Cognition Switch #8

By Pat Long, Sujata Gupta, Lyra McKee and 6 more

Cognition Switch: An Artefact for the Transmission of New Ideas

Issue #8: August 2019

Featuring Ideas by:
Sujata Gupta, Lyra McKee, Henry Nicholls, Carrie Arnold, Vanessa Potter, Will Storr, Simon Usborne, Gaia Vince, Pat Long, and Catherine Carver

• Language: English
• Publisher: Cognition Switch
• Release date: Aug 1, 2019
• ISBN: 9788834136638

Book preview

COGNITION SWITCH #8

Featuring Ideas by:

Sujata Gupta, Lyra McKee, Henry Nicholls, Carrie Arnold, Vanessa Potter, Will Storr, Simon Usborne, Gaia Vince, Pat Long, and Catherine Carver

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License

Originally published by Mosaic

Published 2019 by Cognition Switch

Please visit us at our website: www.cognition-switch.com

ISBN: 9788829561841

Thank you for your purchase. If you enjoyed this work, please leave us a comment.

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CONTENTS

Blocking the high: one man’s quixotic quest to cure addiction

Suicide of the Ceasefire Babies

Why we still don’t understand sleep, and why it matters

A grown-up approach to treating anorexia

My sudden synaesthesia: how I went blind and started hearing colours

Saved: How addicts gained the power to reverse overdoses

Can you think yourself into a different person?

How to get to a world without suicide

Why being bilingual helps keep your brain fit

My déjà vu is so extreme I can’t tell what’s real any more

Postpartum psychosis: I’m afraid of how you’ll judge me, as a mother and as a person

Blocking the high: one man’s quixotic quest to cure addiction

Whether discussing the cannibalistic ways of mantis shrimp or shaking the sticky foot of a male African clawed frog, Sujata Gupta reports on the strange world of science. She is particularly fond of writing about anything that involves science and food. Her work has appeared online and in print in the New Yorker, New Scientist, Nature, High Country News, Scientific American, Wired, Psychology Today, ScienceNOW, Earth Magazine, PNAS and several other publications.

https://mosaicscience.com/story/blocking-the-high/

Toru had always been anxious as a child, but the problem worsened when he was 19 and attending college in Tokyo, Japan. A social science major, he would feel his heart race every time he had to present in front of his class. A psychiatrist prescribed clonazepam, an anti-anxiety medication that belongs to a class of drugs known as benzodiazepines (which also includes Valium and Xanax).

Initially, Toru felt calmer, even when he had to speak in public. Soon, though, the drugs’ potency began to wane and, after about a year, Toru quit taking them. His anxiety escalated. He stopped sleeping and began experiencing panic attacks, one so severe that he called an ambulance to take him to the emergency room. So Toru did the logical thing: he went back on the drugs.

Despite his struggles, Toru completed his degree and began working in information technology. But he had developed a temper and struggled to hold down a job. At a particularly low point, he destroyed a computer and got fired. After that incident, Toru stopped looking for work. Periodically, he would try to go off the meds again, but the withdrawal symptoms always proved too severe.

Toru’s mother, Machiko, was the first to realise just how bad things had become for her son. He was never angry as a child, she tells me emphatically – the drugs changed him.

As Toru floundered, Machiko began calling his doctors for help, but they stonewalled her. I was seen as an interfering mother, she says. Finally, seeking an escape from another winter in Japan, she decided they should go on a sort of extended drug treatment holiday, winding up in Brisbane, Australia. There they met with a doctor who told Machiko: If Toru were my son, I would go directly to Dr George O'Neil.

George O’Neil is an unlikely saviour for the world’s benzodiazepine addicts. A large man with a cherubic face and slight paunch, his expertise lies not in addiction but in obstetrics and infertility.

I first meet O’Neil at his summer home in Lancelin, about an hour’s drive from Perth. The yard is full of scrubby bushes and meandering trails and, a mile off, one can see the faint outline of the ocean. The single-story house is long and disjointed – the only way to traverse from one room to the next is to exit and re-enter from outside – lending the place the feel of a motel. This is fitting. Here, the O’Neil brood (six children, five spouses and nine grandchildren with O’Neil and his wife, Chris, at the helm) congregate away from Fresh Start, the drug rehabilitation clinic O’Neil has run for two decades with near-maniacal fervour.

