When we hear the word “opioid” it refers to chemicals, both natural and synthetic of origin, that when taken correctly mimic the pain dampening ability of the resin obtained from the opium plant. The word “opioid” is, in fact, derived from the substance “opium”, the concentrated juice of the poppy Papaver somniferum which can aid in sleep, pain relief, and relaxation. This is where morphine, codeine, and other alkaloids used as, or in, prescription medication originate. Below is a list of natural opiates, semisynthetic opiates, and synthetic opiates.
|Natural Opiates||Synthetic Opiates||Semisynthetic Opiates|
- Oxymorphone (contains Thebaine)
- Hydrocodone (contains Codeine)
- Oxycodone (contains Thebaine)
- Hydromorphone (contains Morphine)
|NOTE: Semisynthetic opiates are molecules which contain natural opiates and a mix of synthetic chemicals (CDC, 2022b).|
Opium, and to a greater or lesser extent all “opioids,” enter the brain, stimulating chemical receptor sites conveniently known as opioid receptors located in the brain, bowels, and spinal cord. When an opioid is present, the activated receptors slow or block pain signal transmission to the brain, slow bowel function, and in general produce a warmly slightly euphoric feeling in both the limbic areas of the brain that house the central nervous system “reward” response, and the frontal cortex which helps to mediate pleasure. An increase in natural endorphins, pain-relieving chemicals produced naturally by the body, accompanies opioid use, boosting feelings of wellbeing and further suppressing the perception of pain. The longer opioids are utilized, less and less endorphins are manufactured by the body, leaving natural pain fighting abilities handicapped and at a loss to function normally (Shenoy & Lui, 2022).
Let us be clear, prescription opioids are an invaluable asset for the legitimate control of moderate to severe pain.
Misuse of opioids, however, is a problem. For some, the relief from stress, the warmth, the feeling of “at ease with life” that accompanies an opioid’s pain relief, lowering of heart rate, widening of blood vessels, and gentle sedation is the goal. Then, there are those reaching for the intense pleasure elevated levels of the neurotransmitter dopamine; a chemical increased by opioids, can help produce. As explained below, dopamine is known as the “feel-good” neurotransmitter.
Dopamine Makes Good Feelings
|Dopamine is the “feel-good”, or pleasure neurotransmitter. It helps you feel good and rewarded (Guy-Evans, 2022). When nerve cells, called axons, release dopamine, our body tells us that something pleasurable is happening. Dopamine attaches to receptors on the dendrites of neighboring neurons and creating a cascade of pleasure messages.|
In part, according to Nora Volkow, director of the National Institute on Drug Abuse (NIDA), it is the excellent job opioids do to manage initial pain and help us to feel better that contributes to the overuse and misuse problem (Petrus & Carter, 2022). Director Volkow suggests that once pain turns long-term or chronic then over-usage and over-prescription of opioid pain medication occurs by practitioners who depend on them rather than other methods of pain relief. Patients then become dependent on greater amounts of opioids, for longer durations of time, than is helpful or healthy. She suggests that limits placed on prescription opioid quantities and length of treatment allows black-market alternatives such as heroin and fentanyl to provide an unhealthy hope for pain relief desperately sought. Director Volkow emphasizes the need for research tasked with finding nonaddictive pain relievers (Petrus & Carter, 2022), while focusing on the transition from acute to chronic pain and developing reliable biomarkers for the presence and level of pain.