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Opioid Awareness

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Chemistry of addiction

People who struggle with addiction oftentimes don’t choose to make bad decisions. Their brains are affected by the substances they abuse.

Dr. Paul Updike, Catholic Health Medical Director, Substance Use Treatment Services, said brain chemistry is affected by opioids in different ways, including impact to the frontal lobe — which is an area of the brain that is involved with making decisions.

“The parts of our brain that sort of help us make rational decisions, help us to see negative consequences of actions, that starts to become impaired,” said Updike. “We see people doing things that appear to be harmful and are, but their ability to cognitively see that is impaired through drug use.”

Opioid addiction also affects the rewards system of the brain, the area that makes activities such as eating or intercourse pleasurable. The drugs activate that area of the brain in “very profound ways,” said Updike. This reinforces the addict’s use of the drugs and the cycle continues.

The human body naturally produces endorphins, or the “natural opioid of the body,” when people experience stress or pain. The endorphins can inhibit neurons from firing, allowing the body to relieve itself of pain, according to a PBS report.

Opioids make some of the body’s chemical levels spike, which causes the body to ultimately experience less pain and stop making its own endorphins.

“It really makes it difficult for patients to remain abstinent,” said Updike.

When users try to stop, their bodies are not creating the normal level of endorphins. So the addicts not only lose the spike of chemicals from opioids that caused the euphoria, but they don’t even have the normal level of naturally produced endorphins.

That’s where medically assisted treatment comes in. Updike compared it to giving a diabetic insulin because his or her pancreas doesn’t make insulin properly.

The medication-assisted treatment works in the same areas of the brain as the opioids, but they don’t activate the receptors in the same way. The treatment doesn’t lead to ongoing and further pathology, because it doesn’t trigger the euphoria that opioids do. This allows the brain to start to recover and function normally.

“Once the storm of abnormal physiology is addressed, patients oftentimes stop using,” he said. “And the behavioral changes that are associated with it go away. That’s what we want. That’s what we call recovery.”

However, Updike said very rarely can people with opioid addictions return back to “normal” as though their substance abuse didn’t happen. He said the average length of stay for someone in treatment in a methadone program is about eight years.

A diabetic can start on insulin and possibly lose some weight. Maybe the patient can get to the point where they don’t have to take insulin anymore, but Updike pointed out the diabetes is still there. The diabetic has to be careful or the manifestation of the disease will return.

Opioid addicts are the same way. If they are able to improve with medication-assisted programs, it doesn’t mean their addiction will totally go away or they their brain will return to 100 percent “normal.”

“Although (opioid addicts) may be more stable now, the patients are at risk for relapses or having the disease return or be active because it never really left,” he said.
Updike said he believes the majority of opioid addicts are on medications the rest of their lives.

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