more dangerous.

"We all have a level of tolerance for a drug within our bodies. It's different for everyone. We all have a limit to what our bodies can take. When a Nubain or heroin user leaves that drug behind, and then for some unforeseen reason returns to it again, the chance of overdose is great. In fact, it's the second- generation user we see overdosing time and again. You'd think that if the person used it once he would have a good idea of his own level of tolerance, but that changes with age. It changes according to where you arc in the addiction cycle over the course of your life. The subject may not even inject the same large dose from the tail end of his previous stint. It could be a fraction of that, and still constitute an overdose that could kill him. Everyone's personal LD-50 ratio is different, even on different days."

LD-50

The LD-50 of a drug means the lethal dose at which 50 percent of the lab animals being tested die from an injection. Research scientists arbitrarily come up with a starting dose that they believe will be lethal to animals. Then they adjust the dose until the LD-50 is determined. That could be 20m1 or it could be 10 ml. It all depends. And that is just an average.

Human beings have their own LD-50 matrix. Yet, according to Murphy, that changes, often on a daily basis. For the ex-addict who returns to using, the LD-50 can be a very volatile, highly fluctuating figure. That's the complicated part of self- medicating. A lay person cannot easily determine what will be enough and what will be way too much. Finding that out can mean the individual dies on the spot. Obviously the information isn't much use then.

BETTER LIVING THROUGH CHEMISTRY

The problem is, bodybuilders feel like invincible creatures. By their very nature they are superheroes, human cartoon icons who have evaded consequence from the use of illegal substances and have reaped the bounty of physical rewards for the brilliance with which they combine drugs. A bodybuilder who has never had a health problem, yet has packed on 100 pounds of mass in five years, has difficulty grasping the concept that his choice to use Nubain is a poor one.

It's a bitter pill to swallow because most bodybuilders have been, by all appearances, successful at chemistry. Even those academic slackers who tended toward the back of the room in science class are excelling at their unofficial craft of amalgamating chemical compounds. Telling a self-crowned science- fair king that he needs to eliminate Nubain from his drug program is like telling a kid to refrain from masturbation to avoid the punishment of hairy palms. Somehow, it just doesn't seem to make sense when put in those ridiculous terms.

The fact is, however, risk is ever present with drug use. One wrong move could cause a chain reaction of health problems to be set in motion. What would appear to be innocuous experimentation (pseudopharmacology) in one instant turns out to be a nightmare in another. One never knows the direction chemicals will take once introduced into the system, especially if more than one drug is ingested at a time, (Okay, we're talking about bodybuilders here. Of course there's more than one chemical at a time.) Add to that regimen any sort of recreational use of drugs or alcohol and the athlete may be sitting on a ticking time bomb.

CONCLUSION

Nubain, like other narcotic analgesics, has the potential for abuse. Psychological dependence or physical dependence and tolerance may follow repeated administration. Those prone to depression or addiction are at special risk. Narcotics do have a place in legitimate chronic pain management. AIDS patients, cancer patients and a host of other chronic pain sufferers deserve comprehensive pain relief. As most addiction specialists will point out, users don't make abusers. To remain only a user, however, and not slip into abusing, you must legitimately need a narcotic to manage pain so that you can function properly. If you do, it's a godsend. If you don't need a narcotic and are using it for its tranquilizing, pain killing, euphoric effects, you may just have entered a nightmare that you will never walk away from. Narcotics never have a place in the hands of amateurs. Only a doctor is qualified to dictate dosing on the basis of a patient's health profile. While bodybuilders maybe able to dabble in the little leagues of hormonal manipulation, narcotic manipulation is like the majors. And you just don't go from little league into the majors, no matter how good you are.

There's no free lunch anywhere in life, especially with drug use and the cycle of addiction. Eventually haphazard and addictive drug use and abuse will catch up to you. Many experts agree that extended periods of drug use serve only to make the whole addiction cycle telescope much sooner. The more drugs you use, and particularly in combination, the more rapidly the addiction cycle progresses.

THE FAMILIES: THOSE WHO SUFFER MOST

Addicts suffer from a comprehensive, progressive, eventually fatal disease that engulfs - then consumes - the physical, emotional, psychological and spiritual realm of their existence. It pervades all areas of an individual's life. Though this debilitating disease will eventually claim the life of those who go untreated, the most lost and disenfranchised in the shuffle are their families. Loved ones suffer perhaps most of all.

Drug use is a selfish, singular pursuit with zero redeeming value for anyone loving, living with, or working alongside the addict. Family members struggle to comprehend the neglect, the anger, the negativity, the despair and the compulsion that overpower both the addict and, often, themselves. To say that untreated addiction and eventual death affect and upend families of addicts is a vast understatement. Lives are inexorably changed, for both the survivors and the victims. Voids are created and filled every day.

Just remember, you're some mother's son or daughter. You're somebody's brother or sister. You're somebody's father or mother. You're a grandchild, a niece or nephew, an uncle or aunt. You're either an addict or you're in recovery. Depending upon which, you can either stick around to fill all these shoes over the course of a rich, long life, or you can progressively spiral toward death.