Chris tells me that the location is intentional. She’s had addicts drop by their house in Perth and harass her autistic son, Rodney. Once, a deranged patient came to the house and held Chris and her youngest daughter, Jocelyn, then 17, at knifepoint. The patient backed down when Jocelyn cool-headedly pointed out that her anger lay with her father and not them. It was then that Chris realised they needed a safe haven.

O’Neil’s quixotic quest to cure drug addiction began in the mid-1990s when a young woman approached him seeking help for her husband, who was hooked on heroin. Now she was 15 weeks pregnant and terrified about having to raise the child alone. You’re a Christian and a well-known scientist, she pleaded. Surely there’s something you can do. The woman was persistent and very lovely, O’Neil says. She came back every month for 18 months begging for help.

O’Neil may have seemed an odd person for the woman to seek out, but she knew about his other life as an inventor. In his 20s, when O’Neil was completing his obstetrics training in South Africa, he created a localised water filtration system to prevent bacterial diseases caused by inadequate access to clean water, an analgesic inhaler so child burn victims could avoid needles for pain relief and a portable device to rehydrate sick children without resorting to an IV. In the early 1980s, O’Neil invented a catheter that halved the rate of urinary tract infections experienced by paraplegics. To build the device – which remains one of the most widely used catheters in the world today – he established GO Medical (the ‘GO’ comes from his initials), a nonprofit medical device company, in 1984. The catheter was a money-maker and ultimately freed up O’Neil to devote his life to rehabilitating drug addicts.

In one short lifetime you could concentrate on 2000 inventions, O’Neil tells me, but there’s always one that really matters: There’s always a pearl. He found his first pearl in China. There, O’Neil attended a talk by a young scientist working with naltrexone, a drug that appeared to take the high out of heroin (a considerably more potent form of the drug, known as naloxone, was already being used to reverse the effects of an opiate overdose).

O’Neil had his eureka moment. He realised that tweaking blockers like naltrexone for addicts could rein in their cravings. He returned home to Australia and told the woman that he had figured out how to help her husband.

O’Neil’s approach is beguilingly straightforward. Drugs known as ‘blockers’ have been on the market for decades. At high doses, they reverse lethal overdoses, but patients undergo a rapid and excruciating detox. O’Neil suspected that at extremely low doses, blockers could take the high out of opiates like heroin without such a painful detox.

Getting high requires fooling our bodies’ cells. Normally, these cells keep things running smoothly through a system of keys and locks. ‘Keys’ – hormones or neurotransmitters – gain access to cells by binding to specific receptors – ‘locks’. Drugs known as ‘agonists’, including opiates (such as prescription painkillers and heroin) and benzodiazepines, mimic the body’s natural hormones or neurotransmitters and essentially pick the lock. By contrast, antagonists, or blockers, make it impossible for agonists to gain entry by jamming the lock. In so doing, blockers take the high out of drugs. Why, reasoned O’Neil, would an addict continue taking a drug if it no longer feels good?

When O’Neil first started working with naltrexone, he offered it to patients as a daily pill. The formulation was too strong and triggered a rapid, painful detox. It half killed me, one of O’Neil’s patients, who tried the treatment in 2001, told me. Moreover, because forgetting or neglecting to take the pill was easy, staying on naltrexone required pure willpower. As Gary Hulse, a psychiatric researcher at the University of Western Australia and one of O’Neil’s longtime collaborators, puts it: Why would any self-respecting heroin user take it?

O’Neil set to work creating a method of delivery that the addict couldn’t control. He developed a polymer to encapsulate the pill and make it release more slowly into the bloodstream, along with a medical device – which works almost like a Pez dispenser – to implant the pills into a patient. O’Neil’s naltrexone implants can last for almost a year and can be re-implanted indefinitely. Noel Dowsett, the nurse in charge of Toru’s care and a former heroin addict, is on his 11th implant. Methadone you always felt medicated, albeit subtly, says Dowsett, referring to the opiate given to injection users that is supposed to control cravings without inducing its own high. When he’s on naltrexone, though, Dowsett says all that goes through his mind is: God, I’m free. 

In the mid-2000s, O’Neil attended an addiction conference in London where he heard a talk by an Italian researcher. Gilberto Gerra was presenting his research on flumazenil, a drug that appeared to block benzodiazepines in much the same way naltrexone blocks opiates. O’Neil was intrigued. He’d found his second pearl.

