Opioids are the most powerful painkillers we have, but they are incredibly addictive. Every year, tens of thousands of people in the US die from opioid overdoses. Will we ever have drugs that get rid of pain just as well, but without the risk of addiction and overdose?
If you or someone you know is struggling with opioid addiction in the US, SAMHSA (free) can help. Call them at 1-800-662-HELP (4357) or visit them. Video Transcription:
Opioids are the most powerful painkillers we have, but they are also super addictive. In 2017, millions of people around the world were addicted to opioids and 115,000 people died of an overdose.
This is not a new problem. For centuries we’ve been trying to find ways to make opioids less addictive, like in the 1890s, when we changed morphine to make a drug called heroin. We all know this didn’t work.
So will we ever have drugs that get rid of pain just as well, but without the risk of addiction and overdose?
Opioids have been around for thousands of years, since the dawn of human civilization. It all started with opium, which was made from the milky liquid of a poppy.
The poppy was apparently called the joy plant because of how it would make you feel. People also found that it was great at treating civil war pain, the Union Army apparently gave 10 million opium pills to their soldiers.
I soon realized that people were becoming addicted to opium. So scientists started looking for other opioids that might not cause the same problem. In 1803, a German chemist named Friedrich Sertürner discovered a chemical in that milky liquid that was much more powerful than opium.
He called it morpheme, which we now call morphine. He found it to be much more powerful than opium, so he reasoned you would need less of it to get the same pain relief. And that would mean less risk of addiction.
It turned out that Sertürner became addicted during the study. And although he sounded the alarm, the people did not listen. Within a few decades, morphine was mass-produced by a large German pharmaceutical company.
And it soon became clear that Sertürner’s theory was wrong. Humans could be just as addicted to morphine. So what have they done about it? Make heroin. No seriously. They made heroin.
Heroin was also very effective in treating pain, but at an even lower dose. So again, scientists argue that it wouldn’t need that much, make it a less addictive opioid.
In fact, in the early 1900s, a religious organization in the United States delivered free heroin samples by mail to try to rid people of morphine. Here’s your heroin, sir. That did not work either.
Fast forward about a century later and scientists have created opioids like Oxycontin, which would again be less addictive. You probably see a trend here. Throughout history, we’ve tried to get the same painkiller benefits as opioids, without creating a new addictive drug.
But what has happened is that we just created more types of opioids that people become addicted to. So why are opioids so addictive? And if we know that they are so addictive and that people overdose on them, why are they still prescribed? Well, they are incredible painkillers.
And many people rely on it to treat chronic pain from injury or surgery or even cancer. This is why they work so well.
Opioids mimic pain-relieving chemicals or endorphins that your body naturally produces. So when you take an opioid, it enters your bloodstream and from there to your nervous system, where it binds to opioid receptors in your brain, spinal cord and peripheral nerves.
When it binds, it blocks the release of chemicals called neurotransmitters that normally send your brain the message, “Hey, I’m in pain.” Sounds good, right? Now let’s get to the addiction part.
Opioids cause your brain to release dopamine. Dopamine is a neurotransmitter that our brains make when we expect or experience a reward. Like when we eat food we love or get a text from someone we really like.
Dopamine makes us feel happy. And normally levels are controlled by a neurotransmitter called gamma-aminobutyric acid or GABA.
But opioids also blocked the release of GABA. So dopamine can just do its thing, totally unregulated, making your brain addicted to that happy feeling. That’s addiction.
And with addiction comes tolerance where you need more and more of a drug to get the same physical effects. If you take too much of an opioid, you will overdose, and if you don’t get treated quickly, you can stop breathing.
Over-the-counter pain relievers such as ibuprofen do not mimic endorphins. So they won’t be powerful painkillers, but that means they won’t cause a dopamine release either, which means they aren’t addictive.
So will we ever have painkillers that work just as well as opioids, but don’t lead to addiction and overdose? Scientists are trying, but it’s been really hard to find something so good at treating pain without dopamine flowing.
There is a lot of ongoing research on how our bodies experience pain to find out if there may be other targets of the nervous system that would not trigger the release of dopamine.
As for helping people who are already addicted and have developed a tolerance to opioids but want to get rid of it, there are medications that can help with the painful symptoms that result from withdrawal.
Researchers are also developing completely new approaches, such as creating vaccines that keep your immune system from binding to opioids or their breakdown products, and prevent them from binding to opioid receptors on your cells.
This is actually quite a large area of research that has received quite a bit of money in recent years. So it will be interesting to see where it is going.