The Opioid Crisis

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Tackling Addiction on a Personal Level

By Stan M. Gardner MD, CNS · September 24, 2017

“For every thousand hacking at the leaves of evil, there is one striking at the roots.”

Henry David Thoreau 

They were an exceptional family. Churchgoers; they were always willing to help out whenever they saw a need. Emergency? They were the first to volunteer manpower and tools. New mom needed dinner brought in for the family? They were the first to sign up.   They were the ones everyone thought of when they sang about “families…together forever.”

Until he hurt his back and could not tolerate the pain.

Until she was injured at work and nothing helped.

Until the kids were ostracized in school and fell in with the wrong crowd.

The Looming Threat

Recently in the United States, President Trump declared that opioid addiction is at a crisis level. But what does that mean?

Everyone is talking about it. It affects all of us on one level or another. Where did it start? And why are so many good people becoming victims?

Whose fault is it? What can be done about it? What about the War on Drugs…the D.A.R.E. Program we all participated in at school? There are many questions, and so far it’s been tough to find an answer.

Thoreau declared, “For every thousand hacking at the leaves of evil, there is one striking at the roots.”  

If we are going to make headway in this very difficult and heartbreaking arena, we’re going to need to get to the root of the problem.

The Direction of the “Opioidemic” 

In a 10-year period, from 1999 to 2008, the opioid overdose death rate increased 4 times, and the sales of prescription pain relievers increased 4 times. Over that same period, from 1999 to 2009, the Substance Use Disorder (SUD) treatment admission rates increased 6 times. In the 20-year period from 1991 to 2011, the number of opioid prescriptions went from 76 million to 219 million.

Where We Are Today

In the year 2015, in Americans 12 years of age and above:

  • 5 million were diagnosed with SUD
  • 6 million were diagnosed with SUD to heroin
  • There were 52,400 lethal (caused death) drug overdoses
  • There were 20,100 lethal drug overdoses to opioids
  • There were 12,900 lethal drug overdoses to heroin

Steps to Addiction

There are so many factors involved in addiction that it is difficult to pinpoint causes and timelines. Each person is different with the time it takes to go from no use to full addiction. It is much easier for some to become addicted than for others to do so.

  1. The first exposure to opioids (or heroin) is either by prescription or through recreational use. Not everyone experiences a pleasurable “euphoria” with a first exposure to the drug. Those who like the experience have a much greater tendency to use the drug more often.
  2. However, pleasurable or not, continued use leads to tolerance to the drug, which means the same dose does not get the same effect, so doses increase to get the same experience.
  3. As the dose goes up, and the frequency of use increases, the brain adapts to the point that withdrawal from the drug is accompanied by unwanted side effects, relieved by taking another dose of the drug. This is called physical dependence. At some point in time there is no euphoria, and the drug is taken only to get out of withdrawal. Physical dependence does not mean addiction.
  4. During withdrawal, side effects are so severe that the individual cannot function—he/she can’t work, can’t maintain relationships, can’t be a parent. The drug is taken only to get out of withdrawal and maintain a somewhat functional life. There is no ‘high’ or ‘euphoria’ at this point, and as long as there is money to buy the drug, it can all be hidden.
  5. A certain number of those who are physically dependent will go on to be addicted. The craving for the drug becomes a compulsive drive and the greater part of every day is spent figuring out where the next dose is coming from. They lose control of their lives, and continue to use despite adverse consequences—losing their jobs, their homes, their family and friends.

At the onset of these steps, no person fully understood this potential outcome. I think it is safe to say that no one deliberately sets out to follow this desperate path to nowhere.

Risk Factors that Lead to Addiction

Since not everybody who uses becomes addicted, what are some of the risk factors that lead to addiction? We know of several:

  • Genetics, as demonstrated in twin studies, although the specific genes have not been identified
  • Availability
  • Environmental Stressors
    • History of abuse
    • PTSD
    • Lack of “connection,” which will be discussed more in the treatment section

Changes that take Place in the Brain with Addiction 

Various radiological scans have been performed on brains of addicted individuals. The following changes have consistently been documented:

  • Decreased volume of the amygdala, a structure at the base of the brain that has to do with emotions
  • Decreased white matter to and from the amygdala. The white matter is the connective nerve tissue between different areas of the brain
  • Decreased connections from the amygdala to the frontal cortex and nucleus accumbens. The frontal and pre-frontal cortex have to do with executive function skills and motivation. The nucleus accumbens is the major part of the reward/pleasure system that is part of addiction. It also has to do with emotional awareness.

Symptoms/Dysfunctions of Full Addiction

There are specific symptoms that are consistently seen in individuals in full addiction. These include:

  • The loss of executive function skills. These include the ability to plan, prioritize, or execute a task.
  • Increased vulnerability to stress. Stress activates the reward pathways that lead to intense craving and relapse.
  • Increased sensitivity to cues and triggers to use drugs
  • Insensitivity to normal pleasure and reward activities. Drugs activate the reward/pleasure pathways in a stronger way.
  • Loss of impulse control
  • Decreased cognition, learning, memory and proper emotions

If You or a Loved One is Caught in this Web

There is great hope for those caught in this web of opioid and heroin addiction. The next article will address the pharmacologic treatments for opioid addiction and the subsequent article will review other critical options for success. I’ll include some interesting comparisons, and what we can do to restore life, purpose, and healing to our families.

Stan Gardner, M.D., CNS, is board certified in Anti-Aging and Regenerative Medicine. He works out of Keys to Healing Medical Center in functional medicine for all ages, (801) 302-5397. He also works in addiction recovery out of Rising Health, (801) 419-0705.