Understanding Opiate Addiction

Many, even doctors do no understand why people become addicted to opiates. First it's important to understand that taking opiates mimics what the body does naturally. Opiates can disrupt this natural process which can lead to addiction. The natural system that opiates mimic is primarily the Dopamine system. Simplified, Dopamine is a neurotransmitter that your body uses to reward, reinforce positive behavior and relieve pain (it can also be the agent of feeling awe and belonging). Again simplified your body has a reservoir of Dopamine and a number of Dopamine/ opiate receptors. When you do something that is positive for your body (eating, exercising, having sex), your brain rewards you by releasing Dopamine which is absorbed by your Dopamine/ opiate receptors and you feel good; the Dopamine will then be recycled back into the reservoir. Interestingly, your brain also releases Dopamine when you listen to music, meditate and pray among other things we really don't understand. As I said it also relives pain. If you have ever stubbed your toe or caught you fingers in a door, you will remember after about 30 seconds to a minute, you will have a warm feeling and the pain will subside for a short while; this is the Dopamine system at work. It is also worth noting that opiates are a narcotic, which means it systemically slows down the workings of the body, including the heart; take too much and the heart will stop. To counter this a substance called NARCAN is available. What NARCAN does is block the Dopamine/ opiate receptors which counters the affect of the opiates.

When you take opiates, they mimic Dopamine but it flushes your Dopamine/ opiate receptors with a massive amount of a Dopamine like chemical, you feel very rewarded, and the pain goes away. The problem is your body is designed to be very efficient and frugal. Because opiates create an excess amount of Dopamine, as you continue to take opiates, your body reacts to what it sees as an overabundance, so depletes it's reservoir of Dopamine and starts shutting down receptors; this is what causes a tolerance to opiates requiring you to take more to get the same effect. 

If you stop taking the opiates, you will then go through a withdrawal period as the remnants of the opiates you are taking is processed out of your body, refereed to as detox. If that were all there was to opiate use and addiction would not be the problem that it is. First, this is a physical addiction. After the detox period, there is still the issue of your body returning to homeostasis, eg normal. Your body does not immediately refill it's reservoir with Dopamine and turn the opiate receptors back on; this can take, weeks, months and even years and is referred to as PAWS or Post Acute Withdraw Symptoms. During this time, your body will not be able reward you for almost anything, this is the misery of withdrawal. Nothing that you do will result in your feeling good, just the constant pain that goes along with being alive with no positive reinforcement for anything that you do. The two exceptions seem to be the relief of extreme pain and submersion in "hot as you can stand" water; the relief of/by extreme pain response can result in self injury simply to reduce the withdraw or PAWS.

Further there is also the physiological addiction, where the user even after their system has returned to something approaching normal (the tolerance they developed may never completely go away), will forever want to experience the initial high the had with their first opiate use. I also find it disingenuous to say opiates are safe when taken as directed. Again the problem is tolerance and dependency can begin almost immediately, and if the doctor is not monitoring the patient, their opiate use can quickly spiral out of control. In other words, a prescribing doctor should assume if not properly monitored, a patient will start abusing their medication, simply because of the known additive nature of the drug.

I have heard that addiction is nothing more than weakness or a lack of self control; well yes and no. First of all, as I explained there is a physiological reason for addiction that goes beyond simply taking opiates to feel good. Most that become addicted to opiates  do not start off as drug abusers, they are usually prescribed opiates by a doctor to relive pain. However, since many doctors don't really understand the nature of drug addiction, they do a very poor job of monitoring their patients whom they have prescribed opiates, which can lead to opiate dependence and addiction. People also react to opiates in different ways. To some opiates cause them to be drowsy and out of touch, however others react in an opposite way. With many people opiates cause a feeling of exhilaration and added energy, these are the people most likely to become addicted. Further, people vary greatly in their ability to withstand withdrawal symptoms and/or PAWS. This is not really a matter of will power, but more a matter genetics and/or environmental factors. Further, the use of opiates also reduce ones ability to withstand low level pain without the use of opiates; in other words, ones pain threshold is significantly reduced with the use of opiates, because the body has fewer resources to deal with low level pain. 

To put all this in prospective, as a result of the Covid-19 lock downs, more than 100,000 people a year (2020 and 2021) have died from over dosing of opiates (an increase of 28% over 2019), making opiate addiction approximately the number 8 cause of deaths in the US. While the increase of fentanyl (fentanyl is 50 times more potent than heroin which makes dosing much more difficult and potentially fatal)  laced drugs is partially to blame, but the Covid-19 lock downs have caused universal increases in drug and alcohol use/ abuse, depressions and other mental breakdowns, suicides and domestic violence. To say that these overdoses by drug addicts are all simply the lack of self control would seem to be based on ignorance as it completely ignores the physiological causes and the lack of opiates being properly administered by seemingly clueless medical professionals.