Introduction to Opioids
An “Opioid” is the overarching term for drugs that bind to opioid receptors in our nervous system. Receptors are protein substances in which neurotransmitters, drugs and hormones bind to, that can relay or illicit a response or change within the body. Moreover, our brain has many opioid receptors geared towards the natural or endogenous opioids that are produced in the body. For example, exercise can stimulate the natural production of endorphins (natural opioid) that can lead to the “runner’s high” sensation. In essence, the endogenous opioids help buffer the body’s pain response.
Opioids are also used in the form of painkillers. Drugs such as oxycodone, morphine, hydromorphone (dilaudid) and others, are successful for the usage of buffering pain, but can do more harm than good due to its euphoric effects that can lead to addiction.
Street drugs such as heroin (derivative of morphine) and percocet bind to the same receptors that the endogenous opioids bind to, causing an exaggerated euphoric effect. This can also lead to overdose when the system faces an overflow of opioids bound to our opioid receptors.
Opioid related statistics and Dr. Russel Portenoy
When people talk about the opioid epidemic, they are referring to the surging increase of deaths/hospitalizations that occur from prescribed prescriptions. The U.S Department of Health has estimated that 130 people die every day from opioid related overdoses, with an estimate of 10.3 million people who have abused prescribed opioids in 2018. Although these numbers are devisating, we must try to understand how this epidemic began.
In the early 1990’s opioids were advertised as non-addictive and non-problematic (Gale, 2016). Dr. Russell Portenoy, a pain specialist, who is widely known for leading the front in pushing prescription pain medication (opioids) in America. In the 1990’s, he lectured and wrote articles with other leading professionals about narcotics and its non-abusive properties (Gale, 2016).
Dr. Portenoy later renounced his past statements and position regarding opioids and its non abusive properties. Even so, he still created a long lasting impression, and destruction among families for generations. This has created a vicious cycle, because research shows that addiction in the family can attribute about 50% of the risk that a person will develop an addiction (Harvard Mental Health Letter).
Now, the real focus is why did Dr. Portenoy and other Physicians promote these drugs? It’s said that Dr. Portenoy and his pain center received funding from different pharmaceutical companies, such as Mallinckrodt, Wyeth, Baxter, and Pfizer, but specifically Purdue Pharma, the manufacturer for Oxycontin (Gale, 2016). What we see here is a Doctor whose research focused on pain management while being funded by Pharma. This would have confounded the validity of the research outcomes and more importantly the credibility of Dr. Portenoy and his team.
In a 2012 interview with Wall street journal, Dr. Portenoy was promoting the usage/accessibility of opioids in patients with chronic pain (defined as pain lasting for at least 12 weeks). He stated “that we had to destigmatize these drugs, bring them from the cold, into mainstream medical practice, we had to have doctors thinking in terms of risk and benefits, instead of thinking in terms of consequences that are so scary, like addition and death.”
Unfortunately Dr. Portenoy, these “risks” that you were defining, are patient’s lives. Death is scary and addiction is real. Although you now have retracted your unscientific past beliefs regarding opioids addictive properties, you have created damage that cannot be undone.
Addressing the opioid Crisis
This over increasing crisis is prevalent in society. As members of a society we must look for leaders who prioritize the Opioid epidemic. Further, if prescribed pain medication, make sure that you take them in compliance with your Doctor’s orders, and stay informed about the risks. According to the American Medical Association, Doctors prescribe Naloxone along with pain medication for those at higher risk of addiction. Naloxone acts as an antagonist (blocks a drug from binding to a receptor) and has higher affinity towards the opioid receptors than the opioid medication. In other terms, it can save lives by reverting an overdose due to its short term effects of kicking the opiods off the opioid receptors.
If you or someone else you know is struggling with addiction, please refer to the U.S. Department of Health and Human Services, SAMHSA (Substance Abuse Mental Health Services Administration), for more information regarding treatment and help information.
Citations:
Gale, A. H. (2016). Drug Company Compensated Physicians Role in Causing America’s Deadly Opioid Epidemic: When Will We Learn?
Missorui State Medical Association, 244-246