Hey everyone! TGIF! I’m sure most of you are ready for the weekend (with the amazing weather ahead!). Today my blog is focusing on the science behind addiction. Why am I focusing on the touching subject of addiction? Well, this week I came across an article, titled 22 opioid overdoses, 1 fatality in 48 hours a cause for concern, police say that was presented on newsday.com which you can read for yourself here. If you choose not look at the article, it provides an update on the number of opioid overdoses (specifically heroin, fentanyl, and prescription drugs) in Suffolk County, New York (Long Island). Personally, I was heart broken because this is the county I grew up in, and I have read way too many articles about opioid overdoses. Ask yourself how many articles you have read online, on Facebook, and have watched on the news where there is a story related to opioid addiction or overdose. ONE. TOO. MANY! Now ask yourself this, how many people do you know that have lost someone to opioid addiction? How about you personally? Do you feel heartbroken just thinking about how many people are affected by opioid addiction? Because I do. Unfortunately, there are people who do not see the problem, or feel people who have an opioid addiction do not need or really, deserve help. But that’s not the case at all. People with opioid addiction need help and deserve it. But how many of you actually know what opioid addiction does to the brain? This is what I want to focus on today, and maybe make you think about what you can do for those who need help.
To start, most of us have taken a prescribed medication, right? Prescribed medications are also known as prescription opioids, and they are used for the treatment of any kind of pain (including cancer!). Although prescription opioids are among the most effective medications for pain, they are also linked with the illicit use of opioids in the United States (Niikura, et al, 2014). But how do prescription opioids reduce pain? To reduce pain, opioid receptors send signals reaching the brain. Wait, we have opioids receptors!? Yup! Believe it or not, our brain has 4! The 3 most known are Mu, kappa, and delta. The 4th receptor is like-1 (ORL1), but we do not see it as much as the other 3. So which receptor do we see used the most? That would be the Mu receptor. It is the most commonly used opioid receptor for pain management because it is not only the most effective pain reliever, but it is also the most efficient of the mood enhancers (woah). The cool part of this receptor is that it causes activation of ventral dopamine reward pathways (big words) that controls the feeling of pleasure (AKA happiness!). These receptors are expressed in the medulla locus coeruleus and periaqueductal gray area (more big words), which you can see in the picture below. (In case you didn’t know where those are, which I didn’t, so you’re fine!)
Still reading? If so, stick with me!! It is so interesting. Anyways, although an opioids purpose is to relieve pain, they can activate biochemical brain processes in the absence of significant pain, which can motivate repeated use of the drug simply for pleasure. Repeated exposure to escalating dosages of opioids alters the brain so that it functions more or less normally when the drugs are present and abnormally when they are not (Kosten & George, 2002). In more simple terms, this is when you start to build a tolerance for the opioid. Without you taking it as much as you are, your body starts to act up because it cannot function “right” without the prescribed opioid. Now, when you start to become dependent to such opioid, you start to see changes in the locus ceruleus (I will refer it as LC for now on). In the LC, neurons produce a chemical called noradrenaline, that is distributed to the other parts of the brain where it stimulates wakefulness, breathing, alertness, etc. When you start to use opioids excessively, the LC neurons increase their level of activity, however release a normal amount of noradrenaline. PLOT TWIST: when opioids are not present to control the level of activity, the neurons release excessive amounts of noradrenaline. This triggers symptoms such as muscle cramps, jitters, anxiety and diarrhea (Kosten & George, 2002). These are the signs you will see in people who are opioid dependent. However, they are not addicted quite yet. At this point, if they get help, they can come back from the dependency. It is when you go beyond the point of dependency, AKA addiction, where it is the toughest to come back from. And for those who didn’t know, there is a difference between addiction and dependency. Dependency of an opioid is when an individual starts to develop a physical dependence, when your body had adapted to the use of the drug in which a higher dosage is needed to achieve the same level of response achieved initially (for example, you keep getting a headache because you built a tolerance). When a person starts to become dependent on a drug, the person starts to show symptoms of tolerance and withdrawal (like I said before, muscle cramps, jitters, etc). Addiction however, can be defined as the compulsive use of opioids for non-medical reasons (for example, heroin). This individual has developed physical and psychological dependence on the symptoms. People with addiction take an excess amount of opioids for the euphoric (happiness) effects of the drug- the “high”. With opioid addiction, people turn to heroin because they are craving a new high, or are not satisfied anymore with the opioid they have been abusing. The science behind heroin is quite interesting, but I feel that is not important for now. There is so much more behind the science of opioids and opioid addiction, but I feel like this is great level of knowledge you need in order to understand how addiction or opioids work in the brain. How are you feeling after reading this? A little tired? Me too.
I’m sure some of you are reading this, and are thinking, well didn’t they know that people get addicted to heroin? Although in our health classes, especially my generation, we are taught to not to do drugs, heroin is bad, and smoking cigarettes will give you cancer, sometimes it is not enough or even related to what we learned in school. How many of you know someone who is addicted to opioids and then shifted to heroin? Exactly, most people do not know that it can all start with an opioid.
So what was the whole point of my post? I want people to understand that addiction happens in the brain, it is a biochemical process, and there are those who do not realize they are getting addicted until it is too late. Instead of blaming the victim and turning them away from treatment, we need to do the exact opposite. Addiction is a disease, but it is a disease we can cure. But that needs to start with supporting those who need help. I hope this made some of you curious as to what else goes on in the brain when we are addicted to opioids (it is truly fascinating) and realize we can make a change!! Although there are politics involved in medications and doctors and money, there are still things we, as a society, can do! We can think big and try to find a way to create an opioid that does not lead to addiction, or start small but being someones support system. Think twice before you judge someone with an addiction. If you want to know more about addiction, want to know what else you can do to help those who are struggling, I posted the free addiction hotline number and website that I feel is very helpful for this information. Keep those who need help in your thoughts, and try to make a difference not only this up coming week, but every day 🙂
Free addiction hotline: 877-723-1216
Addiction Treatment Helpline website: http://americanaddictioncenters.org/
REFERENCES (in case you want to read some rad articles, journals and studies on opioid addiction):
- Kosten T, George T. The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives. 2002;1(1):13-20.
- Niikura K, Zhang Y, Ho A, Kreek M. Different sensitivity for oxycodone-induced conditioned place preference and sensitization of locomotor activity in adolescent and adult mice. Drug and Alcohol Dependence. 2014;140.