It’s not news that opioid drugs are in the eye of a public health firestorm . Since 1999, the death rate from overdoses of these painkillers has more than quadrupled. In 2014 alone, 28,000 people passed away from overdoses involving opioids. This week, a state sued drugmakers and scientists launched a new initiative to combat the crisis. Here’s what you need to know.
What is an opioid?
The word opioid came about in the 1950s. It’s a combination of the word “opium” and the ending “oid”, borrowed from the Greek word for “resembling” or “like”. Taken together, then, the word opioid means “opium-like”. Experts came up with the word opioid to describe any substance, naturally-occurring or human-made, that has similar biochemical actions to the major active substance in the opium poppy, morphine.
There are many opioids on the market. For simplicity’s sake, I’ll name just a few representative examples. Morphine and codeine are all-natural opioids, made by the opium poppy. Other opioids, such as hydrocodone (found in Vicodin) and oxycodone (found in OxyContin and Percocet), are what’s called semi-synthetic, meaning that chemists start with components of the poppy and make some chemical additions or adjustments to them. And then you have the fully lab-made opioids, designed to act like morphine but made entirely from scratch. This group includes fentanyl and methadone. It’s worth noting that our bodies make their own opioids— in this case, small proteins that dull pain. Endorphins are part of this group— in response to pain, the body produces endorphins naturally.
You may also be familiar with the word “opiates”— that’s an older term that traditionally meant “drugs coming from opium”, such as morphine.
How does an opioid make pain go away?
The nervous system is how we feel pain, and that’s precisely where opioids act. They bind to specific proteins, known as opioid receptors. There’s more than one kind of opioid receptor. And opioid receptors reside in different places— mostly in various parts of the brain and spinal cord.
Each opioid drug has its own painkilling strength, which has to do with the particular receptors that drug binds to, and how tightly it binds to them. Each drug also has its own staying power, which has to do with how long the drug sticks around once it binds.
Of course, opioids don’t just dull pain— they also can provide intensely pleasurable feelings. And in an overdose situation, opioids can stop a person’s breathing.
That whole portfolio of effects once again comes down to opioid receptors— targeting different combinations and locations of opioid receptors leads to different effects.
In other words, if there’s a takeaway here, it’s that pain involves some incredibly complex biochemistry, and opioids tinker with it in ways that, even today, we don’t fully comprehend.
Why are opioids addictive?
Before I get into the details, let me make something clear. While opioids are addictive, not every painkiller is addictive. You can’t get addicted to acetaminophen, the active ingredient in Tylenol. (Taking too much acetaminophen can be toxic to your liver, but that’s a different issue.) You can’t get addicted to ibuprofen (the active ingredient in Advil) or naproxen (the active ingredient in Aleve). In other words, opioids aren’t addictive BECAUSE they kill pain. They are addictive because of the specific way in which they kill pain.
Permit me to explain. I mentioned earlier that when opioids bind to certain types of opioid receptors, they trigger feelings of pleasure. And those feelings of pleasure are one big reason for seeking out more of the drugs. Pleasure alone’s not enough, though, because otherwise we’d all be addicted to chocolate and sex.
After consistent exposure to opioids over time, brain cells become less responsive to opioids. That means a person often will need higher and higher drug doses to achieve the same effect. What’s more, once the brain is used to having opioids around, taking them away cold turkey leads to withdrawal.
Withdrawal is a very serious matter– imagine the worst imaginable aching, sweating, fever, and chills a person could have. Avoiding withdrawal is a powerful motivator for staying on opioids. Eventually, opioid use leads to long-lasting changes in the brain, setting the stage for addiction.
Why are states and local governments suing opioid drugmakers?
This week, the state of Ohio sued five companies that manufacture prescription painkillers such as Percocet. It joins the state of Mississippi as well as multiple county and city governments in filing suit against drugmakers. Kentucky settled a lawsuit with the maker of OxyContin in 2015.
“These drug manufacturers led prescribers to believe that opioids were not addictive, that addiction was an easy thing to overcome, or that addiction could actually be treated by taking even more opioids,” said Ohio Attorney General Mike DeWine in a statement. “They knew they were wrong, but they did it anyway.”
In an emailed statement to Reuters, a spokesperson for Janssen Pharmaceuticals, one of the five companies named in the suit, said: “The allegations in this lawsuit are both legally and factually unfounded.”
Purdue Pharma, also named in the suit, wrote the following statement to Reuters: “We share the attorney general’s concerns about the opioid crisis and we are committed to working collaboratively to find solutions.”
What are experts doing about the crisis?
This week, top government health officials announced over $70 million in grant money to curb the opioid crisis. The money will eventually go to first responders, as well as to organizations making addiction treatments and overdose-reversing drugs accessible to hard-hit communities.
Officials also announced a new research initiative to combat the crisis. The initiative takes a three-pronged approach.
The first objective is to develop better approaches to prevent, detect, and counteract overdoses. This part of the effort has already obtained results. In 2015, FDA approved a nasal spray of naloxone, an overdose-reversing drug that has existed for many years. Why a nasal spray? Well, until 2015, you had to inject naloxone for it to work. In an overdose situation, time is of the essence. A nasal spray is something a family member, friend, or even a bystander can administer, without losing precious time waiting for paramedics to arrive.
The second part of the new initiative is about developing better treatments for those addicted to opioids. Sometimes it can be difficult for a person to take medications on schedule, or they don’t have the support system they need while in recovery. Here again, there’s been a step forward. In 2016, FDA approved an implant that delivers a well-established treatment for opioid addiction steadily for six months.
The third piece is about finding better pain relief drugs altogether. Whether that’s about making drugs that take aim at different opioid receptors, or something else entirely, remains to be seen.
Nothing can bring back loved ones who have died as a result of opioid addiction. Here’s hoping that scientists, government officials, and community leaders can work together to make sure the crisis comes to an end.
Carmen is an independent journalist specializing in chemistry, in particular the places where chemistry meets biology. I was a staff science writer at Chemical & Engineering News, where I covered anything from forensic science to the question of how life on Earth began. Before that, I earned a Ph.D. in organic chemistry at Princeton University. I’m here to show you why chemistry, the study of matter, matters. Follow me on Twitter @carmendrahl.