Can we control our addictions to pain medications?

Throughout late medical history we have seen extensive abuse of pain medications as they are highly addictive to those who are prescribed them. These highly effective medications for pain are also called opioids. An opioid is a type of psychoactive chemical working by binding to its complimentary opioid receptors. These are primarily found in the central nervous system (CNS) and peripheral nervous system (PNS) but also in the gastrointestinal tract. The receptors in these organ systems mediate both the beneficial effects and the side effects of opioids. These drugs are among the world’s oldest as we see the earliest form of them used more than 5,000 years ago.
The reason these drugs work so well is that they have a great reduction in the brain for perception of pain. We still are receiving the stimulation of the pain but our brain is unable to know that this stimulation is indeed pain. Patients experiencing great amounts of pain are often prescribed morphine, one of the more popular opioids. Doctors will also prescribe opioids such as morphine to patients that are near death so they may pass with little amounts of pain as these drugs raise the pain tolerance. For those not on their death bed these pain medications have many side effects and problems with addiction. According to a 2005 national survey on drug use there were almost 2 million Americans dependent on opioids and even more, 4.7 million, use opioids for nonmedical purposes. Obviously there are problems with the system for prescription as we see these numbers rising into our current situation. “The increase in the legitimate use of opioids has been paralleled by a rise in abuse of these drugs, with a 63% increase in opioid deaths during the 5-year period from 1999 to 2004” (Institute of Addiction Medicine).
How do we control these addictions? Traditionally, researchers have looked at controlling the dopaminergic system for addiction to drugs such as opioids but new paths have been trodden for controlling addiction through the glutamatergic system instead. Glutamate is similar to dopamine in that it is a primary excitatory neuron in the brain involved with the side effects, withdrawal, and reward that opioids are linked with. What researchers hope to do is use antagonists (drug that blocks the binding of the natural neurotransmitter) to stop withdrawal and therefore hope to stop the need to go back to the drug. The goal would be to remove the symptoms associated with withdrawal so that patients or addicts were unable to develop a true bodily addiction to the drug in the sense that their body will not need the drug to function properly.
Would this work? Theoretically, it would. We could prescribe pain medications more freely and not worry about addiction and abuse of opioids. Obviously there are many cons to this extra prescribing. Opioids have many unpleasant side effects but these would often be more desirable than pain. This leads to another problem: If we remove the biological addictive factors will we not have a psychological dependence? A patient will quickly associate the pain medications with relief of pain just as reward association often occurs in psychology. This dependence would be also difficult to overcome as there is not necessarily a way to treat this with pills as we could a biological dependence. There are a few ways that we can attack this problem with the better option being a punishment system. As pharmaceutical companies have done in the past we can introduce additives to the drugs to induce more side effects that would me unpleasant enough to deter the prescribed patient to return to the drug for smaller amounts of pain or even taking Tylenol/Advil for larger amounts of pain. This obviously has some ethical problems associated but we must open discussion for what needs to happen next.
As we get closer to solving the problem of biological dependence through manipulation of the dopaminergic system and, more recently, the glutamatergic system we run into other problems with psychological dependence. Much more research needs to be done to successfully do away with biological dependence as this is the first step into conquering the addictive properties of opioids but soon we need to tackle new problems such as our mind’s control over our habits concerning addiction.