Why are pain-management opioids addictive?

Opioids work by binding to opioid receptors on cells located in the brain, spinal cord and the nervous system that are involved with feelings of pain and pleasure. Once opioids activate those receptors, they block the signal from the brain to the body by releasing dopamine. Dopamine is a chemical found in the brain that affects emotions, movement, pain and pleasure. When using opioids, the dopamine level is almost 5 – 10 times higher than the normal level. By using opioids over time, the brain starts “believing” that this level of dopamine is normal, creating the need for a higher dose.

As long as opioid medications are used for a restricted period as per doctor’s instructions, they are generally safe and, for example, significantly help with pain relief interminally ill patients. People misuse opioids by taking them when they don’t need to, for getting “high”, using higher doses than prescribed or by taking someone else’s opioid medication. There are many ways opioids are misused, but mainly they are taken orally, snorted as crushed powder or dissolved in water.

The most common opioid side effects are drowsiness, nausea, constipation, euphoria, sedation, delirium and slowed breathing that can cause hypoxia. Accidental misuse or abuse due to age and taking multiple prescription medications that can interact with opioids can also cause other potential harmful side effects.

Pregnant women shouldn’t use any type of opioid during pregnancy as these medications can be harmful to the baby and the pregnancy. They can cause miscarriage or premature birth, underdevelopment and neonatal abstinence syndrome (NAS), i.e. drug withdrawal after birth. NAS can have adverse effects on the baby, causing seizures, breathing problems, birth defects, brain damage or even death. However, if a pregnant woman is a known opioid addict from before she was pregnant, there are certain types of medications such as methadone and buprenorphine, which can help her and her baby during pregnancy so that they can overcome opioid addiction.

Overdose with opioids can cause life-threatening symptoms or even death. The most common outcomes of overdose on opioids are coma and hypoxia that can lead to severe brain damage and death. However, it is possible to help treat overdose by immediately administering naloxone, which works by blocking the effects of opioid medication on brain receptors. In the US, certain states allow pharmacies to distribute naloxone in the form of an auto-injector to families and friends that know someone who is misusing opioids. This way they can provide aid in case they witness any potential life‑threatening symptoms or overdose.

Currently, there are several types of active substances in medicinal products that can help treat addiction: buprenorphine, methadone and naltrexone help alleviate withdrawal symptoms, reduce opioid cravings and block opioid receptors in the brain. However, there have been reports on addiction to these medicinal products, as well as other mild side effects such as dizziness, vomiting, insomnia etc. In spite of this, it is better to act and try to end an addiction which continues to harm the body and causes potential life-threatening symptoms.