Opioid Addiction and How It Happens
11/01/19: Drug AddictionOpioid abuse has exploded over the past decade, leading to one of the worst drug crises the United States has ever seen. And it’s no wonder that opioids are the cause — not only are they highly addictive, but they are prescribed at a rate of 58.7 prescriptions per 100 people, totaling more than 191 million opioid prescriptions in 2017. In 16 percent of U.S. counties, enough opioid prescriptions were dispensed for every person to have one (CDC). Fortunately, we have seen a decline in the rate of prescriptions since its peak in 2011, but the crisis still persists. Why has this become such a huge problem, and how is it that people become so easily addicted to this form of drug? In this article, we will discuss the reasons that opioids are so dangerous and how addiction takes hold in the brain, among other things.
What are opioids?The term “opioids” applies to any substance that works by binding to the opioid receptors in the brain. The term covers a wide range of substances, including prescription painkillers like oxycodone (as found in OxyContin), hydrocodone (as found in Vicodin), codeine, and morphine, as well as illicit drugs like heroin and the synthetic, fentanyl. Some opioids, like morphine and codeine, occur naturally in opium. Opium is a gummy substance that can be harvested from the seed pod of the opium poppy, native to southern Asia. Others, such as heroin, are made by mixing a chemical with morphine. Most opioids these days are manufactured synthetically from chemicals. Prescription painkillers containing opioids can come in a variety of forms, including tablets, capsules, syrups, solutions, suppositories, etc. Opium comes in dark brown chunks or powder, and can be ingested orally or smoked. Heroin can typically be found in a white or brownish powder.
How do opioids affect the brain?Opioids primarily affect the central nervous system by altering the user’s physical and emotional response to pain. Neurons are covered in proteins called “opioid receptors”, which slow down the neurons’ ability to send pain signals to the brain. When your body is injured, your brain releases natural painkillers called endorphins which activate these opioid receptors. The chemicals within opioids are almost identical to our natural endorphins, and act in the same way, unlocking the opioid pain receptors to slow pain signals. At the same time, however, this process affects the area of the brain called the Ventral Tegmental Area (VTA) which is full of neurons that produce dopamine. When dopamine is released, it gives the person a feeling of pleasure. Under normal circumstances, inhibitory neurons prevent too much dopamine from being created, and only releases the chemical when something good happens. These neurons are also covered in opioid receptors, so when an individual ingests opioids, this area is affected as well. In this case, the inhibitory neurons release the “breaks”, which causes the brain to flood with dopamine in response.
How do people become addicted to opioids?Opioids, even when taken in the recommended dose, can cause feelings of extreme relaxation and euphoria because of the release of endorphins in the brain. Feelings of pain are not only abated, but they are also replaced by pleasurable sensations. On top of this, opioids actually cause a shift in the chemistry and activity of your brain, which is the most dangerous part. The longer a person uses opioids, over time the brain will attempt to balance itself back out again after it realizes that there is an overflow of endorphins and dopamine being produced in response to the opioid. To do this, the inhibitory neurons begin working overtime to slow the production of dopamine. This is called building a tolerance, and most people respond by increasing their dose of the opioid, which can be extremely dangerous.
Tolerance and WithdrawalAfter taking opioids for an extended period of time, the drug can become central to a person’s thoughts, emotions, and activities. But tolerance is more than that. It’s a physical adaptation that results in withdrawal if the person does not continue taking the substance consistently. Withdrawal symptoms can occur around six to 12 hours after a person last took a short-acting opioid, and about one to three days after a long-acting opioid. Withdrawal symptoms include: Early symptoms:
- Muscle aches
- Watery eyes
- Runny nose
- Excess sweating
- Excess yawning
- Abdominal cramping
- Dilated pupils
OverdosesIn 2017, more than 70,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Of those deaths, almost 68% involved a prescription or illicit opioid (CDC). How is it that so many people die from overdoses? It is mostly a matter of tolerance. As we mentioned earlier, opioid abuse happens when a person keeps taking more and more of the substance in order to continue experiencing the “high” it offers. Most overdoses occur after a person has attempted to get clean, or hasn’t had access to the drug in a while. This is because their brain will start repairing itself back to normal functioning. Once this happens, the dose that the person had grown a tolerance for will become dangerous, as the brain has begun to reset itself. A lot of opioid-addicted people misjudge the amount they need to get high again and end up taking too much. Their body goes into shock, as it is not equipped to handle that high of a dose anymore, and this may result in death. These are the signs a person will exhibit during an overdose:
- Loss of consciousness
- Unresponsive to outside stimulus
- Awake, but unable to talk
- Slow, shallow and/or erratic breathing
- For lighter-skinned people, the skin tone turns bluish purple, for darker-skinned people, it turns grayish or ashen.
- Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
- The face is very pale or clammy
- Blue or purplish tinted fingernails
- Pulse (heartbeat) is slow, erratic, or not there at all
Who is at risk for developing an opioid addiction?Opioid addiction isn’t something that discriminates. Especially with how liberally prescription painkillers are prescribed to the general public, anyone is in danger of becoming reliant on opioids. However, when a person is prescribed opioids, the likelihood of them developing an addiction skyrockets simply due to exposure. Even more likely are those patients who are prescribed a long-term regimen of opioids. Any individual who has had surgery or an illness that causes chronic pain is more susceptible to developing an addiction. Usually, it is an addiction to prescription painkillers that leads to a person turning to heroin, as it is easier to obtain and much, much less expensive.
Are you or a loved one struggling with an opioid addiction?Here are some signs that you or a loved one may have an opioid addiction on your hands:
- Inability to control or stop opioid use
- Uncontrollable cravings
- Change in sleeping habits
- Weight loss
- Persistent flu-like symptoms
- Decreased libido
- Neglecting personal hygiene
- Changes in activity
- Isolating from family and friends
- Stealing from family, friends, businesses, etc
- Financial problems
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