Dangerous, even in moderation
Opioids and opioid addiction are common problems in our highly medicated society. They are prescribed in cases of severe and chronic pain to assist patients in overcoming pain so they can continue an active and productive lifestyle. Unfortunately, opioid analgesics can produce addiction, tolerance and dependence after prolonged use. Such prescription drugs as hydrocodone, hydromorophone, oxycodone, fentanyl, meperidine, methadone and morphine, have all been shown to increase user morbidity and have strong drug dependence rates. North America has the highest prevalence of opioid painkiller dispension in the world and it has been related to increasing rates of medication illness and death. The rate of unintentional medication poisoning has been rising for 15 years and is now the second highest cause of unintentional injury hospitalization in the United States. There are obviously dangers associated with the prescription of opioid analgesics, but can the dangers be overcome.
http://www.physorg.com/news189747766.html
http://medicalxpress.com/news/2011-08-prescription-opioids.html
A Poor Reward
The review paper for this week describes opioid addiction and some current research into the topic. Opioids are so addictive because they manipulate the reward system in the brain. When an opioid reacts with the brain it causes a release of dopamine and glutamate. These reduce the feelings of pain and can facilitate feelings of euphoria and pleasure. The body recognizes these effects as beneficial and activates the reward system, which basically tells the brain that this may be an effective way to resolve pain in the future. However, continued use of opioids in this fashion is what begins the spiral to tolerance and dependence. When opioids are used consistently, dosing needs to be steadily increased to feel the same level of relief, this is tolerance at work. Dependence, on the other hand, occurs because the brain recognizes its inability to naturally generate pain relief as effective as opioid medications. Therefore, cravings of the medication are created to signal the desire to return to the state of relief undergone after the use of opioids. Eventually this state becomes perceived as the “normal state” and without the opioid the person can feel depressed and anxious as well as other negative symptoms. These negative symptoms felt after stopping or lessening a drug the body has become dependant upon is known as withdrawal.
Hope-ioids
Good news, there is hope for opioid addiction. The study describes medications used to help block the feelings of withdrawal or even circumventing addiction all together by manipulating the function of dopamine and glutamate, the chemicals mentioned earlier that are released by the brain in the presence of opioids and are suspected in the development of addiction and dependence. Most of these medications have only been tested in animals and are a ways from being available for human use, but the progress is encouraging. Even though the mechanism for addiction in the brain is complex and the scientific and medical community have not reached consensus on the subject, pieces of the puzzle are slowly but surely being uncovered and fit together. I think we can all look forward to a day when chemical dependence has less sway over people requiring medications for chronic health issues.
Oh No Opioids
