Misunderstanding about opioid use disorder

At a recent scientific conference on drugs, one researcher said, “Honestly, opioids make me sick. I don’t see how anyone can become addicted.” This is a bit like a doctor handing in a needle saying, “Honestly, you’re frail. It doesn’t hurt.” Both examples reveal a lack of empathy and a fundamental misunderstanding of current neuroscience.

Contributions or fear, reward, fight and flight are a complex combination of experience and genetics. Fear of the needle comes from a bad shooting experience In a pre-logical developmental state, with a whiff of faint-prone genetics. Opioid use disorder (OUD) flips the ratio, with a genetic influence so strong that it mixes with the family environment. Neuroscience research continues to explain why some people exposed to opioids become addicted to them, with surprising implications for prevention.

1. The areas of emotional and physical pain are highly interconnected, allowing for rapid punishment or reward responses to anything a human being does. Otherwise, how does the brain learn? Reward switches in the brain release neurotransmitters that make you feel a certain way — dopamine for winning, serotonin for pleasure, and oxytocin for love. Certain dopamine switches, called mo-receptors, are activated by morphine and often interfere with the areas of the brain activated by pain. So morphine doesn’t stop the pain, you just feel so rewarding that you don’t mind.

2. Some people have more switches and need less morphine, while some people need more morphine to get enough reward for equivalent pain relief. The basic set of reward switches depends on gender, age, previous experience, and genetics. Pain, both emotional and physical, can leave a constant resting state in the brain Feels new pain strongly, and needs more reward (opioids) to get to “I can handle it”.

3. Since dopamine is the brain’s primary reward and behavioral driver, differences in dopamine processing influence the effects of opioids. Some genetic subtypes are reward deficient, getting less of a dopamine boost from everyday activities. The theory is that when opioids activate their receptors, their experience goes beyond just feeling high. Many “mental health” problems are now believed to be related to differences Dopamine and serotonin processing: seeking excitement due to decreased dopamine response, depression resulting from decreased dopamine production, etc.

4. The behavior of receptors also changes over time. After a short period of exposure to morphine, some people become ill The opioid dopamine receptors are down to the cell to regroup. When oral opioids are taken less intensely, decreased intensity and focus can be exacerbated with no reward switches, so home oral opioids have less of an effect than ibuprofen on pain.

5. Finally, different liver metabolism genes cause about 5-15% of people to rapidly convert oral opioids to morphine. This “CYP 2D6” variation results in more rewards up front but with the pain returning faster. The 85% who have a different gene don’t convert the pill to morphine quickly enough to help relieve the pain. However, nausea, constipation, sweating and withdrawal are not affected.

So, “How does anyone become addicted?” There is a lot to unpack. A colleague of mine developed the Oud after having wrist surgery. There was the theft, the lying, the firing – the whole stereotype. Ignorantly, when he was in recovery, I asked him how he had allowed this to happen. (You know, because postoperative opioids always made me feel lethargic and nauseous…). Reformulate:

“I always feel so awkward and anxious, and I can never relax. When I first took the pain pills, I felt great. I felt so cold. I felt so great, strong, happy, and so deserving of being loved. How could you not want to keep feeling like this?”

Researchers call this feeling euphoria, and it is different from pain relief. Study 2022 They asked people who had misused opioids (took ecstasy) how they felt the first time. Those who developed Oud had a completely different experience.

A family history of addiction may be associated with rapid familial activation or euphoria of mu receptors, rather than a generational environmental risk. People with the CYP 2D6 metabolism gene also have higher rates of smoking and alcoholism. However, the neurotransmitter reward in agarwood is more intense. This is why 95% of successful OUD treatment requires medication, and manipulation of the “switches” to keep reward pathways in check.

My best high school friend died of a heroin overdose while I was away for college. Her vulnerability and foolishness horrified me and kept me mad for two decades. I now bet that my girlfriend, a heavy smoker, and the mother who had given her up for adoption, felt differently on opioids than I did. I wish I could have told her, if nothing else, that feeling high was a sign of taking a risk. And I wish I could have understood then, as I do now, that her overdose resulted from a genetic disorder, not a moral failure. Rest in peace, Sue.

Amy Baxter He is a clinical associate professor of emergency medicine at Augusta University, federally funded neuromodulation research to reduce needle pain, multimodal low back pain, and opioid reduction. After attending Yale University and Emory Medical College, she completed her residency and child abuse fellowship at Cincinnati Children’s Hospital Medical Center, pediatric emergency fellowship in Norfolk, Virginia, and K30-NIH Clinical Research Certificate at UT Southwestern Medical Center. She is also the CEO, Pain Care Labsand can be reached on Twitter @imibaxterMD.