At a recent scientific conference on drugs, one researcher thought: I don’t understand how people become addicted. It’s like the doctor on the side of the needle saying, “Honestly, you’re a wimp. You’re a wimp.” It doesn’t hurt. Both examples reveal a lack of empathy and a fundamental misunderstanding of current neuroscience.
Contribution, or fear, reward, fight, and flight, is a complex mix of experience and heredity.Fear of needles comes from missed shots in a state of pre-logical development, smells of heredity, prone to fainting. Opioid use disorder (OUD) reverses this ratio because its genetic influence is so strong that it is confused with the home environment. Neuroscience research is underway to understand why some opioid-exposed people become dependent, with surprising implications for prevention.
1. Both emotional and physical pain domains are highly interconnected and capable of immediate punishment or reward responses to any action taken by the human system. Otherwise, how does the brain learn? Reward switches in the brain release neurotransmitters that evoke certain emotions, such as dopamine for victory, serotonin for joy, and oxytocin for love. Some dopamine switches called mu receptors are activated by morphine and often overlap brain regions activated by pain. In other words, morphine doesn’t stop the pain, it just makes you feel rewarded and doesn’t care.
2. Some people have more switches and need less morphine, while others need more morphine to get adequate reward for equivalent pain relief. Baseline sequences of reward switches vary by gender, age, past experience, and genetics. Both emotional and physical pain can put the brain into a sustained state of rest I need more rewards (opioids) to feel the new pain more intensely and to be able to “I can handle it”.
3. Because dopamine is the brain’s primary reward and behavioral motivator, variations in dopamine processing affect opioid effects. Some genetic subtypes are reward deficient, resulting in less dopamine stimulation from everyday activities. The theory is that when opioids activate receptors, the experience goes beyond restfulness to euphoria. Many “mental health” problems are now thought to be related to social differences. Dopamine and serotonin processing: Thrill-seeking due to decreased dopamine reactivity, depression due to decreased dopamine output, etc.
4. Receptor behavior also changes over time.After short-term exposure to morphine, some Regression of opioid dopamine receptors Go to cell and regroup. Home oral opioids have less of an impact on pain than ibuprofen because taking lower strength oral opioids results in lower strength and concentration and a lack of reward switching.
5. Finally, approximately 5-15% of people convert oral opioids into morphine quickly due to differences in liver metabolism genes. This ‘CYP 2D6’ variation offers more reward up front, but faster pain recovery. 85% of people with different genes can’t turn pills into morphine fast enough for pain relief. However, it does not affect nausea, constipation, sweating, or withdrawal symptoms.
So, “Why do people become addicted?” There is a lot to unpack. A colleague of mine developed OUD after wrist surgery. There were all the stereotypes of stealing, lying, getting fired. Unknowingly, I asked him how he managed to do that while he was recovering. (Because, as you know, post-surgery opioids make me feel sick and nauseous all the time…). In other words:
“I feel awkward and anxious all the time and can never relax. The first time I took painkillers it felt really good. I felt cool. I am so wonderful, strong, happy and loved I felt like I deserved it.
Researchers call that sensation euphoria, which is distinct from pain relief. 2022 Survey We asked people who misused opioids (taken pills for highs) how they felt for the first time. Those who continued to develop OUD had a very different experience.
| subjective feeling | No OUD | Subsequent OUD | p-value |
| my speech was slurred | Four% | 52% | .0005 |
| was in a bad mood | Four% | 64% | .02 |
| I’d be much happier if I felt the same as I did then | 12% | 64% | .0005 |
| I thought it would be more popular | 20% | 60% | .009 |
| I was afraid that I would lose the satisfaction I felt then. | 20% | 56% | .02 |
| I felt completely in tune with the world and the people around me. | 32% | 62.5% | .005 |
| My movements were free, relaxed and fun | 40% | 96% | <.0001 |
A family history of addiction may be related to rapid familial activation or mu-receptor euphoria rather than intergenerational environmental risk. People with the CYP 2D6 metabolic gene also have higher rates of smoking and alcoholism. However, the neurotransmitter reward in OUD is orders of magnitude stronger. This is why 95% of successful OUD treatments require medication, manipulating a ‘switch’ to suppress reward pathways.
My best friend from high school died of a heroin overdose while I was in college. I was appalled at her weakness and stupidity and she kept angering me for 20 years. My chain-smoker friend, and her mother who put her up for adoption, must have felt differently about opioids than I did. I wish I could have at least told her that her euphoria was a sign of danger. And I wish I had understood then, as now, that her overdose was due to a genetic disorder and not a moral flaw. Rest in peace, Sue.
Amy Baxter He is a Clinical Associate Professor of Emergency Medicine at the University of Augusta, where he has federally funded neuromodulation research aimed at reducing needle pain, diverse back pain, and opioids. After attending Yale University and Emory Medical School, she completed a residency and Child Abuse Fellowship at the Cincinnati Children’s Hospital Medical Center, an Emergency Pediatrics Fellowship in Norfolk, Virginia, and a K30-NIH Clinical Research Certificate at UT Southwestern Medical Center. Got. She is also the CEO of pain care labyou can contact me on Twitter @AmyBaxter.
