Vietnam, heroin and the lesson of disrupting any addiction

Updated 8:12 PM EST, Tue December 22, 2015
ST. JOHNSBURY, VT - FEBRUARY 06:   Drugs are prepared to shoot intravenously by a user addicted to heroin on February 6, 2014 in St. Johnsbury Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun to devastate many communities in the Northeast and Midwest leading to a surge in fatal overdoses in a number of states. As prescription painkillers, such as the synthetic opiate OxyContin, become increasingly expensive and regulated, more and more Americans are turning to heroin to fight pain or to get high. Heroin, which has experienced a surge in production in places such as Afghanistan and parts of Central America, has a relatively inexpensive street price and provides a more powerful affect on the user. New York City police are currently investigating the death of the actor Philip Seymour Hoffman who was found dead last Sunday with a needle in his arm.  (Photo by Spencer Platt/Getty Images)
Spencer Platt/Getty Images
ST. JOHNSBURY, VT - FEBRUARY 06: Drugs are prepared to shoot intravenously by a user addicted to heroin on February 6, 2014 in St. Johnsbury Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun to devastate many communities in the Northeast and Midwest leading to a surge in fatal overdoses in a number of states. As prescription painkillers, such as the synthetic opiate OxyContin, become increasingly expensive and regulated, more and more Americans are turning to heroin to fight pain or to get high. Heroin, which has experienced a surge in production in places such as Afghanistan and parts of Central America, has a relatively inexpensive street price and provides a more powerful affect on the user. New York City police are currently investigating the death of the actor Philip Seymour Hoffman who was found dead last Sunday with a needle in his arm. (Photo by Spencer Platt/Getty Images)
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Story highlights

In 1971, 15% of the active American soldiers in Vietnam were heroin addicts

Operation Golden Flow kept them in Vietnam until they detoxed

The number of relapses among those soldiers was much lower than the average population

Editor’s Note: Dr. Sanjay Gupta, a practicing neurosurgeon, is the multiple Emmy-award winning chief medical correspondent for CNN. The views expressed are his own.

(CNN) —  

When the U.S. military launched Operation Golden Flow nearly 45 years ago, no one could have anticipated the impact it would have on the study of addiction, behavior and your brain.

It was 1971 and U.S. Reps. Robert Steele and Morgan Murphy had just returned from an official visit to Vietnam with news that stunned the American public: 15% of the active soldiers were heroin addicts. Given President Richard Nixon’s promises to both end the war in Vietnam and solve the rising domestic crime rate, this news was especially unsettling.

Unintended consequences: Why painkiller addicts turn to heroin

As a result, Operation Golden Flow was born.

It is what it sounds like. American soldiers in Vietnam would not be permitted to board a plane home until they passed a urine drug test. If they failed, the soldiers would be forced to stay in Vietnam, detox and try again. The expectations were low, given the extraordinary addictiveness of heroin. It was already thought to be the most addictive substance ever produced and impossible to escape.

Why is heroin so addictive?

Researchers at Johns Hopkins were wondering the same thing, right around the same time. In 1972, they stumbled onto an unexpected explanation. They discovered the brains of humans contained naturally occurring receptors for opium. The implications of this were significant. It meant substances such as codeine, morphine and heroin had a natural landing spot in the brain. When ingested, they would light up something primitive deep in our neurons. This is a trait all humans share, evolutionarily.

How heroin kills you

Even more remarkably, they figured out the active ingredients in opium, and all of its derivatives, were nearly identical to chemicals we already have in our brains – endorphins – the feel-good stuff giving us a sense of euphoria after we exercise. (They finally had proof a runner’s high really was a runner’s high!)

As a result of their work, we now know endorphins are the natural opiates of the human body. And, like opium, not only did endorphins relieve pain, they made us feel good. Really good. Sometimes addictively good.

The problem is, unlike endorphins, opium doesn’t require us to exercise to get that good feeling. We could now simply get it through an injection.

And none of the opiates worked faster than heroin. Its chemical structure allowed it to be soluble in fat, and cross the blood brain barrier resulting in a near immediate rush, and subsequent high.

It was almost as if it was chemically designed to be addictive, which of course it was.

Father loses son to addiction, ends up in recovery himself and then …

To make matters worse, frequent users of heroin slowly dampen their brain’s feel-good reward centers, known as the nucleus accumbens, which is stimulated by dopamine. When someone takes a substance like heroin, as opposed to relying on natural endorphins, the dopamine surge is more rapid and longer lasting. The problem is the nucleus accumbens can start to become fatigued from such excessive stimulation. The result: An addict needs escalating doses of heroin to get increasingly diminished pleasure.

In addition, a heroin user would now have a reward center in the brain with very low levels of baseline activity. So when they weren’t using heroin, they crashed and hard – which helped explain the dramatic highs and lows of the heroin addicts brain.

For all these reasons, heroin became scientifically regarded as one of the most dangerously addictive drugs on the planet, in terms of dependence, withdrawal, tolerance, reinforcement and intoxication. Relapse is almost guaranteed, and heroin use is now intensifying dramatically, even in previously unexpected populations. Some of the greatest increases are occurring in higher income women and overdose deaths from opiates have quadrupled over the past 10 years, according to the Centers for Disease Control.