The prescription of opioids for dealing with chronic pain saw a sharp increase starting in the late 1990s, before it was known that such medications were highly addictive. Now, an estimated 90 people die every day in the United States due to an opioid overdose. According to the National Institute on Drug Abuse, as many as 21% to 29% of prescription opioid patients misuse the drug, and about 80% of heroin users were first misusing prescription opioids. The U.S. further spends around $78.5 billion dollars annually on costs related to opioid misuse, including healthcare costs, lost productivity, and addiction treatment.
How do opioids work and who is at risk for an opioid addiction? What are scientists doing to try to combat the opioid crisis?
How Do Opioids Work in the Body?
The class of drugs known as opioids includes illegal versions like heroin and prescription pain relievers like oxycodone and hydrocodone. Some opioids, like fentanyl, are synthesized in a laboratory, while others are naturally derived from the resin of poppy plants. In fact, research has shown that it is possible to test positive for opiates after consuming commercially available poppy seeds like those on a bagel or in a cake.
When prescribed by a doctor, opioids are usually intended to help with acute pain, or pain that is shorter-lived yet more intense than chronic pain, like, for example, the pain you might experience after a surgery. Opioids work by interacting with the opiate receptors in your brain cells. They alter the signals your brain sends out to the rest of your body by blocking the negative signals announcing that your body is in pain and instead sending a message of pleasure or euphoria.
These euphoric signals are the result of a release of endorphins, sometimes called “feel good transmitters.” Endorphins are neurotransmitters, in other words hormone-like chemicals that transmit information between the neurons in your brain. Our bodies naturally produce endorphins, so we can get a completely safe so-called “endorphin rush” from activities like exercise, laughing, or even eating spicy food. When medications are used to increase our naturally occurring levels of endorphins, however, the potential for addiction and other negative side effects arise.
Why Are Opioids Dangerous?
Because opioids are not just effective at dulling pain but also provide a feeling of euphoria, opioid users can find themselves wanting to return to that state of bliss once the drug has worn off. Making matters worse, our bodies build up a tolerance to opioids meaning that the same dose of medication will release fewer and fewer endorphins the longer a person uses opioids. Thus, to continue to dull pain at the same level, increasingly higher amounts of the drugs will be required. According to the Mayo Clinic, higher doses of opioids beyond those recommended by a doctor can cause your breathing and heart rate to slow and can be fatal.
Abruptly stopping opioid usage can also cause pain that is even more intense than the original pain that required the use of the drugs in the first place, creating a negative feedback loop that can lead easily into addiction. Illegally obtained opioids may further be laced with hazardous contaminants or even stronger opioids.
Can You Vaccinate Against Addiction?
Addiction is defined as an irresistible or compulsive and continued use of a substance despite adverse consequences. While we know opioid use comes with a risk of addiction, it can be difficult if not impossible to predict who will be most vulnerable to addiction. According to the Mayo Clinic, the likelihood that a patient will still be taking opioids a year later increase after only an initial five days on the medication. Other known risk factors include stressful circumstances (including poverty and unemployment), a history of severe depression or anxiety, and prior struggles with addiction.
The US Department of Health and Human Services as well as the National Institutes of Health are working to combat the opioid crisis by improving access to treatment services and by promoting awareness of available drugs that can reverse an opioid overdose. Research shows that successful treatment for opioid addiction usually involves lifelong diligence and maintenance with drugs that result in a high tolerance for opioids so opioid use no longer results in the addictive sense of euphoria.
These national organizations are also funding cutting-edge research into how our bodies deal with pain and addiction and alternative methods for managing both. Included in these studies are investigations into whether we can effectively inoculate ourselves against addiction with a vaccination. Such an opioid inoculation would work much like other vaccines: it would produce antibodies that instead of fighting diseases like polio or the measles would instead have the job of fighting opioid molecules.
An opioid inoculation would work like other vaccines: it would produce antibodies that would have the job of fighting opioid molecules.
So in theory, if I vaccinated myself against heroin and then later used the drug, I would not get the rush of endorphins or feel the resulting euphoria. Instead, the antibodies introduced into my system by the vaccine would block the transmission of those feel-good signals before they could reach my brain.
However, the use of vaccines for fighting addiction is still far from being a daily reality. Research into such vaccines is not new, dating back to as early as the 1970s, and has so far been unsuccessful. There have been efforts to produce a heroin vaccine with promising results in mice and monkeys, but no such studies have reached the stage of human trials. Since these antibodies would have to be specialized, a vaccine would further have to be developed for each specific opiate. Such vaccines may also require frequent boosters in order to keep the level of antibodies high enough in your system. So for now, research suggests that treatment plans are the best option.
Abruptly stopping opioid use can have severe side effects and recovery programs that require complete abstinence tend to be less effective. So if you, or someone you know, is struggling with an opioid addiction, please talk to a doctor for help.
Until next time, this is Sabrina Stierwalt with Everyday Einstein’s Quick and Dirty Tips for helping you make sense of science. You can become a fan of Everyday Einstein on Facebook or follow me on Twitter, where I’m @QDTeinstein. If you have a question that you’d like to see on a future episode, send me an email at everydayeinstein@quickanddirtytips.com.
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