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How Do Opioids Alter the Brain?


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Medically Reviewed by Dr. Mohammed Saeed, MD.

In 2018, according to the Centers for Disease Control and Prevention (CDC), more than 67,000 Americans overdosed due to opioid use. The complex relationship between opioid use and brain chemistry makes this group of pain-relievers especially high risk for overdose and dependence, even for those using opioids strictly according to medical guidelines.

Opioids alter the brain’s chemistry and the body’s response to pain. This is especially true if individuals use opioids for a long period of time. Although the complexities of the body’s relationship with opioids, particularly with chronic use, aren’t totally understood, researchers are making headway. Even when used exactly according to a physician’s instructions, however, opioids remain highly addictive.

We offer an overview of the brain’s reaction to opioids and how this impacts recovery from opioid addiction.

How Do Opioids Work

Opioids relieve pain at a molecular level by attaching to certain proteins in the brain, spine, and digestive tract. When attached, the body releases a flow of pain-relieving neurotransmitters like dopamine. This neurotransmission occurs in the synapses between nerve cells.

Ideally, opioids provide pain relief with a steady stream of dopamine. This steady stream, however, turns into a rush of dopamine to the brain when opioids are abused. When individuals take opioids with alcohol or crush and ingest the pills, the brain becomes flooded with dopamine, for example.

While overdosing on alcohol or other drugs requires significant amounts, the potency of opioids, tragically, makes it relatively easy to overdose on these drugs. Saturating the brain with dopamine, even once, can depress a person’s breathing and can lead to death.

Recent research in rats suggests chronic use of opioids also creates degeneration of neurons in nerve cells.

Opioid Dependence and Addiction

To understand the opioid crisis, it’s important to understand the difference between opioid dependence and addiction. Opioid dependence means the user experiences a need to continue taking opioids to avoid symptoms of withdrawal like nausea, anxiety, and vomiting. With opioid addiction, the user experiences an intense craving for the drug and continues to compulsively use opioids after experiencing negative consequences.

Over time, however, opioid addicts build a tolerance to the drugs and require higher doses to achieve the same effects. The body seems to adapt to opioid use quickly, meaning withdrawal may occur after a relatively short period compared to other drugs. Even users who take opioids according to exact instructions from their physician are still vulnerable to this physical dependence.

Research is also uncovering abnormalities that are present in the brains of opioid addicts. Some of these abnormalities are the result of brain chemistry adapting to the presence of opioids. In other cases, certain people seem to be born with a genetic predisposition to addiction because of inherited brain abnormalities. This brain chemistry in opioid addiction is complex and still something of a mystery.

How Understanding the Brain’s Reaction to Opioids Helps Prevention

For an opioid addict, understanding how the brain reacts to opioids is a helpful tool in recovery. For instance, knowing intense cravings are a possibility despite many years of opioid sobriety, gives recovering addicts and their support team a leg up.

In one case, recovering opioid addict Kyle had been clean from opioids for five years when he relapsed. Kyle was no longer opioid dependent, meaning he was free of the physical dependence and withdrawal symptoms of his drug of choice.

During a particularly stressful time after being laid off from work, Kyle ended up back in addiction recovery treatment for opioids. While in treatment, Kyle was given more tools thanks to recent research. These new techniques helped him better handle the intense cravings that cropped up even after five years of sobriety. He learned how to set up a better system of stress management and support to catch any potential relapse early.

Knowing his brain chemistry may still leave him vulnerable to cravings makes it easier for Kyle to manage his recovery today.

If you or a loved one needs help for a problem with opioids, call Into Action Recovery Centers today for support. Recovery is possible.

Dr. Mohammed Saeed, MD.

Dr. Saeed is a psychiatry specialist with over 40 years of experience in the medical field. He received training in General Psychiatry at the University of Texas Medical Branch, where he was selected as the Medical Director of the Division of Child and Adolescent Psychiatry. He currently serves as the medical director at Into Action Recovery Centers. Full Bio

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