tgirl and all interested. Exactly How Opiates Act on the Brain & How Dependence Occurs

[DutchessGolden]

Too long to post here but many of you have been asking me for info. contained in this post. I will post it as a reply.

xoxo- D.

[DutchessGolden]

Keep in mind this is "in a nutshell".... a very small nutshell I might add

Dependence occurs in three steps

Opiates work on your CNS (central nervous system), respiratory system, and gastro-intestinal tract. In simple terms it works in 3 steps:
    First, the brain responds to the presence of the drug and increases the number of(opiate) receptors in the brain and the nerve cells stop functioning properly. The receptors increase due to an increase in opiates in the system. Think of it as "making more room"
    Second, the body stops producing endorphins (your natural pain killers (endogenous opiates-they come from the inside of your body)) because you are receiving the opiates exogenously- meds coming from outside your body.
    Finally, the degeneration of the nerve cells in the brain causes a physical dependency on an exogenous supply of opiates, and reducing or stopping intake of the drug causes a painful series of physical changes called the withdrawal syndrome.

The painkillers literally cause a change in your brain chemistry that you have no control over, this is why dependence and or/ addiction is considered a disease of the brain. Sudden withdrawal (quitting cold turkey) can lead to permanent damage of the cardiopulmonary system and central nervous system. In unhealthy patients this can lead to death.

Exactly how opiates work on the body and brain

Opiates elicit their powerful effects by activating opiate receptors that are widely distributed throughout the brain and body. Once an opiate reaches the brain, it quickly activates the opiate receptors that are found in many brain regions and produces an effect that correlates with the area of the brain involved. Two important effects produced by opiates, such as morphine, are pleasure (or reward) and pain relief. The brain itself also produces substances known as endorphins that activate the opiate receptors. Research indicates that endorphins are involved in many things, including respiration, nausea, vomiting, pain modulation, and hormonal regulation.( hence the withdrawal symptoms eperienced when opiates are stopped c/t and the body has no endorphins to regulate these things)
When opiates are prescribed by a physician for the treatment of pain and are taken in the prescribed dosage, they can be safe and there is little chance of addiction. However, when opiates are abused and taken in excessive doses, addiction can result. Findings from animal research indicate that, like cocaine and other abused drugs, opiates can also activate the brain's reward system. When a person injects, sniffs, or orally ingests heroin (or morphine), the drug travels quickly to the brain through the bloodstream. Once in the brain, the heroin is rapidly converted to morphine, which then activates opiate receptors located throughout the brain, including within the reward system. ( Because of its chemical structure, heroin penetrates the brain more quickly than other opiates, which is probably why many addicts prefer heroin.) Within the reward system, the morphine activates opiate receptors in the VTA, nucleus accumbens, and cerebral cortex. Research suggests that stimulation of opiate receptors by morphine results in feelings of reward and activates the pleasure circuit by causing greater amounts of dopamine to be released within the nucleus accumbens. This causes an intense euphoria, or rush, that lasts only briefly and is followed by a few hours of a relaxed, contented state. This excessive release of dopamine and stimulation of the reward system can lead to addiction.
Opiates also act directly on the respiratory center in the brainstem, where they cause a slowdown in activity. This results in a decrease in breathing rate. Excessive amounts of an opiate, like heroin, can cause the respiratory centers to shut down breathing altogether. When someone overdoses on heroin, it is the action of heroin in the brainstem respiratory centers that can cause the person to stop breathing and die.
As I mentioned above, the brain itself produces endorphins that have an important role in the relief or modulation of pain.(Hence the hyperalgesia( increased sensitivity to pain and decreased tolerance to pain) that can occur after prolonged opiate use and long after opiate use, this can be permanent) Sometimes, though, particularly when pain is severe, the brain does not produce enough endorphins to provide pain relief. Fortunately, opiates, such as morphine are very powerful pain relieving medications. When used properly under the care of a physician, opiates can relieve severe pain without causing addiction.
Feelings of pain are produced when specialized nerves are activated by trauma to some part of the body, either through injury or illness. These specialized nerves, which are located throughout the body, carry the pain message to the spinal cord. After reaching the spinal cord, the message is relayed to other neurons, some of which carry it to the brain. Opiates help to relieve pain by acting in both the spinal cord and brain. At the level of the spinal cord, opiates interfere with the transmission of the pain messages between neurons and therefore prevent them from reaching the brain. This blockade of pain messages protects a person from experiencing too much pain. This is known as analgesia.
Opiates also act in the brain to help relieve pain, but the way in which they accomplish this is different than in the spinal cord.
There are several areas in the brain that are involved in interpreting pain messages and in subjective(your own personal) responses to pain. These brain regions are what allow a person to know he or she is experiencing pain and that it is unpleasant. Opiates also act in these brain regions, but they don't block the pain messages themselves. Rather, they change the subjective experience of the pain. This is why a person receiving morphine for pain may say that they still feel the pain but that it doesn't bother them anymore.
Although endorphins are not always adequate to relieve pain, they are very important for survival. If an animal or person is injured and needs to escape a harmful situation, it would be difficult to do so while experiencing severe pain. However, endorphins that are released immediately following an injury can provide enough pain relief to allow escape from a harmful situation. Later, when it is safe, the endorphin levels decrease and intense pain may be felt. This also is important for survival. If the endorphins continued to blunt the pain, it would be easy to ignore an injury and then not seek medical care.
There are several types of opiate receptors, including the delta, mu, and kappa receptors. Each of these three receptors is involved in controlling different brain functions. For example, opiates and endorphins are able to block pain signals by binding to the mu receptor site. The powerful new technology of cloning has enabled scientists to copy the genes that make each of these receptors. This in turn is allowing researchers to conduct laboratory studies to better understand how opiates act in the brain and, more specifically, how opiates interact with each opiate receptor to produce their effects. This information may eventually lead to more effective treatments for pain and opiate addiction.

