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Tackling the Opioid Crisis

In the past 20 years, over 500,000 people have died from opioid overdose. Most of these deaths were unintentional. The Opioid Crisis is far from being over.

A little history:

The use of opioids was first recorded over 3000 years ago. Ancient Egyptians discovered the poppy flower (containing opium) to be an effective remedy against pain relief. At the same time, across the mediterrarean, the ancient Minoans used this same flower for its high. And so, opium fuelled humanity’s obsession with tweaks that both reduce pain and increase pleasure.

So what really are opioids?

Opiates are all compounds made directly from the poppy flower. In the 19th century opiates, including morphine and codeine were produced.Then in the 20th century, synthetic versions of these substances were mass produced, including heroin, oxycodone and fentanyl. All these compounds are collectively called opioids. 

Opioids, both synthetic and natural are effective pain killers but with a strong drawback: they’re highly addictive. 

When did opioid addiction spike?

In the 1980s and 90s, after mass producing both natural and synthetic opioids, pharmaceutical companies aggressively marketed opioids as pain relief, whilst downplaying its addictive nature. This marketing was directed at both the medical communities (causing opioid prescriptions to shoot up), and also to the general public (skyrocketing the number of opioid users). This sparked a sharp escalation of opioid addiction, called the opioid crisis, which still claims thousands of accidental deaths per year.

What makes opioids so addictive?

All opioids bind to the same receptors in the brain that endorphins usually bind to, in order to tune out pain signals. However, opioids bind to these receptors with greater strength and duration, leading to stronger pain relief than endorphins. 

This is even more alarming when you realise that the binding of opioid receptors doesn’t just affect pain (by triggering dopamine release), it also impacts mood, wakefulness, breathing, digestion and blood pressure (all by suppressing noradrenaline release).

In therapeutic doses, opioids can decrease enough noradrenaline to cause constipation but in higher doses, they can slow down breathing and heart rates enough to cause unconsciousness and even death. 

Over time the body begins to counteract this by decreasing the number of opioid receptors or making them less effective at binding. This can lead to people taking higher doses of opioids to feel the same dopamine hit as before. This creates a cycle that leads to addiction. 

However, with increased opioid doses, noradrenaline levels can decrease to a point where it’s difficult for your body to perform basic functions. So your body compensates by creating more noradrenaline receptors to detect smaller levels of noradrenaline and continue functioning as per normal.

Why is it so hard to quit opioids?

If someone who has become physically dependent on opioids to maintain the noradrenaline balance suddenly stops consuming opioids, then their noradrenaline levels skyrocket within a day. However, there is a lag phase as your body takes a longer time to get rid of the extra noradrenaline receptors it had created.

In this lag phase, your body is too sensitive to noradrenaline and triggers withdrawal symptoms including muscle pain, vomiting, stomach aches and fever. This can continue for days and even weeks, making some violently ill and unable to perform basic tasks or work. It becomes easier for people to continue using opioids to avoid this sickness. 

If people who have been addicted and quit opioids, suddenly re-take it (due to medical treatment), they are at particular risk of death as a dose that would have been fine when they had a high tolerance can now be fatal. 

How can we protect from opioid overdose?

The current treatment is naloxone, a drug that binds to the opioid receptors but does not activate them. This is effective as it blocks other opioids from binding to receptors (that have already been bound by naloxone) and can even knock off opioids from receptors to reverse overdosing. 

Is there an opioid-free treatment for pain?

Currently being considered for pain relief are CBD lotions. The mechanism of action is to inhibit the release of neurotransmitters that flood the body when pain receptors are activated. This negates the sensation of pain after nerve injury and peripheral nerve stimulation and can be an effective alternative to opioids for neuropathic and inflammatory pain. 

Other pain relief methods use technologies such as radio waves (burning the relevant pain nerves via the electric current generated by radio waves), nerve blocks (injecting numbing medication to block the relevant pain nerves), electrical signals (sending low voltage electrical signals to the area of pain through pads attached to skin), spinal cord stimulation (a device is implanted in the lower back and can be stimulated remotely to send signals to the area of pain), and pain pumps (pumps implanted that deliver pain medication to a patient’s spinal cord at the press of a button). 

Another promising opioid alternative looks to be stem cells, where stem cells are harvested from a patient’s bone marrow and injected into the area of pain to build new and healthy tissue. 

There is still evolving research being done to discover effective and safe opioid-free pain treatment. However, if you or someone you know is addicted to opioids, I urge you to contact an opioid lifeline. This number changes depending on your country, but a quick google search will direct you. In Australia the number is 13 11 14 and the site is: https://www.lifeline.org.au/get-help/information-and-support/substance-misuse-and-addiction/