opioid tolerance – Opiate Nation

Where the Buck Stops and Where It's Hiding

Arizona brought a case to the Supreme Court that sought to stop the Sackler family, who own Purdue Pharma, from transferring billions of dollars from the company in an attempt to avoid paying the claims made against them concerning flooding communities with the prescription opioid painkiller Oxycontin. The Court said they would not hear the case – the justices like to hear rulings from lower courts first.

One of the places the Sackler’s have hidden their money is in an estate in England. A recent article* states: “A complex web of companies and trusts are controlled by the family, and an examination reveals links between far-flung holdings…The estate is proof of the great wealth belonging to the family accused of playing a key role in triggering the US opioid epidemic. But there’s little evidence of that connection. On paper, the land is owned by a handful of companies, most based in Bermuda, all controlled by an offshore trust.” Read the rest of the article which cites the Associated Press’ findings of the deceptive and convoluted practices of a family dynasty that has lived like kings and queens off the misery and deaths of millions of people world-wide. Our son was one of them.

An estimated 10.3 million Americans aged 12 and older misused opioids in 2018. These estimates are likely too low. How many people who are taking opioid Rx’s for pain that could be relieved by physical therapy or a change in lifestyle actually report they are “mis-using” them? My next blog will delve further into this aspect of a country that has become averse to pain…

Benefits of Public Dialogue

John and I live in Melbourne, Australia with our daughter and her family several months of the year. Since our son’s death by overdose from heroin 5 years ago, we have become interested in and involved with some of the Alcohol and Other Drug (AOD) programs there. We also receive news reports on current trends etc.

What is interesting to me is the contrast between the Australian approach to AOD use and the American approach. Australians accept that there will be drug and alcohol abuse in their society and therefore speak openly and candidly about it. A recent newsletter (Dec. 13, 2019) from VAADA (Victorian Alcohol and Drug Association) is a perfect example of their approach. It was an alert about “ increasing numbers of reports about very strong heroin in Melbourne, which has resulted in an increase in accidental overdoses.”

The alert asks providers in the AOD sector to alert their clients (heroin users) to this problem and to be careful and look out for their fellow users. They also urge providers to share specific harm reduction information to help reduce the risk of overdose, such as: get naloxone and keep it handy; try not to mix drugs (there is a lot of methamphetamine use mixed with heroin/opioid use); be smart about your tolerance, knowing it can change if you haven’t used for even a few days; and try not to use alone or in an unfamiliar place where you wouldn’t get help if you do overdose (which was the case for our son).

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.

The Hijacked Brain

I watched an interview on the PBS Newshour the other night with a physician whose young son recently died of a heroin overdose. He has started a foundation to help raise awareness and to bring an end to this deadly epidemic. My husband and I connected with him on so many levels: having a wonderful and brilliant son – who desperately wanted to be free of his addiction – die a needless death; the remorse over not knowing what we could have done differently to help our son; the desire to do something to help others before they are forced to share our pain and grief. In the interview he reiterated the truth that few people understand about opioid addiction: once a person is addicted to opioids, they are truly not normal or themselves any more. The drug has hijacked their brain and they are not capable of thinking normally. They must have the drug at any cost.

This is the reason that there are so few opioid addicts who live long enough to enjoy recovery, as opposed to addicts who use uppers like cocaine or meth. As Tracey Helton Mitchell said in her memoir, The Big Fix: “Heroin kept me chasing my tail, but crack (cocaine) finally sent me into recovery.” Our son’s addiction doctor put it this way: “Most people will build up tolerance to opioids and that tolerance is what leads to addiction. Once addicted, it is only over a long period of time with medication and group therapy (like the 12-Steps) that a person has hope of being free. This is why I call it ‘the cancer of brain diseases’.”

In her article in The Washington Post, December 1st, Dr. Sandra Block (a neurologist) gives further evidence as seen on EEG’s on the changes to the brain that opioids cause:

“Neurologically speaking, opioids are crafty. They turn the brain’s own electricity against it, rewiring connections in an endless feedback loop for more drugs. They trick the brain into a death trap, as users chase the chemical bliss from the drugs with more drugs. Acute opioid usage (that is, the high itself) translates into slowing on the EEG. Usually, such an effect is transient, carefully monitored by an anesthesiologist during surgery, for instance. But when the patient becomes the anesthesiologist, the cycle can become lethal…the opioids overwhelm the brain’s respiratory center, causing cardiac arrest… I’m seeing brain death in people who haven’t lived their lives yet, whose brains haven’t even fully developed, brains that are literally killing themselves for drugs.”

My goal in sharing this information is that it will bring awareness to families and friends – and addicts – about why opioids are so pernicious and that we will begin to see those trapped in the addictive spell as individuals who really do want help. Learning what actual help is, as opposed to enabling the addiction, is a topic for another time.