Overprescription of Opioids Leads to Dependence

Opioids usage has become as common as taking daily vitamins. An opioid is a psychoactive chemical which diminishes the sensation of pain. The common name for opioids are painkillers. Whether over-the-counter or not painkillers are one of the most easily obtained drugs on the market. Today’s society relishes the abundance of these painkillers and continues to use them at an astonishing rate. Now having tolerance to pain would not be such a bad thing if it were not for the addicting nature of painkillers. For people suffering chronic pain over-the-counter painkillers such as morphine, vicodin and oxycontin are typically prescribed. However, strong painkillers such as these possess a high risk for the taker to become addicted to and dependent on the drugs.Famous celebrates such as Michael Jackson and Heath Ledger both fell victim to overdose caused by their dependence on opioids.
How can innocently taking a strong painkiller such as vicodin after a surgery turn into a dependence and in an extreme case, death? The answer lies in the chemistry of the brain. The pathway of pain begins in the peripheral nervous system with let’s say a cut on your finger. The signal travels from the receptors in the finger through the body to the spinal cord. The spinal cord then relays that signal to the brain where the signal is processed as pain. Speaking more in depth about the role of painkillers in the pain pathway, painkillers reduce the expression of a chemical called substance P. Substance P expresses itself at an exponential rate. Meaning that if one substance P is initially produced as the neuron fires that one substance P becomes two, which then becomes four, eight, sixteen and so on. Painkillers target the expression of substance P and reduces its production. However, inside the brain, as the neurons receive the opioid, a genetic transcription factor, CREB (cAMP response element-binding proteins), begins to code your genes to that painkiller. This means that the body becomes less receptive to the painkiller. Tolerance builds up and more dosage of the painkiller is required to obtain the same satisfaction as when the usage began. Along with the accumulation of tolerance, a person can develop an addiction to the pleasurable effects of the drugs. Addiction does not lie with the same genetic transcription factor as tolerance, instead a new genetic transcription factor, delta FosB, codes DNA for the craving of the painkiller. Death from overdose comes from the painkiller shutting down the sensitivity of the nervous system. Instead of turning off the body’s pain reception, overdose causes all reception in the brain and spinal cord to halt.
If the risks of addiction and overdose exist, why then are painkillers prescribed so often by doctors? One of the main reasons that doctors prescribe painkillers regularly is because they do not wish to lose their patients. If a doctor does not provide a patient with what they want, then there is a chance that the patient will leave to find a doctor who will give them what they desire. Therefore, doctors are almost forced into prescribing painkillers in order to keep their patients. Does fault solely lie with timid doctors afraid of losing patients? Society too plays a role in the overprescription of painkillers. Due to the abundance of pain medication people now-a-days are more likely to grab a bottle for the slightest pain. Pain tolerance is a factor to this. For example, I see myself as having a high pain tolerance and so rarely do I take pain medication. Because of this a small dosage usually does the job for me. If you look at my mother on the other hand, she has a very low pain tolerance. She not only takes pain medication more often but also needs more dosage to relieve that pain because she takes painkillers more often. Therefore, the fault of overly prescribed pain medications lies both with eager to please doctors and people with varying levels of pain tolerance. To place restrictions on the prescription of opioids would be a difficult manner as there is no universal chart for pain. Everyone experiences pain differently and as such there can be no definite way to administer the prescription of painkillers which is completely inclusive.