The prescription of opioids for dealing with chronic pain saw a sharp increase starting in the late 1990s, before it was known that such medications were highly addictive. Now, an estimated 90 people die every day in the United States due to an opioid overdose. According to the National Institute on Drug Abuse, as many as 21% to 29% of prescription opioid patients misuse the drug, and about 80% of heroin users were first misusing prescription opioids. The U.S. further spends around $78.5 billion dollars annually on costs related to opioid misuse, including healthcare costs, lost productivity, and addiction treatment.
How do opioids work and who is at risk for an opioid addiction? What are scientists doing to try to combat the opioid crisis?
How Do Opioids Work in the Body?
The class of drugs known as opioids includes illegal versions like heroin and prescription pain relievers like oxycodone and hydrocodone. Some opioids, like fentanyl, are synthesized in a laboratory, while others are naturally derived from the resin of poppy plants. In fact, research has shown that it is possible to test positive for opiates after consuming commercially available poppy seeds like those on a bagel or in a cake.
When prescribed by a doctor, opioids are usually intended to help with acute pain, or pain that is shorter-lived yet more intense than chronic pain, like, for example, the pain you might experience after a surgery. Opioids work by interacting with the opiate receptors in your brain cells. They alter the signals your brain sends out to the rest of your body by blocking the negative signals announcing that your body is in pain and instead sending a message of pleasure or euphoria.
These euphoric signals are the result of a release of endorphins, sometimes called “feel good transmitters.” Endorphins are neurotransmitters, in other words hormone-like chemicals that transmit information between the neurons in your brain. Our bodies naturally produce endorphins, so we can get a completely safe so-called “endorphin rush” from activities like exercise, laughing, or even eating spicy food. When medications are used to increase our naturally occurring levels of endorphins, however, the potential for addiction and other negative side effects arise.
Why Are Opioids Dangerous?
Because opioids are not just effective at dulling pain but also provide a feeling of euphoria, opioid users can find themselves wanting to return to that state of bliss once the drug has worn off. Making matters worse, our bodies build up a tolerance to opioids meaning that the same dose of medication will release fewer and fewer endorphins the longer a person uses opioids. Thus, to continue to dull pain at the same level, increasingly higher amounts of the drugs will be required. According to the Mayo Clinic, higher doses of opioids beyond those recommended by a doctor can cause your breathing and heart rate to slow and can be fatal.
Abruptly stopping opioid usage can also cause pain that is even more intense than the original pain that required the use of the drugs in the first place, creating a negative feedback loop that can lead easily into addiction. Illegally obtained opioids may further be laced with hazardous contaminants or even stronger opioids.