Wednesday, September 28, 2022

What Makes Opioids So Addictive

What Are Opioid Addiction Risk Factors

Can Science Make Less Addictive Opioids?

Any opioid use, even short-term, can lead to tolerance, dependence, addiction, and overdose. Therefore, anyone who takes opioid drugs is at risk of becoming addicted to them. Although it is impossible to determine who will become addicted and who will not, here are some of the most common risk factors for opioid addiction:

  • Personal or family history of substance abuse
  • History of criminal activity and/or legal problems
  • History of severe depression and/or anxiety
  • Previous drug or alcohol rehabilitation
  • Association with drug users or high-risk environments
  • Mental disorders/psychiatric problems
  • Stressful life circumstances4

The Mechanism Of Craving

For a long time, scientists thought that the release of dopamine reflected pleasure or liking, but numerous studies now suggest that dopamine release is more about wanting. And not normal, run-of-the-mill wantingbut intense craving.

For example, mice that have been genetically engineered to release more dopamine than normal, seem to crave food in a way that normal mice dont. For one thing, they will run much faster and farther to get it compared with normal mice.

Conversely, mice that have been engineered not to produce dopamine exhibit the opposite symptoms. They dont show any signs of wanting food at all. In fact, they wont bother to walk across their cage to eat even if theyre starving to death.

On the other hand, these genetic alterations in dopamine levels dont seem to influence how much the mice like food. For example, mice typically exhibit characteristic facial expressions and mouth movements when they eat something they particularly like.

But mice that produce more dopamine than normal dont produce any more of these characteristic expressions when they eat than other mice do. Similarly, mice that produce less dopamine dont produce fewer such expressions.

The bottom line is that a burst of dopamine in the reward circuit is associated with wanting or craving more than enjoyment. This isnt thoughtful, planned wanting, like the long-term goal of wanting to be an engineer or a lawyer.

What Does Opiate Do To Your Brain

An opiate drug such as heroin is potent. They are made from morphine extracted from opium poppy plants. When opium enters your body, it mixes with the bloodstream instantly and reaches your brain quickly. It alters your central nervous systems completely. It affects specific receptors in your brain that are responsible for the perception of pain and pleasure. Because of this, a person under the influence of opium experience euphoria that he cannot experience in ordinary life.

Opium numbs down your sensations that are associated with pain. Because of this opium is often responsible for imbuing people with euphoric spells. Moreover, once opium takes its complete control over your nervous system, it also affects the signals that are sent to specific parts of the brain that regulates your heart and breathing rates, memory, balancing control, alertness, and emotional control. It affects the brain stem, cortex, and even the limbic system.

The affect opium has on the limbic system plays a massive roll in a person losing its faculties and falling prey to addiction. Opium is responsible for causing this system to release dopamine. Dopamine leaves people with intense feelings of satisfaction and happiness. Although these feelings last for brief periods, they are often followed by long hours of drowsiness and mental imbalances, too, in some cases.

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Are There Different Types Of Opioids

Yes. There are many types of prescribed opioids that are known by several names, including:

  • Codeine
  • Morphine

These medications are often sold under brand names such as OxyContin, Percocet, Palladone, and Vicodin.

The different types of opioids are prescribed by doctors in different strengths and administered in various forms, depending on the patient, the situation, and the type and level of pain.

Heroin is an illegal and highly addictive form of opioid with no sanctioned medical use.

Origins Of Drug Liking

How Addictive Are Prescription Opioids?

Many factors, both individual and environmental, influence whether a particular person who experiments with opioid drugs will continue taking them long enough to become dependent or addicted. For individuals who do continue, the opioids ability to provide intense feelings of pleasure is a critical reason.

When heroin, oxycodone, or any other opiate travels through the bloodstream to the brain, the chemicals attach to specialized proteins, called mu opioid receptors, on the surfaces of opiate-sensitive neurons . The linkage of these chemicals with the receptors triggers the same biochemical brain processes that reward people with feelings of pleasure when they engage in activities that promote basic life functions, such as eating and sex. Opioids are prescribed therapeutically to relieve pain, but when opioids activate these reward processes in the absence of significant pain, they can motivate repeated use of the drug simply for pleasure.

The Mesolimbic Reward System

When drugs stimulate mu opioid receptors in the brain, cells in the ventral tegmental area produce dopamine and release it into the nucleus accumbens , giving rise to feelings of pleasure. Feedback from the prefrontal cortex to the VTA helps us overcome drives to obtain pleasure through actions that may be unsafe or unwise, but this feedback appears to be compromised in individuals who become addicted to drugs. The locus ceruleus is an area of the brain that plays an important role in drug dependence.

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Randal Lea Ma Ladac Ii Qcs

CHIEF COMMUNITY RECOVERY OFFICER

Randal Lea, our Chief Community Recovery Officer is a licensed addictions counselor with 30 years of clinical and administrative experience.

