GENETICS AND OPIOID VULNERABILITY

Addiction is recognized as a disease by scientists, and now, finally, by most of us. It is no longer considered a moral weakness except by some who, like The Emperor and his new clothes, can’t see their own “moral weakness” but only those of others. Enough said.

As DNA research gains new insights by the day, we are learning how our DNA codes are regulated which will help in opioid treatments and prevention. Tiny differences in a persons DNA called single-nucleotide polymorphisms, SNPs, can indicate whether we have a higher or lower risk for addiction. Some of us have an opioid receptor gene with a single building block change that protects us against substance dependence in general and opioid dependence in particular. This is why the ‘opioid euphoria’ I wrote about doesn’t happen for us. But for others, variations in genes for three dopamine receptors – signaling pleasure – cause increased risk for opioid addiction.

Exposure matters in genetic expression, even across generations, according to how our body’s cells read them. In a recent study of opioids in rats (cited in the Ohio Society of Addiction Medicine’s blog on May 31, where much of this article is referenced from) the parents exposure to opioids changed the way their offspring read their DNA code, lessening their susceptibility to opioid addiction. This shows how one generation’s experiences can change the destiny of the next generation and although it hasn’t been studied in human substance abuse, it has been seen in other complex diseases like obesity.

Research suggests that people born into a culture of drug use may be more inclined to get and stay sober. Epigenetic’s may play a role. How this effects individuals born into a family with addiction issues like alcoholism, drugs, smoking, gambling, etc. is still unclear. For some of us, we observed behavior in our parents or relatives and made a concerted effort to not repeat it. Although our genes may have given us tendencies towards an addiction, a strong repulsion steered us away from it – and in my case, a strong dependence on the Lord.For our son, had we known how many of our relatives had addiction issues and how much power the addictive genes had, we would have been less permissive with our son in regards to drinking at an early age – and certainly more proactive once he was addicted to opioids. It might have changed the outcome for his life. I pray this information will help you, your family, and friends avoid the heartbreak we have had to live with.

Opioid Euphoria

What do you feel when you take a narcotic/opioid pain pill?

There are usually three reactions people have after having being given them for the first time for pain relief: we are disoriented and uncomfortable, even while our sensation of pain is temporarily deadened; we feel ambivalence combined with gratitude for the pain relief and the willingness to have that relief for the next pain-inducing event; or we feel that we have finally found nirvana.The truth about opioids, pain relief, and addiction has long been unclear and confusing. Sadly, this has been purposefully done by the makers of these drugs with one goal: profits. But these statistics are now becoming well known and will hopefully help reverse the trend of opioid addiction and deaths:

Approximately 25% of people who use an opioid will become addicted after a short period of use, which could be once, 3 days or a week.

The longer you use an opioid, the chances will increase that you will be addicted. This is because almost everyone will build up tolerance to them, which leads to addiction.

Genetics play a very important, but as yet not fully understood, role in what type of reaction each of us have to opioids. What is clear is that those families who have tendencies toward addictions – alcohol, drugs, food, gambling, sex, etc – will be those most likely to be drawn to opioids due to sensing them as pleasurable. There is something in their brain that is wired differently than others.

Our addiction doctor and recovery counselors have explained it to us and this is the essence: There are four areas of the brain that handle the substances and experiences we send it. Very simply put, they are:

Pain center: The PAG, known as the central gray, has cells that produce enkephalin that suppress pain

Emotional center: The amygdala regulates how we process emotions, memories, and rewards

Addiction center: The nuclean accumens, due to neuroplasticity, changes over time and builds up tolerance

Control center: The brain stem, the control center between the brain and the rest of the body, controls basic body functions like breathing, swallowing, heart rate, consciousness, etc.

The first three areas have the ability to build up tolerance, which is what keeps addicts coming back for more – and each time needing more. That is the nature of tolerance. The fourth area, the brain stem, has the least ability to build up tolerance. This is why an overdose – using an amount that is significantly more than what your body has built up a tolerance for – shuts down the respiratory center and you stop breathing.

In our family, and in the families of our son’s friends who are addicts or alcoholics, there are definite genetic predispositions to alcoholism that is traceable back many generations. Other addictions are no so easily identified, but they are there. It is not something anyone initiated or wanted or can change. But what can change is knowing the genetic trait is present and taking preventative steps as early in life as possible.

Talking openly and honestly about our predecessors – and our own – addictions is the first step. Seeking wise informed counsel for what things to avoid, especially while young, may help prevent some of the pitfalls. But for most teens, and especially for those from high risk families, experimentation will be unavoidable. Knowing as soon as possible if your child is moving away from their normal behavior and intervening with proven methods may save them – and you – from the pain that hundreds of thousands parents like my husband and I have now had to live with.

