Menachem M. Kiwak Ph.D, LMHC

Make a difference in the current opioid crisis.

Updated July 25, 2024 | Reviewed by Ray Parker

The Basics of Addiction

What Is Addiction?

Addiction, particularly opioid use disorder (OUD), is a significant public health challenge. Adolescents are especially vulnerable to addiction, as drug experimentation can cause problematic changes in their developing brains.

Key Points

Preventing Adolescent Drug Use

It’s crucial for adolescents to avoid experimenting with drugs to prevent long-term brain changes. The developing brain is highly susceptible to the effects of drugs, leading to higher risks of addiction.

The Opioid Crisis in the U.S.

The U.S. has primarily focused on reversing opioid overdoses, but a broader approach is necessary. Over a million people have died from drug overdoses since 1999, with fentanyl being a significant contributor in recent years.

Three Phases of the Opioid Crisis

1. Oxycontin Epidemic: Users had access to pure, FDA-approved pills.

2. Heroin Epidemic: Users switched to heroin.

3. Fentanyl Epidemic: Fentanyl and other synthetic opioids have flooded the market, often in counterfeit pills, leading to unknown dosages and increased risk.

Naloxone Overdose Reversals

Naloxone can reverse opioid overdoses, but its effects are temporary, requiring emergency medical attention afterward. It’s important for those administering naloxone to call 911, as users can re-overdose once naloxone wears off.

Addiction and Time

Addiction develops over time, creating a strong bond between the user and the drug while weakening other relationships. The concept of pre-addiction focuses on early intervention to prevent full-blown addiction.

Multiple Drug Use

Opioid users often abuse multiple substances, complicating treatment. Effective treatment must address all co-occurring substance use disorders (SUDs) and any underlying medical and psychiatric conditions.

Medication-Assisted Treatment (MAT)

MAT is effective, but only if patients adhere to their treatment plans. Many drop out, risking relapse. Treatment should include comprehensive options, such as telehealth and residential programs, and consider those with treatment-resistant OUD (TROUD).

Underuse of Methadone

Methadone is highly effective in preventing overdoses and retaining patients in treatment. However, its use is limited by strict regulations. Unlike other FDA-approved OUD medications, methadone cannot be prescribed as freely, which needs reevaluation.

Genetic Risks and Addiction

Genetic factors may increase susceptibility to OUD, suggesting the potential for future genetic testing to identify at-risk individuals. However, environmental factors can modify these risks.

The Brain’s Pleasure System

Drugs alter the brain’s pleasure system, creating a dependency that overrides natural pleasures. Opioids, particularly fentanyl, can cause severe depression and suicidal thoughts in users.

The Bottom Line

Addressing the opioid crisis requires ongoing research and the application of effective, evidence-based treatments. Outdated approaches must be discarded in favor of strategies that save lives and improve outcomes.

References

• Connery HS, Weiss RD, Griffin ML, et al. Suicidal motivations among opioid overdose survivors: Replication and extension. Drug Alcohol Depend. 2022.

• Lee YK, Gold MS, Blum K, et al. Opioid use disorder: current trends and potential treatments. Front Public Health. 2024.

• Mahoney JJ 3rd, Winstanley EL, Castillo F, et al. A pilot study investigating cognitive impairment associated with opioid overdose. Drug Alcohol Depend. 2023.

About the Author

Mark Gold M.D.

Mark S. Gold, M.D., is a pioneering researcher and professor, contributing significantly to our understanding and treatment of various substance use disorders. His work has influenced the fields of psychiatry and addiction medicine, offering new insights and therapies.

This blog post is based on the article by Mark S. Gold, M.D. His extensive research and insights into addiction and the opioid crisis provide a critical foundation for addressing these pressing public health challenges.