Why Are Opioids So Addictive? Here’s How Opioid Addiction Occurs

Last updated on July 1st, 2019 at 01:51 pm

More than 115 people are dying every single day from this soul-stealing disease.

Let’s break that down.

There are 24 hours in a day. That means nearly five people are dying every single hour.

Every year, the two million people affected, in the U.S. alone, spend approximately $78.5 billion on this disease.

What is this mysterious disease? The culprit is none other than opioid addiction.

“Addiction? That’s not a disease!”

Contrary to the popular belief, addiction is a disease, just like diabetes, cancer, or heart disease. Addiction is defined as, “Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist.”

But, why are opioids so addictive? And how do you know when you have a problem?

Read on to answer these questions and find out more on opioid addiction.

Terminology: Opiates vs Opioids

To get things started, let’s go over some basic terminology.

You’ve heard the term opioids, but you’re probably more familiar with the term opiates as well. More than likely, you’ve heard them used interchangeably or incorrectly. But what really is the difference?

Opiates

Both the terms opiate and opioid are derived from the opium plant. Opiates are the actual chemical substances that are extracted from the opium plant, also known as opium alkaloids. Opiates are natural compounds from the opium plant.

Morphine, Codeine, and Thebaine are the three main opium alkaloids scientist use to synthesize many medical compounds.

Opioids

Opioids, on the other hand, is a broader term. It refers to any substance that binds with the opium receptors in your body. This substance could be natural or synthetic. So, opioids can be opiates, but opiates can’t be opioids.

In this article, we’re going to focus on opioids because it is a broader term and covers more.

How to Spot an Opioid Addiction

How can you spot an opioid? Are they all dangerous? How can they be taken?

If you suspect your loved one has an opioid addiction, it’s important to learn how to spot it and what danger signs to look out for.

What Does Opioid Addiction Look Like?

A person that is recreationally using opioids might show any of the following signs:

  • High resting heart rate
  • Increased energy
  • Decreased appetite
  • Increased sexual arousal
  • Difficulty sleeping
  • Irritability
  • Depression

How Are Opioids Taken?

Opioids can be taken orally or through injection. Many medical professionals will prescribe opioids for severe pain, cough, or diarrhea. Doctors will usually prescribe the opioid to be taken orally, however, if you’re in immediate need for pain relief your doctor make give you an injection.

Some abusers may even snort crushed pills, as this allows the opioid to absorb into the bloodstream much faster.

Why Are Opioids So Addictive?

There are two main factors in addiction: physiology and psychology.

The physiology refers to the body’s biological response to synthetic opioid chemicals, where the psychology focusses on behavioral symptoms.

The Physiology

Did you know that your body makes opioids naturally? You have special protein receptors in your brain, spinal cord, and digestive system called opioid receptors. These natural opioids kill pain, slow down breathing, and relax the body.

Opioids like heroin or oxycodone mimic the chemical structure of these natural opioid neurotransmitters and bind to your receptors. This triggers the brain’s reward system and causes dopamine to be released.

Dopamine is responsible for emotion, motivation, body movement, and is a hedonistic hotspot, more often referred to as the “pleasure center”.

The Psychology

A person’s psyche is affected by many factors, the BRA being a major one in addiction. In addition to the BRA affects, we have deeper roots such as dependence and tolerance.

The BRA

Your brain is absolutely incredible. It has a built-in reward system. The brain reward system, or BRA, is a group of neurons that control what you like and what you want.

Liking something and wanting something are two completely different stimuli.

When you like something, it’s called intrinsic. Intrinsic stimuli are things that you naturally like. For example, food.

Extrinsic, on the other hand, are learned motivated behaviors, or wanting. Money, for example, is just a piece of paper. But through learned association, money now triggers the BRA.

Opioid addiction is an extrinsic stimulus, meaning that a person doesn’t actually like doing drugs, but they have a begging want for them.

The want center, or incentive salience, is responsible for making abusers feel like they need their next fix.

Roots of Addiction

Many abusers don’t want to keep doing these drugs, but they might feel like that have to keep doing them just to feel normal. Things like tolerance, dependence, and withdrawal are big factors in a person’s detox.

Addiction may start out where the user enjoys the euphoric feeling that opioids provide, but it quickly morphs into dependence.

Remember how we said that your body makes a natural opioid neurotransmitter? When the body gets used to receiving the fool chemicals, it actually stops making the natural neurotransmitter. Because of this, users have to continue to take opioids just to feel normal.

The euphoric feeling that once was is now just a dose of “normal” to long-term abusers.

What Makes Opioids Deadly

Opioids kill a person by slowing down the breathing processes. Breathing delivers fresh oxygen and removes poisonous carbon dioxide. When this process becomes too shallow, cells throughout the body begin to die off.

Many of the opioid receptors are found in the brainstem. The medulla and pons are regions inside the brainstem that are responsible for involuntary breathing, they control that rate and depth of breathing. Because the opioids taken are not the exact natural neurotransmitter, the cells react in a different way than normal, causing malfunctions.

Fentanyl, for example, can cause the diaphragm and surrounding muscles to tense up and further restrict breathing. This condition is called wooden chest syndrome.