Who Is Dying Today?

In 2017, 16,000 people were killed by gun violence in America: some of them innocent children and young people while they were in school; some while they were just growing up in poor neighborhoods. Our first-world allies are stupefied that we can continue to allow such preventable deaths.
According to the US Centers for Disease Control (CDC) there were 63,632 drug overdose deaths in the US in 2016 – preventable deaths: 172 deaths per day; 42,249 (66.4%) of those deaths were due to opioids. More deaths in one year than those as a result of firearms, homicide, suicide, or motor vehicle crashes. And more deaths in one year than all the deaths from the Korean or Vietnam Wars.
Why are opioids so addictive – and deadly? One area in the brain that opioids directly affect is the amygdala – the pleasure center. For a large percentage of people, once those receptors that regulate emotions have sampled opioid joy, no other experience compares: not sex, food, sights, sounds. And, as Thomas Aquinas said in the 13th century:

“No man can live without joy.”
I watched the truth of Aquinas’ insight in increasing measure with our son over the years as he fought his addiction to heroin. Heroin, the goddess of fleeting joy, always requiring more of her while she offers less pleasure. It was not just the misery of the horrendous withdrawal symptoms every time John Leif would try to get clean again. After they subsided, it was the flatness in his emotions and the dullness of living life without joy. What could replace the euphoria of a heroin high? How long would it take for that pleasure center to normalize – would it ever return to its pre-opioid state?

Eventually we would see the light return to his eyes … this was especially true during the last 8 months of his life. Clean, sober, awake, in touch with life and with those around him. Enjoying the opportunity to see life “through a child’s eyes” as he played Legos with his 3 and 5 year old nieces: the real John Leif, alive and participating in the joy that life without addiction can offer. But, even this period of recovery ended – as did his life.

There is another part of the brain that opioids directly affect: the nucleus accumbens, which is the addiction center. Opioids change the neuroplasticity in this region so the brain physically craves them. Scientists are not sure how long it takes to rewire the addiction center because even after periods of sobriety, it does not return to normal, and thus the cravings continue. For most people, the cravings are irresistible and the easy solution is to return to using. For some, a strong impetus for freedom along with a spiritual renewal that gives them the strength to do the hard work of recovery with adherence to a 12-step program, is a life-saver.

For a recovery program to actually bring long-term changes to the brain, anything less than 6 months will not work. And the current thought by many professionals now is that recovery programs for opioid addiction should be 6 mo-1year and include a strict sober living program for a year following. Don’t let costs deter you. The Salvation Army has very solid alcohol and drug rehab/recovery programs in many cities and they are free:
https://www.salvationarmyusa.org/usn/combat-addiction/

If you are struggling with addiction and feel trapped – or if you know someone who is – please do not let another day pass without seeking help. It is urgent – it is more than important – it is essential – it is life and death – your’s or someone you love.

Our Children’s First Opioid Exposure: The Dentist

Dentists are the leading prescribers of opioids for U.S. teens and the largest increase in dental prescriptions from 2010 to 2015 occurred in 11- to 18-year-olds, according to a study published in the Journal of the American Dental Association…For many young patients, this is going to be their first experience with opioids. “The fact that we’re still prescribing opioids when we’ve demonstrated that non steroidal’s are as affective most of the time is a little disturbing,” said Dr. Paul Moore, co-author of the study. (03-27-18, Az Daily Star)

If these statistics are delivering a disturbing jolt to you, as they did to me, read on. The American Dental Association recently published an analysis of five studies in their Journal evidencing that non steroidal anti-inflammatory (NSAID) drugs work just as well – or better – for most dental pain (such as tooth extractions, root canals, implants) as opioids. The ADA announced a new policy that essentially tells dentists to eliminate opioids from their arsenal, if at all possible, while it is also pushing for mandatory education for dentists that encourages using other painkillers. Finally.

Many of us remember having teeth extracted before braces as young teens and also our wisdom teeth when we were young adults. We were sent home with a few pain pills that contained codeine. When I had a root canal a few years ago, the dentist sent me home with a prescription for a huge supply of Vicodin. What on earth was he doing? This same oral surgeon gave our son a 10-day supply of Percocet until his appointment to get his wisdom teeth extracted – and then another 10-day supply (with a refill) after the surgery. Over twenty days of Percocet? Our son then returned to heroin and within two weeks died of an overdose. JL had been clean and sober for 6 months until that first Percocet….

