Dr Greg Amer Fairview Addiction Medicine Physician Explains Why Some People Become Addicted To Opioids And Offers Tips On How To Prevent Developing An Addiction
As an addiction medicine physician and because of the current opioid crisis facing our nation, Im often asked, Why do some people become addicted to opioids while others dont?”
Before I answer that, lets first review what opioids are. Simply put, opioids include prescriptions like codeine, hydrocodone or oxycodone , but they can also be illegal street drugs, including heroin. You can learn more about what opioids are in this blog post.
The answer to why some people become addicted and not others is quite simple: Addiction is a disease that some people have and others dont, just like any other disease. Its estimated that about 10-15 percent of our population are actively battling addiction or recovering from it.
If you dont have it, its very unlikely youll form an addiction to opioids or any other addictive substance or behaviors.
So, how does one develop addiction? The disease is in a persons genes. The makeup of the responsible gene affects the receptorsthe circuits and wires, in other wordsin the persons brain that cause him or her to react differently to addictive substances than a person without the disease. But beyond that, wedoctors and researchersdont know much about the cause.
Until then, I offer this advice:
Knowing your family history, and being aware and honest about the way opioids make you feel, can play an enormous role in whether or not addiction becomes a problem.
How Is Naltrexone Used To Treat Addiction
This medicine is very different and doesnt activate the opioid receptor the way that buprenorphine and methadone do, but instead blocks the euphoric/sedative effects of opioids. Your system must be completely free of all opioids before beginning naltrexone. It can be taken orally or as a once-a-month injection.
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Is Opioid Addiction A Disease
Opioid addiction is not simply like diseases such as pneumonia theres not a magic bullet that cures the person, like an antibiotic can cure pneumonia. We can think of opioid abuse as a medical illness that is governed by things inside of us and outside of us.
Medical conditions typically have a core defining feature. With drug abuse, we can think of the defining feature as the dysregulation of choice that is governed by things inside of us and outside of us . For example, think about eating there is a physical craving, but environmental queues can engage our choice to eat, even when we arent hungry.
When we talk about addiction or opioid use disorder, often people refer to a syndrome of symptoms. There is a syndrome of problematic use of the opioid. The syndrome has features, such as the person using the opioid is giving up other things in their life, and the use of the drug starts to impact them . They crave the drug, and the use of it starts to impact their whole life. Their life becomes organized around the use.
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Signs Someone Is High On Opioids
There are some marked clues of opioid use, Andrew Tatarsky, PhD, psychotherapist and founder of the Center for Optimal Living in New York City, tells WebMD Connect to Care.
âOne of the hallmark characteristics is pinned pupils. Thatâs one of the very specific effects heroin has,â Tatarsky says. âYou might find somebody being oddly activated in some way, or in higher doses, certainly having trouble staying straight or nodding, which is sort of the traditional way to talk about it.â
In other words, if someone is high on opioids, you may notice symptoms like:
- Pinpointed pupils
The person whoâs high might have physical symptoms including:
- Low blood pressure
How Do People Misuse Prescription Opioids
Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by a doctor, but they can be misused. People misuse prescription opioids by:
- taking the medicine in a way or dose other than prescribed
- taking someone else’s prescription medicine
- taking the medicine for the effect it causes-to get high
When misusing a prescription opioid, a person can swallow the medicine in its normal form. Sometimes people crush pills or open capsules, dissolve the powder in water, and inject the liquid into a vein. Some also snort the powder.
Why Is It So Easy To Get Addicted To Opiates
The Centers for Disease Control now says that prescription opiates surpass heroin and cocaine for number of caused deaths in the United States. The use and abuse of opiates has reached epidemic proportions. This epidemic started because of the way that opiates work on the brain and body. Unfortunately, once addicted treatment is usually necessary to prevent relapse due to how easy it is to become addicted to these prescription drugs.
How Do You Become Addicted To Opioids
More people in the U.S. die from opioid overdoses than from other drugs.
Over time, the body gets used to having the drug and feels terrible without it. Withdrawl is like having the flu but much worse, and it can make it hard to stop taking the drug. If a person starts seeking and taking an opioid despite how it is interfering with work, school, or relationships, it is called addiction.
Its important to know that anyone can become addicted to opioids. It doesnt matter where you live or how smart you are. There is no way to predict who is likely to become addicted.
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Pharmacological Interventions And Treatment Implications
In summary, the various biological models of drug addiction are complementary and broadly applicable to chemical addictions. Long-term pharmacotherapies for opioid dependence and addiction counteract or reverse the abnormalities underlying those conditions, thereby enhancing programs of psychological rehabilitation. Short-term treatments for relieving withdrawal symptoms and increasing abstinence are beyond the scope of this article instead, we refer readers elsewhere for detailed neurobiological explanations of the various nonopioid-based abstinence initiation approaches such as clonidine and clonidine-naltrex-one for rapid detoxification .
