The Opioid Catastrophe!

With 10.3 million misused opioids, 130 people dying from opioid related causes every day, and 2.0 million people with opioid addiction disorders in the US in 2018 alone, how did we get here? 

In the past, opioids were only given to those who were terminally ill, had very severe acute pain, or were suffering from cancer. 

In the mid 1990s, physicians began providing opioids to patients to relieve pain, at alarmingly high rates as a result of pharmaceutical companies aggressively marketing “less addictive” opioids such as oxycontin. This led to increased accessibility of opioids to the general public.

The majority was unaware of opioids true addictive qualities, hence patients continued to request doses, and physicians to prescribe. It was only when this small mishap transformed into a national crisis- when opioid prescriptions exploded- that the pharmaceutical companies and physicians realized their mistake: that these ‘new’ opioids are still dangerously addictive. But why?

Opioids are most commonly used as painkillers. Codeine, morphine, oxymorphone, hydrocodone, and fentanyl are all types of opioids. Opioids are used to treat very severe persistent pain and are also used for anesthesia. They can be prescribed to those with migraines, injuries from sports or accidents, back pain, or pain associated with cancer or surgery. 

Opioids attach to the opioid receptors found most on nerve cells in the spinal cord, brain, and gut. This binding prevents pain signals from the body to reach nerve cells in the brain, hence working as a painkiller. Opioids essentially prevent a nerve cell from doing its job.

With repeated use, drug dependence occurs, where the neurons adapt to only function properly in the presence of the drug. While effective at reducing pain, opioids can be extremely addictive. Reason being that opioids condition the body to believe that opioids are necessary for survival and ease. Opioids stimulate the reward areas of the brain, stimulating dopamine production and creating a feeling of euphoria. Opioids are able to do so by binding to inhibitors, in the VTA (Ventral Tegmental Area) of the brain, thus preventing these inhibitors from doing their job, which is to inhibit dopamine production unless something good occurs. This lack of inhibition causes great production of dopamine, making the person feel euphoric. 

Patients often get addicted to this feeling of euphoria, and ease of pain. Over time, the body learns to tolerate certain opioid doses, more opioid receptors are created, and then begins to crave larger and larger doses, which can lead to addiction. 

The explanation for this cycle is tolerance. As the body’s tolerance of opioids increases, the person needs more and more opioids in order to stimulate dopamine production. Hence, the person increases their dose amounts. This cycle is dangerous, as withdrawal makes it extremely tough to break free. The road to recovery is possible but extremely tough.

Another major issue which poses thousands of former opioid users is heroin, an opioid made from morphine. Many people recovering from addiction get addicted to heroin, completely stunting their chances of full recovery. 

In the midst of this calamity, there still remains hope. With increased awareness in the past few years about opioids, measures being made, and serious discussions being conducted about the ethics of these painkillers, there does appear to be light at the end of the tunnel. 

Citations:

Assistant Secretary of Public Affairs (ASPA). “What Is the U.S. Opioid Epidemic?” HHS.gov, https://Plus.google.com/+HHS, http://www.hhs.gov/opioids/about-the-epidemic/index.html.

Lipari, Rachel N, et al. “WHY DO ADULTS MISUSE PRESCRIPTION DRUGS?” Why Do Adults Misuse Prescription Drugs?, 27 July 2017, http://www.samhsa.gov/data/sites/default/files/report_3210/ShortReport-3210.html.

Margolis, Elyssa. “The Role of the VTA-Lateral Habenula Circuit in Opioid Mediated Behaviors.” Grantome, NIH, 1 Sept. 2017, grantome.com/grant/NIH/R01-DA042025-01A1.

“Opioid Overdose.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 May 2020, http://www.cdc.gov/drugoverdose/.

“Understanding the Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Mar. 2020, http://www.cdc.gov/drugoverdose/epidemic/index.html.“What Are Opioids? – When Seconds Count.” When Seconds Count | Anesthesia, Pain Management & Surgery, http://www.asahq.org/whensecondscount/pain-management/opioid-treatment/what-are-opioids/.

Images:

https://www.theguardian.com/us-news/2018/feb/10/oxycontin-maker-purdue-marketing-opioids-painkillers

https://tincture.io/the-opioid-crisis-time-for-a-change-27de0c2af5c6

Understanding Naloxone

https://www.matclinics.com/matclinics-blog/2017/2/20/why-is-it-so-hard-to-stop-using-suboxone