To put it simply, an addiction is a condition wherein a pleasant-feeling habit turns into an unavoidable obsession, one you cannot cut ties with or live without. This isn’t like developing a love for a dish and “not getting enough of it”. It is like developing the sense of a need for opioids like you have a need for water and food.
But why do these addictions occur, and why is it that one of the country’s most prescribed drugs also happens to be one of the most potent and addictive? And finally, why is it that opioids have become so ubiquitous, and how did the opioid crisis come to be nearly 30 years ago?
Why Opioids Are Addictive
Opioid medication is any medication that is either directly or synthetically derived from opium, an extract of the poppy plant. Historically used as an anesthetic and recreational drug, opium has a long history tracing back to some of the first civilizations in all of human history. Today, most of the opium in the world (both medical and illegal) is produced in Afghanistan, by synthetic opioids are often produced in other countries such as Mexico and China.
However, we don’t use opium in its raw form. Instead, certain chemicals are isolated within opium to produce a variety of compounds, including morphine and codeine. Thebaine extracted from opium is used in the production of synthetic opioids, including hydrocodone (Vicodin), hydromorphone, and the infamous oxycodone (OxyContin). On the illegal side of things, morphine is extracted from opium, then turned into diamorphine (heroin).
While opioids have been known for their addictive potency, opium’s early history is largely medicinal, particularly for pain relief and anesthetics. It wasn’t until the 19th century that morphine and heroin were developed from opium, and since then, other opioids have been designed for pharmaceutical use, ranging from the less potent codeine to the far more potent fentanyl.
But just as opium has a legacy of addiction and debauchery tracing back thousands of years, opioids are still very addictive drugs. Despite this, the production and consumption of prescription opioids soared in the 1990s, making the US the largest consumer of opioids in the world bar none. To this day, the sudden and explosive rise in opioid use late in the last century continues to bear a terrible fruit in the form of thousands of opioid-related overdoses per year, many through a growing heroin market capitalizing on the demands of a large number of American prescription opioid addicts.
When you take an opioid, it binds to opioid receptors in the brain and does a number of things, including relieve and numb pain. But it also releases a large amount of dopamine and produces a powerful euphoric effect. Over periods of time, opioid use confuses the brain, and it begins to form a habit of using the drug as a way to feel good. Pushed so far off its equilibrium with each use of an opioid, the brain slowly changes, making regular opioid use the new “normal”. On the other hand, quitting opioids after developing this dependence leads to a series of emotional as well as physical symptoms, and an intense craving for your newfound habit. This kicks other habits and cravings to the curb, as the addiction for opioids overpowers nearly any other form of pleasure.
Opium was a powerful drug, contributing heavily to the temporary downfall of the most dominant economic force on the planet in the mid-19th century. Opioids can be just as dangerous, dealing a massive blow to the US both financially and through loss of life.
How the Opioid Crisis Began
Opioid-related deaths rose sharply in 1991 and coincided with the increase in prescription opioids on the market, particularly through pharmaceutical companies like Perdue. A combination of mass marketing for painkillers, the development and sale of OxyContin, campaigns such as “Pain as the Fifth Vital Sign”, and the sheer power and influence of drug lobbying led to an astonishing number of painkillers flooding onto the streets through pressured doctors, far more than were every needed.
While the FDA began cracking down on some of this behavior, it went on for decades. In one particularly astonishing example, a single town of 392 people received a ludicrous 9 million hydrocodone pills over two years. Meanwhile, two pharmacies in Williamson, West Virginia received 21 million opioid painkillers between 2006 and 2016. Opioid deaths rose from over 1 per 100,000 in the late 1990s, to nearly 9 in 100,000 today. That’s an average of about 130 opioid-related overdoses per day.
Treating an Opioid Addiction
Opioids are incredibly damaging, but their effects can be mitigated through proper treatment. Sadly, this treatment is not available to all Americans, and even fewer take advantage of it. Opioid addiction is incredibly undertreated in this country and is one of the major reasons why the epidemic continues to be such an issue.
Treatment begins with separation. By separating a patient from the drug, they begin undergoing the process of withdrawal. The withdrawal process takes at most about one month and can be over in as little time as one week. Withdrawal begins anywhere from a few hours to half a day after the last dose. While withdrawal symptoms can be very uncomfortable, they are not lethal. Despite this, it is recommended to undergo withdrawal with the help of a medical professional, within a rehab or detox facility. Certain discomforts can be mitigated through proper management. Furthermore, unlike many other addictions, there are certain medications that can potentially help recovering addicts manage cravings. Opioid antagonists completely block the euphoric and painkilling effects of opioids, rendering them nearly useless. Certain opioid antagonists are used to save an addict’s life during an overdose, by breaking the connection between the opioid and the brain’s cells, and kickstarting respiration.
After withdrawal, the priority is to prepare for a drug-free life. While opioid addiction is potent, long-term management can do a lot to tremendously mitigate the potential of a relapse. Group meetings, support systems, strict schedules, a healthier coping mechanism, and a series of other tools and techniques, such as sober living communities, can be utilized over the course of a recovering addict’s lifetime to continue to commit to sobriety and avoid opioid use.