Top Questions on Opioids and Opioid Addictionby Christina Lasich, MD Health Professional
What exactly are opioids and where do they come from?
An opioid is any chemical that binds to the natural opioid receptor system located in the body. Because this system is within the body, some opioids are produced by the body thus are called endogenous opioids. Examples of endogenous opioids are endorphins produced in the nervous system. Other opioids come from outside the body and are called exogenous opioids. Examples of exogenous opioids include everything from opium to methadone.
Opioids cover a wide range of drugs, from painkillers to heroin. Can you explain how they are similar and how they are different?
Looking at the group of exogenous opioids, it can be broken down into three categories: opium derivatives, semi-synthetic, and fully synthetic opioid. Opium derivatives include morphine and codeine and are directly related to the naturally occurring opium. Semi-synthetic opioids are slightly manipulated with chemistry to look like the real thing. Heroin and oxycodone are both semi-synthetic but with different chemical footprints. A fully synthetic opioid is methadone which is chemically unrelated to opium but still interacts with the opioid receptors in the body. Again, all opioids interact with the opioid receptors, each having different footprints.
How do opioids affect the body?
By binding to and activating the opioid receptor, opioids produce a variety of effects. Opioids that bind to the mu receptor produce an analgesic effect, the painkilling effect. The reward signals, the "highs", are also produced by activation of the mu receptor. Thus, the mu receptor is not only involved in the painkilling effects but also the potential for cravings and abuse. The other two opioid receptors, the kappa and delta receptors may be closely affiliated with the emotional feelings when activated. Research is ongoing to further understand exactly how opioids work.
How does addiction work in the brain?
Thanks to the recent research done by people like Dr. Nora Volcow at the National Institute on Drug Abuse (NIDA); we know that addiction changes the brain. Within the brain is a whole network of regions like the nucleus accumbens that are involved in the reward mechanism that is altered by addiction. According to Dr. Volcow, "The overstimulation of this reward system, which normally responds to natural behaviors linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to psychoactive drugs. This reaction sets in motion a reinforcing pattern that "teaches" people to repeat the rewarding behavior of abusing drugs." To learn more about the science of addiction, I highly recommend the NIDA website at:
Why do some people become addicted to opiates and others don't?
The fact of the matter is that anyone can get addicted to drugs. There are many factors that contribute to the risk developing addiction including the genes one is born with, the environment that one is exposed to, and the ways that the genes and environment affect the development of an individual. In addition to the risk factors, there are many protective factors that reduce the risks of becoming addicted like the social support network, health of the body and mind and a person's sense of spirituality. With so many potential contributing factors, it is impossible to predict who will and who won't become addicted.
Should people be worried about getting painkillers from their doctor?
The rule for doctors is to take "universal precautions" when prescribing opioids because everyone is at risk of becoming addicted. The rule for patients is to be cautious about using opioids by understanding the potential benefits and potential risks. Everyone should be cautious about opioid use, not worried, just cautious. Opioid use comes with a number of potential consequences. The worst case scenario is opioid overdose death followed by others adverse events such as addiction, more pain, side effects and hormonal imbalances.
What are the potential benefits of opioid use?
The primary benefit or goal of treatment from opioid use is to improve function. By controlling pain, a person should be able to do more of life activities. By controlling pain, a person should be able to sleep better, walk better, work better, and live with a better quality of life.
Can you explain the difference between dependence and addiction?
Chemical dependence means that the body needs the chemical to "survive" in relative balance or homeostasis. Addiction means that the chemical is used despite the harmful effects and dysfunction it produces.
What is the biggest myth about opioids?
The most common myth about opioids is that people with chronic pain do not get addicted to opioids. Unfortunately, this myth is perpetuated in the medical literature and believed by many doctors. We know for a fact that the presence of chronic pain does not somehow magically protect a person from developing the disease of addiction. The disease of addiction can get a foothold in someone's life after an injury and with the first exposure to prescription painkillers.
What should someone do if he/she is concerned he/she is becoming addicted to opiates?
If a person finds that the chemicals are controlling his/her life, causing harm and/or causing life to unravel, the first thing to do is talk to someone. The worst thing to do is to live in silence when suffering from addiction. Help is usually just a phone call away.
Anything else you think people should know about opioids?
Different drugs of abuse all affect the brain in a similar fashion by sensitizing the reward center. This concept is called "cross-addiction". Thus, reinstatement of addictive behavior can occur if one starts using opioids instead of alcohol, cocaine, marijuana, methamphetamine or other drugs of abuse. Anyone with a history of chemical abuse, no matter what the preferred chemical of choice was at the time, should keep this risk of relapse in mind before starting to use prescription opioid medications even if it is for a legitimate reason.