Opioids, The Double Edged Sword

Written By: Arsakulasooriya Juwan Arachchillage Kavindya Kavindi Fernando, Class of 2025

This blog is about how pain and pleasure are two closely intertwined feelings that we as humans have learned to both love and hate in different proportions.

INTRODUCTION

Pain and pleasure are two closely intertwined feelings that we as humans have learned to both love and hate in different proportions. Although seemly contrasting, both have shown to be at the center point from which many decisions and actions that we make resonate from.

The main sources people opt for is the usage of drugs to achieve the sense of euphoria. But as we all are aware of, there is an extreme substantial disadvantage to the usage of drugs that can lead to drug use, abuse and addiction which is certainly also a result of these two factors – whether it is to alleviate pain, escape from actual problems or to find pleasure.

However, it may begin, it eventually leads to a cycle of dependence, harm and deterioration when abused. We must ask ourselves, “how does one start taking drugs?” Well, it depends, some individuals might start from pure peer pressure from society, or some take drugs to fit in with the popular crowd, these circumstances are witnessed in teens and young adults, but for some, it’s to escape reality. But are you aware that drug addiction can also begin with a simple prescription from a doctor? This prescription is prescribed for pain relief from an injury or surgery. One of the main drug groups that are utilized medically for pain relief but also used for drug addiction are opioids

 WHAT ARE OPIOIDS AND THEIR MECHANISM?

Opioids are a group of drugs that are either derived naturally from opium poppy plant or mimic their effects, they interact with our brain cells to produce morphine like effects. These opioids can be Fentanyl, Morphine, Oxycodone etc. They are also sold illegally, which we all have heard of as Heroin.

The duration of opioid intake is the first major step to decide whether one can result into an addict in the case of medically induced addiction, as even short-term opioid usage can lead to addiction.

This is because opioids have a mechanism that can activate powerful reward centers in the brain. They mimic the natural chemicals occurring in our body called endorphins.

THE POWER OF ENDORPHINS

Endorphins are neurotransmitters created and released by the pituitary gland and hypothalamus in the brain.

They function to alleviate pain, lower stress, give a positive state of mind, and enhance the sense of well-being. Endorphins are released by the body during any kind of pleasurable activities such as sex, working out, and by eating. There are about 20 subtypes of endorphins.

Beta endorphins are the type that is responsible for blocking the perception of pain and that gives the euphoric sensation. This mechanism takes place when they bind to the brain’s reward centers that are known as opioid receptors.

There are three types of opioid receptors “mu, delta and kappa” , but the main role of analgesia is played by the mu receptors, as these receptors function for euphoria and mountains for rewards.

When they are bound, a cascade of reactions takes place that results in the inhibition of the release of a protein mediator called tachykinin, distinctly a substance P, that is involved in the transmission of pain, which then carry out the signals across the nervous system. The analgesic process begins here, with the boost of euphoria, and by muffling the perception of pain.

SO, WHAT HIJACKS THE BRAIN TOWARDS ADDICTION?

The euphoria attracts recreational use and frequent use of opioids leading to addiction. Opioids attach to these same receptors and give off a more effective potent action than endorphins do.

Synthetic and semi synthetic opioids mainly bond more efficiently to the opioid receptors compared to opiates, so therefore it leads to a greater sense of pleasure and greater relief which leads to what we know as “runner’s high”.

Along with the characteristic features of runner’s high, it also offers its fair share of withdrawal symptoms that manifests itself by persistent dependance of the strong drive to use opioids. We must also understand that long term use or increase in dosage of these drugs can also disrupt the normal physiological functions in our body and can lead to chronic diseases, such as depression of respiratory centers in the brain, sleep disorders, anxiety, depression, immunosuppression, reduction in gut activities and they also develop Opioid Induced Hyperalgesia (OIH), which is a condition that occurs with the long term use and high doses of opioids resulting to an abnormal increase in pain sensitivity.

In some cases, with the increase in dosage, it can result to a medical crisis known as overdose, as we have mentioned earlier it can cause threatening side effects like respiratory depression, with decrease in heart rate, constricted pupils, they can have bluish lips, fingertips, loss of consciousness and eventually death!

CONCLUSION

We all should be educated about the long-term harmful actions with the use of pain killers, we must also be educated on substance abuse and addiction. If we are to be prescribed drugs for pain relief, we must stop as soon as the severity of pain improves. Individuals must seek professional support through rehabilitation centers when necessary.