Randal received masters degrees in counseling from Trevecca Nazarene University and in psychology from Pacifica Graduate Institute. He is a frequent presenter on a variety of topics such as assessment, sexual behavior in children, ethics, dreamwork and trauma. He is a certified practitioner of DreamTending and a qualified clinical supervisor.

Prior to his current role as Chief Community Recovery Officer, Randal served eight years as Assistant Commissioner with the Tennessee Department of Childrens Services. In 2008, he was recognized by the Praed Foundation as a national Systems Champion for implementing a statewide childrens assessment for DCS. He also received the Friend of Children Lifetime Achievement Award in 2010 from Tennessee Voices for Children after seven years on their board. Randal was also recognized in both 2000 and in 2015 as Professional of the Year by the Middle Tennessee chapter of the National Association for Alcoholism and Drug Abuse Counselors .

Signs Of An Opioid Overdose

Every year, thousands of deaths in the United States are attributed to opioid overdose. If you fear that someone has overdosed on opioids, call 9-1-1 right away. Signs that someone may have overdosed include:

  • Loss of consciousness
  • Slow and erratic pulse or no pulse
  • Irregular breathing or no breathing
  • Face is very pale and/or clammy
  • Pupils are constricted
  • Body is limp

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Emerging Trends In Substance Misuse:

  • MethamphetamineIn 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • CocaineIn 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • KratomIn 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.

Resources:

What Is Being Done To Stop The Opioid Epidemic

What are Opioids?

New rules for prescribing opioid medications were issued by the Ohio State Medical Board in December 2018. These rules detail the importance of prescribing lower dosages for shorter periods of time when an opioid is the appropriate medication. When possible, other medications should be explored. The regulation discusses patient education about the prescribed opioid, the risk of addiction and documentation of those conversations by healthcare providers. In addition, there are requirements for additional review at the level of 50, 80 and 120 MED .

Abuse-deterrent opioids are a form of the drugs with safety measures built-in. These medications are developed to help prevent misuse. Some have very hard exteriors to make crushing them difficult, while others have naltrexone integrated into the capsules so that if it is crushed and taken orally or injected, the additional drug will halt the effects of the opioid. However, even abuse-deterrent medications are not abuse-proof. The determination of a user can overcome these safety measures.

Last reviewed by a Cleveland Clinic medical professional on 05/02/2019.

References

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Why Do People Become Addicted To Opioids

Opioids can make your brain and body believe the drug is necessary for survival. As you learn to tolerate the dose youâve been prescribed, you may find that you need even more medication to relieve the pain or achieve well-being, which can lead to dependency. Addiction takes hold of our brains in several ways â and is far more complex and less forgiving than many people realize.

Richard Schottenfeld Md Psychiatry

Its important to define opioid addiction carefully, because the stigma is so strong. Someone who is prescribed opioid medications for pain for prolonged periods may develop tolerance, which means they need a higher dose to get pain relief. Or they may experience withdrawal symptoms when they stop taking the medication. But these are not considered cases of opioid addiction.

Opioid addiction, or technically opioid use disorder, is defined as loss of control over use of opioids. This means that the person continues to use opioids despite negative consequences or is unable to stop using opioids despite wanting to. This person may also have a preoccupation with using opioids, obtaining opioids or craving for opioids. These patients may also develop tolerance or experience withdrawal when they stop using, but those symptoms by themselves do not define an opioid use disorder.

Some people think that an opioid addiction is just psychological or a weakness of character, and that people who are addicted simply dont have the willpower to stop. But its more complicated than that. Long-time use of opioids in an addictive way actually alters brain functioning. It causes chronic and lasting changes in the brain reward system, causing the person to feel less motivation and get less pleasure from other, naturally occurring rewards. Opioids become the primary reward and the primary focus of the persons life, and they need more of it to activate the reward system.

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What Are Some Of The Benefits Of Stopping Opioids

While withdrawal symptoms can be difficult to endure, they can be managed effectively with positive results, especially with the assistance of a specialist like a physician anesthesiologist. According to the Centers for Disease Control and Prevention, most people have improved function without worsening pain after stopping opioid use. Some patients have even experienced improved pain relief after weaning off the medicine, even though pain might briefly get worse at first. Additionally, alternative therapies with fewer risks and side effects may be effective in managing pain.

Because opioids mask pain, removing them can also give the pain management specialist a better understanding of the nature and level of your discomfort. With that understanding, the physician can better assess which alternative treatments could be effective for you.

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.

Who Is Most Likely To Become Addicted

Maine Struggles to Make Opioid Addiction Therapy Available ...

