Dec 10, 2017
From Painkillers to Killers: The Evolution of Opioid Abuse
Taken under a physician’s supervision, prescription opioids have proven value alleviating pain. But outside a therapeutic context, opioids nurture destructive addictions, and even death. The painkillers can become killers.
To understand this path from prescription drug use to lethal overdose, it’s helpful to appreciate two features of how opioids work. Both pharmaceutical opioids like Percocet, and Vicodin) and illegal opioids like heroin mimic the activity of neurotransmitters, disrupting the body’s signaling mechanisms.
How Do Opioids Work?
Consider an example. Suppose you break your ribs in an automobile accident. Your nervous system is communicating acute pain, and your body tenses in agony.
At this point, the physician might administer Vicodin to help you feel better. To receptors in the brain, the drug’s chemical profile looks like the body’s own neurotransmitters. So they allow the opioid to attach itself to the receptors and send its own message: slow your breathing, calm down, and stop feeling discomfort.
Once this happens, your pain recedes, and your condition improves. You might even experience a wave of euphoria, since opioids target the “reward centers” of the brain responsible for triggering pleasure.
It’s easy, then, to see why both doctors and patients favor opioids: by imitating the body’s signaling, they counteract the effects of painful trauma. That’s good for everyone involved.
The Addiction Factor
But there’s a second, more troubling dimension to how opioids work: they are fiercely addictive. Because they chemically bond to receptor sites, opioids become part of the body’s operations, fostering dependence. Many patients who were prescribed opioids to help them manage pain soon find themselves coping with the new pains of withdrawal.
Both dimensions – pain reduction and addiction – play a role in the unfolding opioid epidemic.
Because they provide effective relief, more physicians began prescribing opioids to treat chronic pain in the late 1980s and early 1990s. Their motives were understandable: they wanted to ease discomfort and improve patients’ experience.
Unfortunately, doctors’ desires to keep their patients from suffering led to over-prescription; patients might receive thirty days’ supply when they only needed two or three three days of therapy.
These longer regimens brought more relief, but also increased risks of addiction. Once the patient had become accustomed to the sensation opioids delivered, it was hard to go back. But their prescriptions inevitably ran out. As craving set in, many began seeking substitutes.
Those unable to get their hands on a script increasingly turned to a less expensive and more readily-available alternative: heroin. It was cheaper than prescription pills and didn’t require a prescription. But it also carried the effects of serial addiction, painful withdrawal, and deadly overdose.
Addicts seeking alternatives to prescription drugs contributed to a sharp spike of heroin distribution and abuse. This link between prescription opioids and heroin has since been well-documented. According to the American Society of Addiction and Medicine, four out of five new heroin users formerly misused prescription painkillers.
Heroin was dangerous enough, but the crisis worsened in the mid-2000s when dealers started lacing heroin with fentanyl. Boasting 40 to 50 times the potency of heroin, fentanyl was designed to treat intense pain, such as what patients experienced in the terminal stages of cancer.
Now, heroin fortified with an even more powerful opioid was hitting the streets at a lower price point, causing overdose rates to skyrocket. A 2016 study of opioid fatalities across ten states found fentanyl was involved in over half the cases.
The story of how opioids developed to alleviate pain created new forms of suffering can therefore be traced to its twin chemical properties of relief and addiction. How those prescribing and using opioids managed these risks and benefits is the story of how a crisis began. And now we as a society are dealing with the consequences of these choices..
We share a responsibility to address this deepening crisis. If the opioid epidemic has become a collective problem, only by coming together as a community can we begin to address it – the subject of the next blog in our series.