  
PAWS: is typically the result of permanent damage to the receptors & nerve cells due to long term opiate use and/ or withdrawal. This is caused by the attempt of the CNS and body to repair the nerve cells and normalize itself again. Keep in mind that the extra opiate receptors created in the brain during opiate use do not just go away, so your brain is literally trying to adapt to an altered brain chemistry. There are many effective ways to help yourself cope with and deal with PAWS psychologically and socially. However, physiologically the research is still very new. I have worked on some research on cloning one of the opiate receptors in the brain that might make it possible to implant in the brain in the future and could be etremely effective in opiate dependency and addiction. Long term users of opiate pain killers, unlike alcohol abuse, may have PAWS symptoms for up to 10 years, some longer. It takes the body a very long time to "normlize" and adapt itself as much as physically possible.

[sosad5306]

Wow!  I was just reading that post you mentioned about that girl's b/f and I was thinking about asking you to post this.  Thank you so much for posting this and taking the time!!!
Also, this has been on my mind for awhile - I wanted to tell you that I think you are such a valuable member of this forum!  Your expertise and experience are an amazing asset here.  Thanks!

[mominstress]

Thank you very much for sharing your knowledge.  It is scarier than I ever knew.  

[tgirl1128]

Thank you for the info, it was very helpful in learning more about this.

[wheredidmyenergygo?]

I keep hearing aboout PAWS, what is it?

[gnomie]

Do Docs really know what happens to people when they prescribe morphine to their patients?  I think, from my experience, they really aren't aware of the effects after the "end of the story"-my doc hasn't given me any prep for ending.  His lack of info led me to believe that when I took my last morphine, it was over.  I had no idea there was another chapter to the story called "after you think you're done".   This forum has been more educational to me than my doc has been-ever.  

[DutchessGolden]

The "doctor thing": they do not typically warn patients about the specific effects of opiates. One reason is that pretty much every drug prescribed can have these types of effects on the brain and are potentially dangerous (side effects etc.) If they mentioned every detail of every medication they would be scaring patients into not taking anything which in turn is much much more dangerous in the big picture. Another major factor is money. Doctors get money from the pharmaceutical co. that manufactures the drug for every single prescription they write. Opiates pay quite a bit in kickbacks. And any new drug on the market is pretty much always going to be paying the most to get their drug out there. Unfortunately, to many doctors now a days you are simply a huge dollar sign walking into their office. Doctors are liable for what happens to you for the prescriptions they give you, but there are limits to their liability being that a small percentage of the population will experience dangerous side effects. They ARE liable if they attempt to take you off of a benzodiazepine cold turkey and do not inform you of how to taper it off as withdrawal from this class of drugs can be lethal even in the healthiest of patients.

sosad: Your comment made me feel really good, It's really nice to know that I can be of help here. I know that doctors do not provide patients with all of the information they would like to know.

PAWS:(post acute withdrawal syndrome) Withdrawal symptoms that cycle long after you have been detoxed from a drug. With opiates this can go on upwards of ten years unlike with alcohol and other drugs where PAWS might last one to 2 years. I can leave a post on PAWS, what it is, how long it lasts, and coping mechanisms if you guys would like. I have had quite a few questions about PAWS over the past week or so.

I really appreciate all of your comments and really, truly am glad for any help I can be here.

xoxo- D.

[saraheden]

Thank you for your post it was so imformative.  I would appreciate the information you have on PAWS.  
Thanks,
Sarah

[DutchessGolden]

Not a problem, I'll post the info on PAWS in a new post.

xoxo- D.

[construction]

I thought that the cells were actually damaged due to the abuse of opiates ( too much drug destroying the binding site)?   I also thought that the abuse of drugs did not increase the amount of room or space needed in the brain but that the stimulus (the drug) increased the amount of impulses per second through the neurons to the brain,  Which it always made sense that when the artificial endorphin binds to the receptor site it stops the production of natural endorphins and destroys the nerve cell, but I never thought the brain would elicit the production of more receptor sights?  I also thought that it took a year or less for the regeneration of the bodies endorphins to kick in?  Why do you say up to ten years? The fight or flight occurance produces endorphins or adrenaline?  Also do you know if the dopamine from cigs. helps alleviate the pain some how when quitting opiates ?  I know it sounds weird but they tell you in NA not to quit smoking right away so I thought it might somehow be connected.

Do you do actual research yourself?  If so then can you tell me where I can find this information.  Or what would be the best book to check out for this information?  

I may just be really confused now?  If I asked too many questions I am sorry but could you please answer a couple of them?

Thanks, Justine