The medications most commonly used to treat opioid abuse attach to the brain cells mu opioid receptors, like the addictive opioids themselves. Methadone and LAAM stimulate the cells much as the illicit opioids do, but they have different effects because of their different durations of action. Naltrexone and buprenorphine stimulate the cells in ways quite distinct from the addictive opioids. Each medication can play a role in comprehensive treatment for opioid addiction.
One Receptor To Rule Them All
Say you have chronic back pain. Your muscles are inflamed, constantly beaming pain signals to your brain. Your natural endorphins arent enough and your back wont let up, so your doctor prescribes an opioid painkiller like oxycodone.
Prescription opioids and natural endorphins both land on tiny docking stations called receptors at the ends of your nerves. Most receptors catch chemical messengers called neurotransmitters to activate your nerve cells, triggering electric pulses that carry the signal forward.
Opioids and their receptors are inhibitory. Rather than spark electric pulses in our nerves, opioids dampen them. Image by Adam Sarraf
But opioid receptors do the opposite. They stop electric pulses from traveling through your nerve cells in the first place. To do this, opioids bind to three major receptors, called Mu, Kappa and Delta. But the Mu receptor is the one that really sets everything in motion.
The Mu-opiate receptor is responsible for the major effects of all opiates, whether its heroin, prescription pills like oxycodone or synthetic opioids like fentanyl, said Chris Evans, director of Brain Research Institute at UCLA. The depression, the analgesia , the constipation and the euphoria if you take away the Mu-opioid receptor, and you give morphine, then you dont have any of those effects, Evans said.
Addiction begins in the midbrain, where opioids receptors switch off a batch of nerve cells called GABAergic neurons.
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Comparing Heroin & Fentanyl
- Illegal drug with no accepted medical uses
- Manufactured in powder form
- Injected, smoked, or snorted when abused
- Fast-acting and creates a short but intense rush
- Semi-synthetic opioid
- Potential for rapid onset of overdose, leading to fatal respiratory depression
- Highly addictive
- Often requires medical detox and opioid replacement medications to safely process the drug out of the body
- Comprehensive treatment ideal for long-term recovery
Opiate Addiction Causes Depression
When the body stops producing its own endorphins, a person feels sick and depressed whenever they are not taking their opiate of choice. At this point, taking the opiate is no longer about experiencing positive feelings as it is to avoid negative feelings and symptoms. When this occurs, the person has become addicted to opiates.
There are various types of opiates, prescription, and nonprescription, for mild to severe pain relief. Opiates are meant for short-term pain relief and use only. If taken longer than a few days, your chance of becoming dependent or developing an addiction increases tremendously. Heroin, which is a street drug, is also considered an opiate. Due to the regulations on controlled substances, especially opiates, in the United States, heroin abuse and overdoses have risen substantially. Here is a list of some of the common prescription opiates available:
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Who Gets Addicted To Opiates
People who experience normal pleasurable sensations and have relatively normal happy lives do not usually get addicted to opiates. It is when that normally pleasurable life is interrupted by pain such as:
- pain after surgery
- chronic pain due to rheumatoid arthritis
- pain after an injury
- painful diseases such as fibromyalgia
This interruption causes someone to take an opiate pain medication. The opiates then start to change the way that a person experiences pain and pleasure. It is part of why they work. They fill the opioid receptors and cause the body to release dopamine. Dopamine is one of the chemicals that makes you feel pleasure.
People who get addicted to opiates are those that become dependent on the way that the opiate makes them feel. Usually those that become addicted suffer from depression or anxiety as well as a painful condition.
Tolerance Vs Dependence Vs Addiction
Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.
Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.
Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.
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How Do People Become Addicted To Heroin And Opioids
Physical addiction can be difficult to understand, especially once dire consequences arise and a person continues using a drug. Most people donât start off addicted to a substance like heroin, in fact, by definition, addiction is something that occurs with repeated use of a substance. People become addicted to opioid drug like heroin by simply by using the drug over and over. Though in some cases, NAS might occur, wherein a baby is born with the addiction.
For a regular user and person someone suffering from addiction, what they are essentially doing is feeding the compulsion, which then leads to an obsessionand when a person decides they donât want to use opioids, they canât stop.
âThis will be the last time I useâ or âI will stop as soon as this bag is gone!â The obsession with opioids takes over a personâs thoughts to the point where, even if they donât want to think about drugs, itâs all they can think about. At this point of addiction, they are very likely to have withdrawals when they stop using the drug, and quitting âcold turkeyâ can be ineffective and dangerous.