Other possible causes of death are caused by vomit aspiration or abnormal heart rhythm.

Signs and Symptoms of an Overdose

If you have a loved one that is facing an opioid addiction, there is a possibility that you may one day find them overdosing. While this is a tough truth to hear, it’s important to know the signs and symptoms of an overdose so that you can call for the appropriate treatment.

Signs and symptoms:

  • Pinpoint pupils
  • Drowsiness
  • Confusion
  • Depressed breathing
  • Uncontrollable vomiting
  • Slow movements

First responders carry a drug called naloxone, which is used in life-threatening overdose situations. Naloxone works by latching onto the opioid receptors and effectively blocking the damaging opioids from continuing to bind. Naloxone works within minutes and may reverse the effects of an overdose if taken in time.

Risk Factors For Addiction

Opioids post the biggest threat when you take them differently than your doctor prescribes. Your risk factor also increases based on the length of time the opioid is taken. The longer the opioid is taken, the higher dependence your body will have formed.

Other known risk factors for addiction include:

When Do Opioids Become a Problem?

Opioids become a problem when a person builds up what is called a tolerance. A tolerance is when the body needs more and more of a substance to create the same effect.

Because of tolerance and dependence, detoxing on your own can actually be a very dangerous process. The body has stopped creating its own opioid neurotransmitters, so when the body all of a sudden stops receiving these chemicals that it’s learned to rely on, it can go into a state of shock. Being in a state of shock can be deadly if not cared for appropriately.

For this reason, it’s important to detox in a certified rehab facility.

How to Detox Safely

Suboxone, for example, can be prescribed in these facilities to aid in successful detox. Suboxone contains two different opioid agonists: buprenorphine and naloxone. We mentioned earlier how naloxone can help, but what is buprenorphine?

buprenorphine is a partial opioid agonist, meaning that it only partially blocks the opioid receptors, and partially activates them. This allows the user to be gradually weaned off of the drug, preventing the body from going into shock.

Why isn’t suboxone given out in drugstores?

Just like other opioids, suboxone can be abused. Rehab facilities that prescribe suboxone carefully monitor the recovering addicts and watch for warning signs of abuse.

If you know someone taking suboxone, you should learn the warning signs of misuse as well. The following are a few signs and symptoms:

  • Nausea
  • Fever
  • Muscle aches
  • Headaches
  • Insomnia
  • Mood swings

Emotional Recovery

During and after a person successfully detoxes from opioids, there are many emotional phases they must go through. These phases are very similar to those a grieving person may go through.

Depression

The first emotional recovery phase a person may go through is depression. Depression may be felt during or even before opioid use.

This depression is not to be confused with sadness. Just like addiction, depression is a mind-altering disease.

Clinical depression affects the way a person’s brain chemistry works and directly affects the BRA. This depression may be temporary or, sadly, the person may never recover from it.

A treatment facility may prescribe medication to help curb the depression. Finding an anti-depressant medication is never easy, so you’ll want to leave it up to the professionals.

Anger

Anger is the second stage a person may experience. This stage tends to be felt during the beginning to the end of the detox process. The user may feel anger towards friends and family, especially if those loved ones suggested the rehabilitation.

This anger is never personal, as it is a side effect of the BRA. The user’s body is used to receiving a stimulus to the BRA, so when that stimulus stops, well, basically the body throws a chemically induced temper tantrum.

This stage is temporary, as the body is working out the kinks. Let some time go by and this stage will correct itself.

Guilt

Guilt is often felt after the detoxification process is complete. The user begins to realize the many harmful things that they have said or done to their loved ones. Guilt can be more than overwhelming, so it’s important to be patient.

Therapists will usually suggest apologizing as the first step. The therapist will also inform the ex-addict that not every person will accept the apology.

In some cases, similar to depression, the feeling of guilt will never leave a person – no matter how many times they apologize. For this reason, many rehabilitation facilities will recommend further therapy after detox. This therapy may be a personal therapist or NA meetings.

NA, or narcotics anonymous, meetings are held by many ex-addicts, each of them sharing their stories and recovery tips. Some members of NA groups have been clean for many years, others only days.

Whichever type of therapy is chosen, it’s important to stick to it. Leaving a therapy prematurely can result in a relapse.

Getting Help for Addiction

Now you know the answer to “why are opioids so addictive?” If you or a loved one is experiencing opioid addiction, there is hope.

We have state-to-state centers that offer multiple levels of rehab care, including detoxification, inpatient treatment, partial hospitalization, and outpatient treatment.

Contact our addiction intervention specialists for help in overcoming the disease that addiction really is.

Our addiction specialists are available 24 hours a day to help you or your loved one take the first step into recovery before it’s too late.

Article Reviewed by Dr. Keerthy Sunder, MD, DFAPA

Dr. Keerthy Sunder, MD, DFAPADr. Keerthy Sunder, MD is an accomplished and internationally recognized expert in the field of addiction. He has earned diplomates from the American Board of Psychiatry and Neurology, the American Board of Addiction Medicine, and the Royal College of Obstetricians and Gynecologists.