Opium has been used for pain relief for many millennia. Heroin has been used for pain, cough, diarrhea and insomnia since 1898, when a German chemist created this very first true opioid. Morphine had been isolated from opium some ninety-six years earlier by another German chemist. With the advent of the hypodermic syringe in about the mid-1800s, a far more effective way to take morphine was available. At the time, opioids were not controlled or regulated. Most general stores carried a line of patent medicines containing heroin or morphine. Laudanum, an alcoholic preparation of opium dissolved in ethanol, was a popular remedy for “women’s troubles.” The danger of overdose and the risk of addiction was poorly understood at the time. In 1916, a clever chemist, German again, contrived to make a non-addictive opioid that would relieve pain without being addictive. His creation, oxycodone, although highly effective, proved to be one of the most addictive opioids of all time. Many have tried to create a true substitute for opioids, but all have failed. This article will answer the following question: Why are opioids addictive?
The Process of Addiction
Addiction begins with the production of pleasant feelings by a particular substance. Everyone wants to feel good, so it’s natural to want to repeat the things that cause positive feelings. This is called reinforcement. This reinforcement can occur with other substances, too. Sugar can create a strong craving and type of addiction that’s similar to the craving for opioids in many ways. In fact, opioid addicts will often crave sugar as they recover from opioid abuse and withdrawal.
Once the pleasurable feelings are experienced, the user wants to experience them again and again. More and more of the opioid is ingested, and over time this causes profound changes in brain function. This is true of all addictive drugs to one degree or another. With opioids, and also alcohol, benzodiazepines and amphetamines, these changes rewire the brain until it can no longer function at all without the substance. In the case of opioids, there are several important alterations:
- The brain stops producing endorphins
- The brain grows new and extra opioid receptors
- The existing opioid receptors are down-regulated, causing tolerance
Endorphins are natural opioid-like compounds produced by the brain to relieve pain, create feelings of reward and mild euphoria. They are probably responsible for what is sometimes called the runner’s high. Such exertion triggers the release of endorphins. The brain isn’t designed to handle large amounts of opioids, though, so if someone repeatedly takes opioids, especially stronger ones, the brain will respond by growing new receptors. These extra receptors aren’t natural and probably play a strong role in the opioid withdrawal syndrome. The brain stops producing its own endorphins because it doesn’t need to, not when the user is supplying it with opioids all the time. The existing opioid receptors become desensitized to the constant presence of opioids, causing the user to need to take more and more to get the same effect. This is called tolerance. Not everyone who takes an opioid will become addicted, however. There are other factors involved, and many people find the effects of opioids to be unpleasant, eliminating reinforcement.
It’s a steadily escalating picture of brain disaster. When the substance is suddenly withdrawn, the addicted brain revolts, demanding the substance. This is perceived as the experience of opioid withdrawal syndrome, a set of nasty, painful, horrible symptoms that can only be relieved by taking more opioid. The brain sends out powerful cravings for more of the drug, creating further misery for the abuser. Only time, or more opioid, can stop the withdrawal symptoms. Withdrawal from opioids is highly unpleasant but not typically dangerous. On the other hand, withdrawal from alcohol and benzodiazepines can be fatal if not done under medical supervision.
In short, addictive drugs are such because of the changes they cause in the brain. It is not known if these changes are reversible or permanent, but there is strong evidence that some of them may be permanent. We know this because many former opioid abusers will say that if they don’t take an opioid, they don’t feel right. They don’t feel bad necessarily, but they feel like “something is missing.”
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