Every year the United States spends $78.5 billion dollars on costs related to opioid misuse, according the Centers for Disease Control and Prevention. 

Opioids, a powerful narcotic, have recently been the recipient of media attention due to the onset of what many are calling an “opioid epidemic.” 

“It’s important to understand that opioids are important; we actually do need them, and many people cannot live without them for legitimate medical reasons,” said Dr. Mohab Ibrahim, an assistant professor of anesthesiology and pharmacology and director of the UA Comprehensive Pain Management Clinic. “Just like any other medication, they have to be given in the right amount to the right person.”

Opioids utilize a specific process to kill pain.

“An opioid is a chemical structure which interacts with an opioid receptor,” said Todd Vanderah, head of the UA Pharmacology Department.

Think of a receptor as a gateway to the cell, with the drug being the key, Ibrahim said. 

“These receptors that are activated by the opioids are distributed in strategic positions in the body—in the brain, in the spinal cord, in the peripheral nerves, in so many areas that are involved in the pain signal transmission and processing,” Ibrahim said. 

According to him, this is what makes opioids so powerful and successful when it comes to managing pain. 

Opioids, however, pack more than one punch. Opioid receptors are found in the area of our brains which houses the reward system, Vanderah said. 

The reward system is the brain’s way of encouraging us to perform actions essential to our survival. The neurotransmitter for reward, dopamine, can be released whenever we do something tied to our survival, such as eating food, Vanderah said. 

Opioids also activate the rewards system much more powerfully than the body’s natural opioids, Ibrahim said. 

“What opiates [a type of opioids] do is they sort of hijack that system, so they will activate that pleasure and cause an increase in your release of dopamine in the brain,” Vanderah said.

This allows the body to achieve a sense of euphoria without actually performing any of the actions necessary for survival, such as eating, which would have naturally activated the reward system, Vanderah added.

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While this process contributes to the opioids’ effectiveness, it also makes them highly addictive.

According to Vanderah, there are two reasons for this: 

“The amount of euphoria or dopamine that you can get released right away is large, but also in humans, it is counteracted by the fact that withdrawal can be very nasty,” he said.

On average, withdrawal symptoms can take anywhere from a few days to a few weeks before subsiding, Ibrahim said. 

For many, the severity of the withdrawal is worth the risk if it means eliminating pain.

“Sometimes people feel that they should never have pain,” Ibrahim said. “That’s not realistic. It can be achieved, but the consequences are very high.”

In the last 10 years, people have been more likely to abuse opioids because they can come in the form of pills prescribed by a doctor, rather than something you buy off the street, Vanderah said. 

“People feel that the pills they’re being prescribed from a doctor are more safe, and unfortunately, they are dangerous just like all drugs,” Vanderah said. “I think the epidemic is really sort of pushed by [this] fact.”

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Some of the more common forms of opioids include morphine, dilaudid and heroin, Ibrahim said.

Both scientists agreed the best approach to combating the recent opioid epidemic is education. 

Ibrahim said it’s important for the physicians and patients to know what they are prescribing and being prescribed. Many patients aren’t aware of the addictive properties of opioids, which could affect their decision to remain on the opioids for long periods of time. 

“Not all pain is the same,” Vanderah said, adding that doctors should be educated on the best ways to treat various types of pain. 

Patients can make use of pain clinics and specialized pain physicians for additional treatment options, according to Ibrahim.

“There might be other ways, and usually, at least in most cases, there are other ways to manage pain and we use opioids as the absolute last card to play,” Ibrahim said. 

Many researchers, both at the UA and around the world, are studying pain and working toward creating new narcotics and medications that won’t produce a drug addiction, Vanderah said.

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