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.

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.