How Opioid Addiction Works

Over the course of our community conversations around Ohio, we’ve heard many different questions about those suffering from opioid addiction: Why do people begin using pain medication? Why is there a stigma around addiction? Is addiction a choice? Why don’t people seek help? Our philosophy of addiction shapes our treatment of it, which is why we are exploring how opioid addiction actually works. Understanding the impact opioid use can have on the brain is imperative when crafting an appropriate and effective response to such a complex societal crisis.

Opioids have been used in societies all over the world and their use can actually be traced back to 3400 B.C. It can be an extremely important drug for those dealing with severe chronic pain or those in end of life care. But in recent years we’ve witnessed a steep increase in prescriptions. Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been an overall change in the amount of pain Americans report.

A 2013 study examining national-level general population heroin data (including those in and not in treatment) found that nearly 80 percent of heroin users reported using prescription opioids prior to heroin. We also know that roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. We’re witnessing an epidemic with all roads leading back to prescription opioids.

How do people “get hooked”?

For most people, our pain fibers work in concert with the central nervous system. If you stub your toe, your body will work to quiet the pain nerves through the production of natural opioids called endorphins. The trouble is when these pain pathways become overloaded.

For example, someone that suffers from chronic pain, their body is constantly sending pain signals to their brain; which doesn’t allow their body to produce enough natural endorphins. At this point, a doctor would prescribe an opioid medication. Now the opioids and their natural endorphins can both land on their nerve receptors.

Next, the brain cells that have opioid receptors on them gradually become less responsive to the opioid stimulation. Once someone develops tolerance, withdrawal symptoms begin to occur if a higher dosage is not given. Repeated exposure to escalating doses of opioids alters the brain so that it functions more or less normally when the drugs are present and abnormally when they are not. Therefore, even more opioid intake becomes necessary to produce pleasure comparable to that provided in any previous drug-taking episodes.

An addiction to opioids becomes entrenched after a person’s neurons adapt to the drugs. As this addiction progresses and tolerance continues to increase, the body requires more and more just to keep withdrawal at bay. Overdoses occur when someone takes so much of the drug that the brain stem slows breathing until the point of stopping entirely. Luckily, overdoses can often be reversed by using Naloxone.

How do we fix it?

The current issue is not a lack of solutions; it is the lack of implementation of solutions that are proven to work. The data shows that we could save millions of lives by expanding medication-assisted treatments, adopting harm reduction strategies (such as needle exchange programs), and increasing funding for treatment courts.

Addiction is not a moral failing. Right now, we have an opportunity to assess the way in which we respond to addiction, and work to create compassionate, long-lasting, and equitable responses that will promote the health, safety, and well-being for all.

If you or someone you know is struggling with drug use, we list local treatment and counseling resources here. Next week, we will discuss family support, including places families can turn right away if a loved one needs help. To follow our new research and research of our local media partners, sign up for our weekly news roundup.