Anyone, regardless of race or socioeconomic status or any other demographic factor, can become addicted to opioids. They are powerful and dangerous and nondiscriminating. However, some groups do seem to have a greater risk, including:

  • Those who live below the poverty level
  • People who are unemployed
  • A person with a family history of addiction or substance use
  • Someone who has a history of substance use
  • Young people
  • People who have a criminal record
  • Those who enjoy seeking thrills or risky behavior
  • Smokers
  • People who are under a great deal of stress
  • Women

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What Are The Signs Of An Addiction

People addicted to drugs may change their behavior. Possible signs include:

  • Mixing with different groups of people or changing friends
  • Spending time alone and avoiding time with family and friends
  • Losing interest in activities
  • Getting into trouble with the law
  • Attending work or school on an erratic schedule
  • Experiencing financial hardship

Opioid Dependence Vs Addiction

Dependence is likely for anyone who takes opioids for an extended period. If the person stops taking the opioid, they will experience a variety of withdrawal symptoms. These can range from physical symptoms, such as muscle cramps, to psychological symptoms, such as anxiety.

A smaller percentage of people will develop an addiction. A person who has developed an opioid addiction will experience serious negative impacts in their lives because of their need to find and take opioids. Consuming the drug may take priority over their relationships, their jobs, and their health.

Of course, it is possible to take opioids responsibly. To do so, users should closely follow the instructions of the health care provider who has prescribed the opioids. Individuals should also take responsibility for their own health and be actively involved in the pain control strategy they will be using.

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How People Get Hooked On Opioids

Most people who use opioids do so responsibly, according to their doctors instructions. However, even under these circumstances, these drugs can cause an accidental addiction because of the way they affect brain chemistry. Opiates create artificial endorphins, which leads to a sense of euphoria. Over time, these drugs prevent the brain from producing any endorphins on its own. At this point, the only way to experience that same high is to use more opioids.

The risk of addiction increases with longer-term use or when people use opioids in a manner other than how they were prescribed, such as crushing pills to snort them. Taking more than the prescribed amount or using the drugs more often than directed can also lead to addiction. Research has shown that taking opioids for more than a few days increases the odds that someone will go on to develop a drug dependence.

How Should You Stop Taking Prescribed Opioids

Opioid Addiction and Treatment

Patients who suddenly stop taking opioids can sometimes experience symptoms such as jittery nerves or insomnia, so itâs important to work with your physician anesthesiologist or another doctor to taper, or wean yourself off of, and ultimately stop the medication.

Your physician anesthesiologist can:

  • Individualize your tapering plan to minimize symptoms of opioid withdrawal.
  • Monitor your withdrawal symptoms.
  • Diarrhea
  • Tremors

These symptoms can be minimized through measures such as a slow reduction in dosage, consultation with the appropriate specialists, and psychological support for anxiety.

Courtesy of the California Society of Anesthesiologists

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Butch Glover Mba Ncac Osap

CHIEF OPERATIONS OFFICER

Butch Glover, a state licensed and nationally certified addiction counselor, accepted his role as Chief Operations Officer in 2015.

Butch began counseling in 1989 and worked with Cumberland Heights throughout the 90s doing Aftercare, contract work and individual counseling.

Butch worked for one of the states first intensive outpatient programs in Jackson, TN and the Jackson Area Council on Alcoholism. During this time, he developed two pilot addiction programs in the Greater West Tennessee area. Butch also maintained a private practice, specializing in family of origin work and addiction populations.

Butch is a Tennessee native. He is a graduate of Lambuth University and earned an MBA from Union University.

David A Fiellin Md Internal Medicine

The idea of treating opioid addiction without medication is attractive, especially because such programs can be effective for some patients with alcohol use disorder. A lot of people think that the goal of treatment for opioid use disorder is not taking any medication at all. However, the truth is that the many people in abstinence only programs for opioid use disorder will relapse. Research shows that medication-based treatments are the most effective treatment. Opioid use disorder is a medical condition just like depression, diabetes or hypertension, and just like those conditions, it is most effectively treated with a combination of medication and counseling.

There are two common medications used to treat opioid use disorder: methadone and buprenorphine. These medications help address patients withdrawal symptoms and block the reward or the high that people get from using opioids. They help restore normal brain functioning. In certain cases, other medications can help improve impulse control and treat any underlying psychiatric disorders.

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Addictive Properties Of Prescription Opiates

Prescription opiates affect the brain the same way morphine and heroin do. They attach to opioid receptors found throughout the brain, spinal cord, gastrointestinal tract, and other parts of the body. When prescription opiates attach to these receptors, they reduce the perception of pain, which provides relief. These drugs also produce euphoria and feelings of well-being as they act on the brains reward systems. These feelings, which often accompany activities that promote survival, such as eating or having sex, produce a sense of motivation to repeat the behavior, even when doing so causes harm.

Repeated use of opiates can inhibit the production of the bodys natural opioid neuropeptides, including endorphins, which are the bodys feel good chemicals. Endorphin is a word adapted from the concept of endogenous morphine and, essentially, is the bodys natural morphine. Over time, opiates desensitize the brains natural opioid system, making it less responsive. This creates tolerance, so the person will no longer respond to the drug as strongly and will need a higher dose to achieve the desired effect. Tolerance fuels addiction because the addict will need to continue to increase his dosage in order to experience the desired high. Tolerance can also contribute to overdose, as dangers increase significantly with higher doses.

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