For the past few decades, the graph of opioid addiction in America has exponentially grown. It is an epidemic like none we've ever seen before in the history of this country. Especially when it comes to a drug that can be prescribed by your doctor. In 2016 alone, there were over 64,000 deaths by overdose due to the misuse of these prescription drugs. In 2015, it was found that 122,000 adolescents, classified as 12-17-year-olds, were confirmed to be addicted to prescription pain relievers. 12-year-olds. That's a 6th grader. That's the 12-year-old son or daughter of someone. While the epidemic is centered around the addict, you cannot forget the fact that it severely impacts everyone around the victim. It's expensive too, as data has shown that the annual impact of the opioid epidemic sums out to about $78.5 billion dollars.
So what are these viruses circulating around our country? Opioids are a class of drug used to relieve pain. There are several kinds of these drugs, FDA approved and prescribed by doctors around the world regularly. Popular strains are oxycodone, codeine, morphine, and fentanyl. Different names, but the same deadly effects. These opioids may provide pain relief, but they come at a cost, which branches out into many more costs.
For one, the pain relief that comes with opioids is complemented with waves of euphoria, as the drug targets dopamine receptors in your brain. This makes the drug pleasurable and places a deep imprint in your memory, reminding it of this euphoria, which leads to cravings for more. Some opioids are more fat soluble than others, which means they can pass through the blood-brain barrier quicker, and stay there longer. If the drug is continued long-term, the nerve cells begin to grow used to the opioids, so when they are not there, you begin to feel unpleasant withdrawal symptoms. This is where opioid-induced hyperalgesia, or OIH, becomes an issue, as Dr. Oladosu from NorthShore University spoke about.
As Dr. Oladosu mentioned, long-term effects of opioid use contribute to OIH, which Dr. Oladosu defined as increased pain sensitivity due to acute or chronic opioid administration, distinct from the originally reported pain. This occurs when endorphin signaling in the brain changes the way the user perceives pain. This means that when the user is not on opioids, he or she because much more sensitive to pain, which ultimately leads to many returning to the drug. Dr. Jeremy Teissere, Professor and Director of the Neuroscience Department at Muhlenberg college discovered that it goes even farther than this. What he found was that there is a relationship between opioid tolerance and the environment it was consumed in. Therefore, if the user was to return to the location where they took the opioid, their body remembers and anticipates consumption. This heightens the users OIH, and leads them to seek new methods of consumption, whether it be the strain or location, one that their body is less sensitized to.
This is another significant reason why people choose to go back on the drug. Dr. Oladosu studies OIH, and emphasizes the MOR-1 receptor. Opioids target this mu opioid receptor, and its activation can alter the transduction, translation, and perception of pain. Dr. Oladosu found that the MOR-1K gene plays a huge role in this. Basically, after establishing morphine-induced hyperalgesia in 3 genetically diverse mice, she found that the mouse resistant to opioid tolerance found a significant increase in pain sensitivity. She also found that MOR-1K gene expression is required for the development in that mouse. This opens the door to researching new drugs that avoid this gene expression.
In a study reported by The Journal of Nature and Science, researchers from the University of Michigan have attempted a new drug that would do this. They studied Buprenorphine, a mu-opioid agonist, and administered this drug to 20 patients experiencing OIH. The patients were split into two groups. 13 of the patients were users of <100 mg of some kind of opioid, while the remaining 7 were prescribed >100mg. They first discovered that the 7 patients who were prescribed higher doses of opioids experienced more severe cases of OIH. After giving them doses of 2-16mg of Buprenorphine, they found trends at the 1-week mark of reduced pain sensitivity. However, after the first week, the results, unfortunately, returned to baseline. While this attempt at an alternative may have been successful, it's a start and shows the potential of finding this drug. Dr. Oladosu's data provides more details in the targeting needed to be strategized when creating or finding this alternative.
While many people are looking for alternatives, many people look further in their spotlight of blame for this epidemic. Dr. Kate Richmond, Associate Professor of Psychology at Muhlenberg college asked a question during one of her opioid panels that completely captures the few of this other group of people: "The United States is the only country dealing with a crisis of this magnitude. The truth is everyone around the world experiences pain. What is it about American culture that has contributed to this epidemic?"
This is a very interesting question, as it makes a crucial point about the American epidemic. The whole world administers opioids, so why is it that we're having a significantly worse crisis than anyone else? This leads to an even bigger question: Is it the opioids, or is it our culture? If it is the opioids, then work like Dr. Oladosu's is absolutely vital in searching for the antidote. However, if it's the culture, our country is going to need a lot more than alternative drugs to solve this issue.
Rodriguez, T. (2017, April 11). Is Opioid-Induced Hyperalgesia Lessened by Switching to Buprenorphine? Retrieved from http://www.clinicalpainadvisor.com/neuropathic-pain/opioid-induced-hyperalgesia-full-mu-opioid-agonists-vs-buprenorphine/article/649672/
Kantor, G. (2017, November 16). Painkiller Crisis. Retrieved from https://muhlenbergweekly.com/news/painkiller-crisis/
https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
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