What role did we, as parents, play in this tragedy? JL didn’t want to tell the dentist that he was a recovering opioid addict and we, reluctantly, agreed. He knew, and we should have known, that this was drug-seeking behavior. He was 25 so we had no authority to deny him medication. But we did have leverage – we were paying for the surgery – we could have very easily stood our ground and insisted that he not have opiates before or after. But we would have had to be willing to let our son experience pain, which we had been trying to help our children avoid since birth. (see my blog Pain, Feb 19, 2018)

Parents of children and young adults do play an important role in the prevention of exposure to opioids – and all addictive substances. We are not powerless and regardless of angering our kids, our love for them and our commitment as their parents and guardians needs to be embraced and encouraged. I hope these insights into one of the earliest and easiest avenues of a negative life-altering experience will help others avoid the mistakes so many of us made over a decade ago.

Note shared by a friend:

Thanks to Opiate Nation for not only bringing to our attention the issue of addiction in this country but also for providing an understanding approach to those of us who suffer from addiction or from its disastrous spin-off. I have to live, as they say, a day at a time dealing with the history of addiction in my family of and of the irretrievable loss of my beloved son as a result of it.

While my son abjured the use of pain killers following oral surgery when he was in his teens, a subsequent year-long hospitalization as the result of an accident in a mine of necessity introduced him to the world of opiates. He left the hospital addicted to prescription medications. an addiction from which he never recovered. He ultimately took his own life. Parents are often accused of being the culprit in this vicious cycle. If indeed we were, it was from our own ignorance that we did not intercede. We simply didn’t see the danger. Bless the writers of this incredibly informative blog for understanding the pain that each of us with addiction in our family suffers daily. We still enjoy life, but not as much, and we still laugh, but not as robustly.  Our lives have been irrevocably  diminished. Having a sympathetic ear through this blog brings surcease from our ongoing anguish.

 

 

 

H.A.L.T.

What does the acronym HALT mean? And why is it an important part of a recovery plan? Hungry, Angry, Lonely, Tired: these are warning signs, red flags. HALT is a tool to remind us to stop – halt – and take a moment to listen to what our emotions and body are telling us.

I am not an alcoholic or addict – you may not be either. So why did I use ‘us’ as I wrote this blog? Because all of us are subject to these basic needs – human needs – and if they are not met, we will instinctively search until we find a way to have them fulfilled. Our responses may not be as self-destructive as an addict or alcoholic, but they will affect our relationships in one way or another. Let’s be careful to not make such a wide differentiation between addicts / alcoholics and us: the ‘us vs them’ mentality that makes ‘us’ superior and ‘them’ inferior.

Hungry. This can be physical, emotional, or spiritual hunger. Physical hunger is fairly easy to satisfy, but for many addicts, getting nutritional meals can be a struggle. Yet it is still easier than getting the affection and understanding that is even more vital to our well-being. This is why a strong support system is so important – and must already be in place before a time of need. Attending meetings is good, but being part of a small group is even more critical.

Angry. This is a normal human emotion. The key is to self-assess and decide why we are angry and what we can do about it. If the issue is out of our control or we aren’t ready to confront it, we look for other ways to release the anger. Exercising, meditation and prayer, and creative outlets can help, as is having a trusted friend or counselor to discuss our feelings with. Whatever we do, denying or repressing anger will not be healthy for us long term.

Lonely: We can be lonely in a crowd or in our room. It is a sense of being isolated, not understood, not appreciated, fearful. Withdrawing feels safe when we are overwhelmed or anxious, but for many addicts it can lead to relapse. I will never forget a conversation with our son when he said “I hate being alone”. I was shocked because he had always been more of an introvert than our daughter. But once he was addicted to opioids, I think the isolation that occurs while using became like prison to him. Perhaps it made him feel less ‘normal’, which he wanted so badly to be. A healthy relationship where we feel safe reaching out to in times of need will make all the difference.

Tired: We all get out of sorts when we are tired. When our lives are filled with activities such as work, school, family, meetings, our need for rest gets pushed to the side. But it is not healthy for us physically, spiritually, or emotionally and it affects our ability to reason and cope with difficulties. Relapse is just around the corner unless our body and mind are restored. It may be hard and uncomfortable to say we need a break to get some sleep, but it will benefit us and it is critical to maintaining sobriety.

Self-awareness and self-care are not self-ish, as many of us were taught when we were growing up. They are vital steps to help maintain a life on the path of recovery and will not only benefit us, but all our relationships.

 

Spring: New Life?

Spring is the season of regeneration, new life, hope. The time of year when the whole earth seems excited to be alive after being dormant all winter. For those who celebrate Easter, the season begins with introspection through prayer and repentance. As we reflect on our life and behaviors that are destructive to ourselves and our relationships, we hope to shed them like the husk of a seed when it is buried in the ground. We expectantly wait for the transformation that happens deep inside that will spring up as new life, like the sprout from a seed. Yet, as it pushes up through the crusty ground, the process of transformation is not without struggle.
This is what those who are living with addiction hope for when they go to AA meetings and enter recovery programs: as they surrender control, they’re hoping for a total change from agony and depression into a new life.

