Because of the recent increase in opioid usage, it is important that we examine why opioids are addictive, and how the drug functions in the brain. This drug can be incredibly destructive, and the rise of the opioid epidemic is very concerning. What makes opioids such powerful painkillers? How do they interact with the different components and receptors in our brains to produce this effect?
But first, let's examine the data trends to see how opioid addiction has slowly started to become a problem:
This graph taken by the CDC shows the trends in deaths from the usage of "Any Opioid", "Other Synthetic Opioids", and "Commonly Prescribed Opioids" from the years 1999-2020.
Looking at this graph, it is apparent that the use of opioids are increasing, as seen by the positive line of trends. It seems as though the number of deaths from any opioid begins to skyrocket from 2013 with about 7 deaths per 100,000 people, reaching an all time high in 2020 with about 21 deaths per 100,000 people. In total, from 1999-2020, more than 564,000 people have died due to overdosing on any opioid. The stark increase in overdoses in 2020 is due to the COVID-19 pandemic, which has caused many mental health problems, in turn causing them to possibly turn to drug or alcohol abuse. Synthetic opioids have also shown a similar trend line.
How do opioids work in the brain?
There are two different types of opioids:
Endogenous opioids: opioids produced by the body
Exogenous opioids: heroin, fentanyl, morphine, etc...
Our body has many opioid receptors, the main ones being Mu (1, 2, and 3), Kappa, Delta, Nociceptin, and Zeta. Firstly, the peripheral receptors sense the pain signals. The opioid binds to these receptors, which are located on the outer membrane of neurons, respiratory center in the cerebral cortex, thalamus, hypothalamus, and baroreceptors in the brain. This then blocks the pain and sends signals to the brain to release dopamine, which produces a euphoric effect of intense calmness and relaxation. People may use these drugs to ease pain or stress caused by depression and anxiety.
Opioids are easy to build a tolerance to, which motivates the user to keep taking larger and larger amounts of the drug in order to attain a similar euphoria. It has been found that women are less sensitive to opioids than men, which means that opioid addiction is more prevalent in men than women.
What happens when you overstimulate the receptors?
Overstimulating these receptors can cause:
Respiratory Depression (symptoms include shallow breathing, shortness of breath)
Low Blood Pressure and Syncope (fainting)
Endocrine Abnormalities (symptoms include fatigue, nausea/vomiting, excessive urination, weight gain/loss)
Immune Dysfunction
Mood Changes and Social Withdrawal
Sleep Changes and Insomnia
These symptoms are common for addicts, and to relieve these effects, many would likely take the pain-killing drug again.
The opioid epidemic is an overlooked problem that is current and relevant for our time. With the rising mental health crisis in the US, there will be rising usage of these drugs as a consequence. Bringing awareness to the opioid epidemic is an important cause. If we don't do something about it, many more lives will be lost due to this powerful drug.
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Sources:
Dhaliwal A, Gupta M. Physiology, Opioid Receptor. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546642/
“Understanding the Opioid Overdose Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 June 2022, https://www.cdc.gov/opioids/basics/epidemic.html#:~:text=The%20number%20of%20drug%20overdose,death%20rates%20increased%20by%2038%25.
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