Drop It Like It’s Hot = Johnny Depp + The Rarely Heard Opioid Shower
“Withdrawal feels like the very inside of you is trying to escape your body”
Prescription opioids pirate pain-filled lives while society pours megapints of economic burden. During his defamation lawsuit, Johnny Depp revealed that a back injury led him to a “roxies” addiction. Seeing himself on the path of the heroine “junkies” he shunned, Depp jetted off to his private Bahaman island and showered himself with scalding hot water.
Wait… what?
He described battling withdrawal by standing under extremely hot water to “trick” his ‘receptors or neurons away from the pain’. Scientists should be alarmed that people are driven to burn their skin in an effort to feel less pain from clinically developed prescriptions.
Roxies = Roxicodone*, immediate-release opioid drug, drowsiness is a side effect
Depp testified that he was given the drugs phenobarbital, lithium, Seroquel and Neurontin to combat the pains from withdrawal. In Little Hall’s Ponds Cay, he was to take a personalized treatment at a certain point before the onset of withdrawal symptoms (e.g. stomach pain), but his then partner, Amber Heard, would not administer them. A dispute ensued about the timing for need or desire. Clinical observations for Seroquel have shown that patients are careful to not miss a timely dose because symptoms are considerably painful. After breaking down on the floor to “beg” for the meds to no avail, Depp hit the “scalding” shower.
Depp V Heard Trial Day : Johnny Depp discusses undergoing detox from “roxies” and overcoming opioid addiction. (Image: Law and Crime TV)
Neurontin = gabapentin for alcoholism + no benefits in opiate addiction + sleepiness is a side effect (anticonvulsant)**
Seroquel = quetiapine for schizophrenia + weakens withdrawal symptoms from opioids during detox + sedation is a side effect (antipsychotic)
“When your receptors are in full bloom and begging for the opiates that my body had become used to, that the receptors were being fed by.”
The “trick” = Depp’s scalding shower replaced the pain of withdrawal with the pain of burning skin.
This self-induced thermal therapy has been clinically reported in some marijuana users who suffer from cannabinoid hyperemesis syndrome (CHS). Habitual users of substantial amounts of marijuana estimated that hot showers moderately relieved withdrawal symptoms and some can only mitigate CHS with hot baths. CHS compares to opioid withdrawal symptoms in nausea, abdominal cramps, agitation and anxiety. The alleviation of these symptoms might be due to opioid receptors in the dermis and gastrointestinal (GI) tract.
“The scalding shower would reverse the nerve endings and they would go up to the top of the skin because there was a problem”
Despite clinical observations, how hot showers relieve opioid withdrawal pain is scientifically unsubstantiated. Essentially, the nervous system is in shock when a substance abuser stops providing the addictive substance that maintains common reward feelings. Changes in the neurochemistry, neurobiology, and brain structure during substance abuse manifest in withdrawal. Like long term heavy marijuana use, opioid use can alter an addict’s “pain system” to make pain more susceptible when immediately abstaining and beginning detoxification. The hot shower is likely a diversion method because the nervous system is focusing on one pain rather than the other.
Feel It:
Drugs + Receptors = Interactions
Cannabinoids and opioids are not the same, but are also not different in pain. The difference is partially attributed to drug-receptor interactions and functions despite both attaching to G protein-coupled receptors (GPCRs). The correlated symptoms may be due to the activation of receptors connecting the gut-brain axis since cannabinoids “overstimulate” gut receptors and “downregulate” brain receptors. Cannabinoids inhibit the HPA axis after they activate CB1 receptors, possibly giving rise to CHS.
Receptor = molecule that drug attaches to, triggering events inside you
GPCRs = sense signals outside cell so it can trigger responses inside of cell
HPA (Hypothalamic–pituitary–adrenal axis) = brain/gland areas involved in digestion and mood regulation
CB1 = cannabinoid receptor in brain etc
Skin + Neurons = Pain
In addition to pain receptors, thermal receptors adjust for dangerous situations. Scalding water (48°C/118°F) is extreme for regular body temperature (37°C/99°F), thus activating pain receptors under the skin to sense a burn. These receptors are deposited along pain nerve fibers that become stimulated through chemical alterations at approximately 45°C/113°F. When Depp submerged his body in scalding water, the additive stimulation “tricked” the signaling pathway along nerve fibers because of the similar sensory interpretation as withdrawal pain.
Bottom Line:
While this may seem like a profligate celebrity trial, it publicizes the harm on our social structures and economic stability from addiction to prescriptions. The highly addictive nature of the “roxies” prescribed to Depp and the opioid epidemic are well documented. The fact that this particular treatment is intended for moderate pain should be unnerving due to the gravity of its negative impact. Cultural phenomena do not circumvent science despite how gossipy they seem. We can’t just burn away our lab creations.
“I won’t take opiates again unless I want the pure horror of detoxing coming off those drugs.”
Image from Send me No Flowers
* OxyContin = controlled-release
** limited to the scope of this article
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