People, Places, Things is a play about addiction and wearing masks by British playwright Duncan MacMillan and director Jeremy Harren. It opened to rave reviews. In an interview with NPR the creators share that at the center of the play is the 12-step process. It shows that for those who have trouble with AA and surrendering to God perhaps it is easier to understand it as acknowledging that you can’t have control over life. We are all powerless over People, Places, Things. It is literally one day at a time. They visited a recovery center in London to get insights for the play. And as one of the actors said after witnessing the daily life-and-death struggle that addicts fight:

“One day at a time. And Life has to win every single day.
Death has to only win once.”

In Tracey Mitchell’s blog (http://traceyh415.blogspot.com/2018/03/) she shares about a young person she has been corresponding with since 2013 and the cycles of opioid addiction and attempted recovery he went through repeatedly. He voiced his utter frustration: “It’s so insane how this drug has taken hold over me.” Tracey heard from him a few more times and then nothing: “I don’t know all the details. I just know I could have written this story. This was my story. Except I did not die at 25. I didn’t need to worry about fentanyl (in the late 1990’s). I got off everything at 27. I consider myself lucky…No one should ever have to die alone like this.”

Yes, no one, especially a young person, should have to die having failed to experience a new beginning – after so much effort at turning over control and hoping for a normal life. But, with the purity of heroin in America having risen sharply in the last 15 years, and fentanyl now mixed in unbeknownst to users, the physical addiction is beyond comprehension. For those who are overdosing and dying in record numbers, they had no intention that their next use would be their last. This was what happened to our 25-yr-old son. Whatever he bought and used was more potent than what he was expecting and accustomed to. He died alone, with the needle still in his vein. Death only had to win once.

Prevention is the best way to stop these needless deaths. But once addiction to opioids has taken control, harm reduction with a solid 12-Step program is the best way to help addicts emerge from the darkness and be able to have a truly new life.

 

The Well-Known Effects of Opioids

I was re-reading a book by George MacDonald, entitled The Curates Awakening. I had forgotten an aspect of one of the main characters plight: opioid addiction. What struck me as I read this paragraph was the age-old, well-known addictive qualities of opioids:

“From a tragic accident of his childhood, he had become acquainted with the influences of a certain baneful drug (opium), to which one of his Indian servants was addicted. Now…to escape from gnawing thoughts, he began to experiment with it. Experimentation called for repetition, and repetition first led to a longing after its effects, and next, to a mad appetite for the thing itself…on the verge of absolute slavery to its use.”

This was written in 1870. Laudanum – an opium tincture that contains almost all of the opium alkaloids, including morphine and codeine – was developed in the 16th century. By the 18th century, the medicinal properties of opium and laudanum were well known.

By the 19th century, laudanum was used in many patent medicines to relieve pain, to produce sleep, to allay irritation.The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. The early 20th century brought increased regulation of all narcotics as the addictive properties of opium became more widely understood. By mid 20th century, the use of opiates was generally limited to the treatment of pain, and were no longer medically accepted “cure-alls”. (Wikipedia)

How is it that the manufacturers of OxyContin (Purdue Pharma) and other prescription opioids claimed and advertised that they were not addictive? Their scheme was so persuasive that I have friends today that believe that if you are truly in pain, opioids are not addictive. This is absolutely false. And how did the FDA let this go on?

Yes, we can be thankful that new ways to deliver pain relief were developed for patients with extreme pain from cancer and terminal illnesses. I have seen the need for it when I cared for my sister who was dying of brain cancer and had a morphine drip. But the wholesale promoting – pushing – of these drugs for every ache and pain while knowing how absolutely addictive they were is unconscionable. Had we really understood the power of opioids when we first learned our son was addicted, we would have taken a much more pro-active approach to his initial recovery program.

On October 30, 2017, The New Yorker published a must-read multi-page exposé on Mortimer Sackler, Purdue Pharma, and the Sackler family, by Patrick Radden Keefe:
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

“The Sacker dynasty’s ruthless marketing of painkillers

has generated billions of dollars – and millions of addicts.”

The article links Raymond and Arthur Sackler’s business acumen with direct pharmaceutical marketing and the rise of addiction to OxyContin. The article implies that the Sackler’s bear moral responsibility for the Opioid epidemic. During the sixties, Arthur got rich marketing the tranquilizers Librium and Valium using techniques were sometimes blatantly deceptive. In 1974 Mortimer renounced his US Citizenship and lived a flamboyant life in his many residences in Europe.

OxyContin was introduced in 1996 and just since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. Our son is one of those statistics – and fatalities.