Why Are Opiates So Addictive?

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Opiates are notorious for their addictive qualities and the impact they have on people who become dependent on them. Opium and its derivatives have been a part of human history for more than 3000 years. According to the National Institute of Mental Health, it wasn’t until 1806 that the active ingredient in opium was first isolated. It was named morphine, after the ancient Greek god of sleep and dreams. (1) That marked the beginning of humanity’s complex pharmacological relationship with opioid compounds.

The agony of withdrawal soon became apparent to anyone who used morphine for more than a few days and tried to quit abruptly. However, we wouldn’t begin to understand the disease model of addiction until more than 100 years later when Dr. William Silkworth proposed that addiction was a psychological illness in the 1930s. It wasn’t until 1954 that the broader medical community accepted the idea. One of the early pioneers of addiction medicine, Ruth Fox, would later go on to form the American Society of Addiction Medicine (ASAM). (2)

Why Opiate Withdrawal is so Severe

All opiates work, in part, by activating receptors in the brain and causing the brain’s “reward system” to flood with dopamine. One of the functions a healthy brain uses dopamine releases for is to reinforce positive behaviors. For example, regular strenuous exercise produces dopamine. The brain is hardwired to seek that chemical that delivers a sense of well-being and calm. When abusing drugs becomes the primary source of dopamine surges, it can easily disrupt the usual set of priorities we have. The drug-seeking and using behavior is repeatedly reinforced and a pattern quickly develops.

Opiate addiction is complex. It very directly involves the brain’s reward system in a way unlike any other category of chemical. The double-edged sword of pleasure and pain it wields makes it a cruel master. It causes people to quickly develop deep-seated behavior patterns that can be incredibly challenging to change. Ironically, semi-synthetic opiates like heroin were initially developed in an attempt to make a less addictive opioid which could still be useful for pain relief. Modern research into opiate addiction has moved the field of addiction treatment beyond simply trying to treat symptoms into a deeper understanding of addiction and a focus on long-term outcomes.

Good News About a Solution

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) more than 2 million Americans are currently grappling with an opiate use disorder.(3) The positive news is that more research has been done into opioid addiction in the past 30 years or so than ever before and it is yielding promising results. The more we understand the mechanism of opiate addiction, the more effective interventions we can devise. As the opioid epidemic has exploded in the U.S. the demand for effective long-term solutions has become more urgent than ever before. Medication-Assisted Treatment or MAT has gained mainstream acceptance for delivering demonstrably better outcomes. The CDC is currently conducting a long-term study of over 1,000 patients to research outcomes for MAT patients. (4)

The ultimate goal of MAT along with other long-term programs is lifetime abstinence. Research has shown that longer engagement with opioid use disorder patients improves outcomes. Aftercare planning and outpatient treatment with or without MAT mitigates relapse events more effectively than the old treatment model where a patient was discharged after a couple of weeks and told to simply attend meetings on their own. MAT is only one of several solutions however and it’s not generally meant to continue for a lifetime. The powerful and complex addictive nature of opiates means that patients must be committed to change in order to maintain their recovery. There is no single cure for addiction in the form of a pill, no easy answer. The good news is that the treatment field is constantly evolving. Some very real and very promising developments in the treatment of opioid addiction have emerged in recent years. As science learns more about the inner workings of the brain and how genes play a role in addiction, we can expect to see more and more effective treatment.

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC46725/
(2) https://journalofethics.ama-assn.org/article/evolution-addiction-medicine-medical-specialty/2011-12
(3) https://www.samhsa.gov/medication-assisted-treatment
(4) https://www.cdc.gov/opioids/Medication-Assisted-Treatment-Opioid-Use-Disorder-Study.html

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