Opioids are substances that attach to opioid receptor sites found on neurons, cells that transmit information between the brain and the rest of the body. This transmission of information is known as neurotransmission. During neurotransmission, chemicals called neurotransmitters spread messages between neurons by either activating or inhibiting those neurons from producing chemical messages. Thus, neurotransmission is naturally regulated by a series of inhibitory and activation signals that control neuronal activation; some neurotransmitters cause neurons to activate while some neurotransmitters prevent neurons from activating.
According to the National Institutes of Health (NIH), opioids function as neurotransmitters capable of activating certain pathways of neuron signaling by binding to their specific opioid receptor sites. The body naturally produces endogenous opioids that bind to and activate opioid receptor sites on neurons to release “feel-good” chemicals such as endorphins, serotonin, oxytocin, and dopamine that control our reaction to painful stimuli.
However, the NIH further states that externally-administered, opioid drugs not produced by the body can disrupt the natural regulation of neurotransmission. These opioid drugs mimic the molecular structure of the brain’s natural opioids to bind to natural opioid receptor sites, activate neurons, and cause neurons to overproduce the “feel-good” neurotransmitters. In this way, these opioid drugs “fool” the nervous system into a state of overstimulation that ultimately results in the excess release of neurotransmitters that produce feelings of relaxation and pleasure.
According to the National Institute on Drug Abuse (NIDA), in addition to producing high levels of neurotransmitters that cause pleasurable feelings, opioid drugs also produce high levels of neurotransmitters, such as dopamine, that cause the desire to repeat behavior. Dopamine signaling activates the brain’s reward system and causes the desire to repeat pleasurable experiences. This desire is referred to as the opioid effect, which promotes addictive behavior.
There are three main types of opioids, distinguished by their synthetic properties:
- Natural opioid: opioids derived from the opium poppy (e.g., morphine, codeine, thebaine);
- Semi-synthetic opioids: opioids created from natural opiates (e.g., hydromorphone, hydrocodone, oxycodone, heroin); and
- Fully synthetic opioids: opioids created entirely synthetically (e.g., fentanyl, pethidine, levorphanol).
While many effects of opioids can be useful for medicinal purposes such as pain relief, some patients develop an addiction to opioids. In such patients, regulated prescription opioid usage devolves into addictive nonprescription opioid abuse. According to NIDA, there is evidence to support that many patients begin using prescription opioid medicine and only resort to illicit opioids when their prescriptions run out. For example, the usage of heroin is nineteen times higher for individuals who began using opioids as prescription medication than those who had no prior prescription access to opioids. Further, 80% of current heroin users self-reported using prescription opioids prior to using heroin. Despite the established link between prescription opioid usage and illicit opioid usage, the NIH reports that the prescription rate has skyrocketed throughout the last three decades.
According to NIDA, around 2.4 million people suffer from opioid addiction. This number is growing dramatically and opioid overdoses are driving the increase in drug overdoses in the United States. NIDA further emphasizes the dangers of this addiction, reporting that opioid addiction has severe mental and physical effects on users. Repeated usage of opioids causes users to develop a tolerance for the substance through desensitizing neurons. NIDA explains that, as a result, users increase their dosages, perpetuating the addiction, and sometimes resulting in overdose.
To combat opioid addiction, there are three main types of corrective treatments available to opioid abusers:
- Pharmalogical treatment (medication-assisted treatment): aims to reduce opiate withdrawal symptoms to allow patients to return to a productive lifestyle instead of constantly seeking the substance. These drugs stimulate opioid receptors but avoid producing the “high” associated with recreational use, allowing the user to shift their dependency away from their drugs with minimal withdrawal symptoms and cravings.
- Methadone is a slow-acting opioid agonist, a drug capable of activating receptors in the brain, that reproduces the euphoric effect of opioids to relieve withdrawal symptoms for 24–36 hours per dose.
- Buprenorphine is a partial opioid agonist which partially reproduces the euphoric effect of opioids, with many time-release formulations.
- Naltrexone is an opioid antagonist, a drug capable of blocking opioid receptors in the brain, that blocks opioid receptors for 20–30 minutes and prevents opioids from inducing feelings of euphoria in the user.
- Naloxone is a drug used for short term overdose reversal instead of long term treatment. It blocks opioid receptors and prevents harmful symptoms such as drowsiness and shortened respiration from continuing.
- Behavioral therapy treatment: targets the psychological and sociological aspects of addiction.
- Cognitive behavioral therapy is a classification of outpatient therapy strategies which provide psychotherapy to patients and attempt to correct the learned behavioral patterns behind drug abuse.
- Contingency management treatment is a form of outpatient therapy that rewards patients for negative drug screens to incentivize healthy living and a stepwise return to independent living.
- Community reinforcement approach is a form of outpatient therapy that makes a substance-free lifestyle more rewarding than a substance-use lifestyle through vocational, familial, and social incentives and reinforcement.
- Family behavior therapy is a form of outpatient therapy aimed at addressing familial problems such as abuse, mistreatment, and conflict that function as risk factors and triggers for drug abuse.
- The matrix model is a form of outpatient therapy that attempts to achieve abstinence by teaching patients about issues of addiction and the self-help and support systems available to them.
- Motivational interviewing is a form of outpatient therapy that provides counseling to patients aimed towards eliciting self-motivation from patients for behavioral change.
- Residential treatment is inpatient therapy that removes patients from toxic environments and helps them to shift to a more positive lifestyle.
- Long-term recovery treatment: groups that provide those who want to live a drug free lifestyle with a support network of recovering narcotic abusers.
- Narcotics Anonymous (NA) is a community-based organization which holds weekly group meetings for recovering drug abusers.