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How Should You Store And Dispose Of Opioids To Protect Family Members
If you are taking opioids, you are not the only one in your household who is in danger of misuse, addiction, and overdose. Other members of your household, including children, are also vulnerable. Hereâs how to protect them:
- Always store opioids in a safe and secure place. Do not leave prescription bottles in the medicine cabinet, and keep the medication away from others, particularly young children. Children sometimes confuse medications with candy and end up swallowing them, which can lead to overdose. Other family members and visitors could also find prescription medications in the house and use them inappropriately.
- Never share your prescriptions. More than half of people who misuse prescribed opioids get them from a friend or relative, according to the Substance Abuse and Mental Health Services Administration.
- Donât throw unused opioids in the trash. Improper disposal of prescription medicines can lead to other people finding and taking them.
If you have leftover or expired prescription medications, follow these drug disposal tips:
Physician anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management, and critical care medicine, with the education and training that can mean the difference between life and death.
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Why Are Opioids So Addictive
Opioids work by blocking out pain and making you feel calm and happy, which can lead to a huge potential for abuse and addiction . The 2018 National Survey on Drug Use and Health reports that approximately 10 million Americans misuse opioid painkillers each year.
âHuman nature is to maximize pleasure and minimize pain,â addiction counselor Lin Sternlicht, LMHC, MA, EdM, tells WebMD Connect to Care. â Opioids are highly effective at doing so on a psychological and physiological basis.â The power of these addictive drugs lies in their ability to disrupt essential neurochemical systems in our bodies.
So When Does It Actually Make Sense To Take An Opioid
Only when you really need it, says addiction specialist Indra Cidambi, MD, medical director of the Center for Network Therapy in Middlesex, New Jerseyif you just had major surgery, for example, or you’re in crippling agony after an accident.
And in general, you should limit your use of an opioid as much as possible: Most of the time, for acute injuries, you dont need it for more than a few days, Dr. Cidambi told Health. If your doctor suggests you take an opioid for longer than a week, ask if there other options.
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The CDC also recommends talking to your doc about nonopioid alternatives, such as physical therapy and interventional therapies . Other matters to discuss: Any problems you’ve had with drug or alcohol abuse, and the risks involved in taking these powerful drugs.
As many as one in four people who are prescribed opioids long-term by a primary care physician will struggle with addiction, according to the CDC. But the risks go beyond addiction and overdose. They may include vomiting, dizziness, depression, itching, even increased sensitivity to pain.
Finally, if you do decide to take an opioid, be sure to follow up regularly with your doctor, the CDC urges.
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How Old Is The Average Heroin User
According to the Substance Abuse Mental Health Services Administration: âIn 2013, an estimated 169,000 individuals aged 12 or older used heroin for the first time in the past year Among individuals aged 12 to 49 who initiated heroin use in the past 12 months, the average age at first use in 2013 was 24.5 years.â 24 years old, but that is a gross average of people between ages 12 and 49which means that half of the people using the drug are younger than 24 and half are older. Could you picture your mom or dad, or your grandparents using heroin? Well the truth is, statistically, itâs plausible that a person over 60 years old could be using the drug.
Opioid Alternatives For Pain Management
There are many other options to help control pain, whether acute or chronic. Some of the options include non-opioid drugs, alternative therapies , and counseling that can be used to manage pain. Many people choose alternatives to opioids because of a history of a use disorder or fear of developing an opioid addiction.
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What Effect Do Opiates Have On The Body
Opiates can be found in several widely-used drugs including: heroin, morphine, codeine and hydrocodone. Opiates create artificial endorphins in the brain -which produce in the early stages of use warm, good feelings in the user. But over time, opiates trick the brain into stopping the production of these endorphins naturally. At this point, the only way an opiate addict can experience positive feelings is by using the drug in question. This process is the reason why opiates are so addictive.
When the body stops producing its own endorphins, a person feels sick and depressed whenever they are not taking the opiate. For these individuals, taking the opiate, say heroin, no longer is about the positive feelings that were felt the first few times they took the drug. Now, the opiate use has become about avoided negative feeling and symptoms. When this switch occurs the person has become addicted to opiates.
This Article Looks At The Following:
- Why do some people get addicted, while others seem to have full immunity?
- Why do some people appear to be more addicted than others?
If you havent already read it, take a peek at our article covering the origins of opioids and narcotic addiction titled, Narcotic Addiction Where it all Started. As it turns out the poppy plant has been a very popular part of both Eastern and Western cultures for thousands of years.
Be it friends or family, we all know people who are addicted to opioids, and many more who arent addicted. According to hhs.gov, an estimated 10,000,000 Americans abuse prescription pain killers, and nearly 800,000 people use heroin. However, those numbers may be low, since tracking the use of illicit is difficult to monitor.
That also means that over 321,000,000 people in the United States are not abusing opioids. Considering those stats, it would seem a very small segment of the population gets addicted, but most people do not. Why is this?