Benzodiazepines are among the most widely prescribed class of anti-anxiety drugs in the world – and for good reason. Several years ago, Sean Hood, a psychiatric researcher at the University of Western Australia in Perth, conducted a study of social anxiety sufferers in Bristol, UK. We looked at people who had been unwell for social phobia. On average in that group, they’d been unwell for 28 years before they got treatment. And you give them one of these benzodiazepines, within 40 minutes, they say, ‘My anxiety is better’.

Benzodiazepines were first introduced in the early 1960s, and just a decade later they had become the most widely prescribed class of drugs in the world. In the USA between 1969 and 1982, more prescriptions were written for Valium than for any other drug. Soon, however, signs began to emerge that the drugs were far from benign. They have been linked to grogginess, cognitive impairment and dementia. Worse, addiction can set in within weeks, even at low doses, and the drugs can actually trigger the very same conditions they’re meant to control, such as panic attacks and seizures. Some users who have tried to quit, like Toru, find that withdrawal symptoms linger for months or even years. (One man told me that coming off both meth and heroin was easier than coming off benzodiazepines.) Many countries have now adopted drug policies stipulating that benzodiazepines be used for no more than 2–4 weeks, but such recommendations are frequently ignored.

Flumazenil was first identified as a benzodiazepine blocker in 1981 while scientists were trying to create an even faster-acting benzodiazepine. The drug had a half-life of just 7 to 15 minutes, making it useful for quickly reversing an overdose. The FDA approved flumazenil for that very purpose in 1991.

I call up Gerra, who’s now based in Austria and helping low-income countries establish drug policies with the UN. From 1983 to 2003, he was a practicing physician and spent a lot of time in the ER treating patients who had overdosed. Reversing the overdose with naloxone worked, but patients typically woke up angry and hostile. The patient was dying in a pleasurable way, Gerra explains, and then we put him through profound chemical withdrawal.

Complicating matters, many of those patients had taken both opiates and benzodiazepines, a particularly lethal combination – according to the US Centers for Disease Control and Prevention, about 30 per cent of lethal overdoses involve the mix, which killed actor Philip Seymour Hoffman in 2014. In those cases, Gerra suggested that the hospital also administer flumazenil in as low a dose as possible to avoid hostility during withdrawal. The patients responded beautifully. There was, recalls Gerra, no terrible reaction at all. Flumazenil had the potential, Gerra realised, to become the naltrexone of benzodiazepines.

Gerra’s talk in London inspired O’Neil, who set to work developing a blocker for benzodiazepine addicts. O’Neil knew he wanted something long-acting and addict-proof, like the naltrexone implant. He initially developed and patented a pump, a straightforward device akin to an old insulin pump, which allowed flumazenil to be delivered intravenously over several days on an outpatient basis. But getting addicts to comply with the pump was difficult as it could be removed at will, so O’Neil created slow-release flumazenil tablets designed to go inside an implant.

Jon Currie, director of the addiction medicine unit at Saint Vincent’s Hospital in Melbourne, Australia, raves about both the pump and the implant. I haven't done a gradual reduction of benzodiazepines in ten years now, he says. I just use flumazenil. It’s absolutely revolutionised the benzodiazepine withdrawal process.

In early 2014, Toru and Machiko flew to Perth to meet with O’Neil, who immediately started Toru on the flumazenil pump before switching him over to the longer-lasting implant. In November, when I meet Toru at the small apartment in Perth he shares with his mother, he has just had his third implant.

Broad-boned with a mop of thick, slightly greasy black hair, Toru recounts his story in halting English. Returning home to face all the stressors that prompted him to take anti-anxiety meds in the first place scares him most of all, he says. If I go back to Japan now, I don’t think I can stay away from benzos. Yet everything about his life in Perth feels temporary. The furnishings in the apartment are sparse and the walls unadorned, save for several 8 x 11 sheets of paper tacked up with tape and all bearing the same inspirational message in colourful script: Walk the path! Say Little, Love Much, Give All, Judge Not, Shine up, Keep On, & See Good, followed by footprints walking off the page.

His level of anxiety is really horrific, the most severe I’ve ever seen, Toru’s nurse, Noel Dowsett, says when O’Neil and I reach him over the phone for an update on Toru’s condition. After 25 weeks without any benzodiazepines, Dowsett adds, Toru has managed to get his hands on