By Alyssa Cho The opioid epidemic has been called the deadliest drug crisis in American history. From smuggled packets of fentanyl passing between stealthy hands on street corners to the illicit prescriptions of OxyContin and Vicodin offered by corrupt “pill mill” doctors, opioid drugs have increasingly deluged the nation in recent years, ensnaring millions of Americans in the relentless grip of addiction. The highly addictive properties of these opioid compounds result in an annual rate of about 3 million Americans abusing prescribed medication or turning to illegal opioid substitutes when they crave a cheaper or more potent substance. Before delving into how opioids entice people to repeatedly abuse them, you should familiarize yourself with what exactly an opioid is. Opioids are drugs that act on the nervous system; they can either be harvested in nature—extracted from opium poppy seeds in the form of a milky substance—or can be synthetically created in a lab.* You may be surprised to know that endorphins, enkephalins, and dynorphins produced by the body are also opioids. These endogenous opioids constitute the body's system of pain control for acute injuries. Whether natural or manmade, all opioids have in common a wide range of effects. Their most useful property is pain mediation, but they also control perfunctory bodily functions—such as breathing—and feelings such as pleasure, relaxation, and euphoria. Every opioid-related effect is caused by a biochemical reaction that occurs in nerve cells. For example, the perception of pain is mediated by creating a difference in voltage between a cell’s inner and outer environments. The process holds similarities to fitting a key into a lock; by binding to a specific site called a receptor (the lock) on the cell membrane of a neuron, an opioid molecule (the key) activates the opening and closing of membrane channels, which quickly usher calcium and potassium ions out of the cell. This hyperpolarizes the neuron, making it less likely to fire and thus dampening the transmission of pain signals. Likewise, other signal transduction pathways exist for controlling emotions, cardiovascular and respiratory functions, and responses to stress. If some opioids occur naturally in the body, why are non-medical drugs that contain it considered dangerous? The answer lies in the fact that cells cannot differentiate between natural and synthetic opioids. Because receptors work by recognizing molecule shapes, any molecule that simply has an opioid-like structure can gain entry into a cell, even if the molecule is artificial and flaunts different chemical properties. For example, opioid compounds produced by the body are not strong enough to cause overdose or to stop severe pain. Artificial compounds, on the other hand, are typically modified to be more potent. It is these subtle chemical differences that lure whole populations into cycles of addiction and dependence. Hopefully, this in-depth look into the cellular capabilities of opioids has heightened your awareness of their potential dangers. The next time you are offered “pink” on the streets, or a doctor suspiciously suggests that you pile up on prescriptions, don’t forget to make the safe choice. Your future self will thank you. *To clarify, “opiates” are drugs derived from opium, while “opioids” refer to synthetic opiates—drugs that mimic the effects of opium but have slightly different chemical properties. However, when not used in a medical sense, the term opioid is used for both natural and synthetic opiates. cITATIONSMerica, D. (2017, October 26). What Trump's opioid announcement means. Retrieved November 19, 2017, from http://www.cnn.com/2017/10/26/politics/national-health-emergency-national-disaster/index.html Rhodan, M. (2017, October 26). Opioid Crisis Plan Draws Mixed Praise From Experts. Retrieved November 19, 2017, from http://time.com/4998975/opioid-crisis-donald-trump-public-health-emergency/ Opioid Overdose Crisis. (2017, June 01). Retrieved November 19, 2017, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis How Do Opiates Work? (2016, April 19). Retrieved November 19, 2017, from http://www.opiaterehabtreatment.com/how-do-opiates-work Stoppler, M. C., & Shiel, W. C. (n.d.). Endorphins: Natural Pain and Stress Fighters. Retrieved November 19, 2017, from https://www.medicinenet.com/script/main/art.asp?articlekey=55001 How Do Opioids Work? (n.d.). Retrieved November 19, 2017, from https://teens.drugabuse.gov/teachers/mind-over-matter/opioids/how-do-opioids-work Eil, P. (2017, July 18). The Pill Mill That Ravaged Portsmouth. Retrieved November 19, 2017, from http://www.cincinnatimagazine.com/features/pill-mill-portsmouth/ Al-Hasani, R., & Bruchas, M. R. (2011, December). Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior. Retrieved November 19, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698859/ Labonville, S. (2017, March 29). Opiate, Opioid, Narcotic - What's the Difference? Retrieved November 19, 2017, from http://info.iwpharmacy.com/opiate-opioid-narcotic-whats-the-difference European College of Neuropsychopharmacology. (2007, October 15). How does the opioid system control pain, reward and addictive behavior?. ScienceDaily. Retrieved November 19, 2017 from www.sciencedaily.com/releases/2007/10/071014163647.htm National Institute on Drug Abuse (n.d.). Opioids. Retrieved November 19, 2017, from https://www.drugabuse.gov/drugs-abuse/opioids Neurotransmitters (The Neuron) Part 1. (n.d.). Retrieved November 19, 2017, from http://what-when-how.com/neuroscience/neurotransmitters-the-neuron-part-1/ National Institute on Drug Abuse (2017, March 09). Impacts of Drugs on Neurotransmission. Retrieved November 19, 2017, from https://www.drugabuse.gov/news-events/nida-notes/2017/03/impacts-drugs-neurotransmission Akst, J. (2013, September 19). Natural Opioids Linked to Chronic Pain. Retrieved November 19, 2017, from http://www.the-scientist.com/?articles.view/articleNo/37538/title/Natural-Opioids-Linked-to-Chronic-Pain/ SUGGESTED READINGSFroehlich, J. C. (1997). Opioid Peptides. Neurotransmitter Review, 21(2), 132-136. https://pubs.niaaa.nih.gov/publications/arh21-2/132.pdf
Katz, J. (2017, August 03). Short Answers to Hard Questions About the Opioid Crisis. Retrieved November 19, 2017, from https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html Opioid Crisis Fast Facts. (2017, October 29). Retrieved November 19, 2017, from http://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html
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