“OUD is a chronic brain disease that comes about because of the effects of prolonged opioid
use on brain structure and function. These brain changes—and the resulting addiction—can be treated with life-saving medications, but those medications are not available to most of the people who need them. Methadone, buprenorphine, and extended-release naltrexone are safe and highly effective medications that are already approved by the U.S. Food and Drug
Administration (FDA) to treat OUD. By alleviating withdrawal symptoms, reducing opioid
cravings, or decreasing the response to future drug use, these medications 2 make people with OUD less likely to return to drug use and risk a fatal overdose. These medications also help people restore their functionality, improve their quality of life, and reintegrate into their families and communities. These medications save lives, but the majority of people with OUD in the United States receive no treatment at all.”
National Academies of Sciences, Engineering, and Medicine. 2019. Medications for
Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press.
https://doi.org/10.17226/25310.
The changes that take place in the brain from opioids:
The brain adapts to new stimuli in situations around it. It can produce new responses in ways of thinking about things. This is called brain plasticity. Very small children’s brains are very plastic, meaning they can change very easily. By the time we become adults our brains are not very plastic anymore.
However, certain things, like trauma or drugs can cause our brain to change very quickly and drastically. Once our brain is exposed to opioids it places the opioids into a category necessary to survival and safety, not just pleasure. This is why trying to stop taking opioids can cause extreme fear and anxiety. Our brain thinks we are missing something that is essential for survival, such as food, water and safety. Also, our body becomes dependent on opioids this means that if we stop taking them, we have what we call physical withdrawal.
Neurological disease vs bad behavior:
In many people exposure to opioids can cause rapid changes in our brain neurological functioning. These changes are what result in addiction withdrawals and cravings. From modern research it has become clear that reversing these neurological changes takes a long time. In most people this will be 18 months.
Traditionally, addiction treatment has primarily relied on short-term treatment such as one-week in-patient detox or 30–90 day in-patient rehabilitation. These treatments are very effective for helping patients through withdrawal and temporarily stopping the use of opioids. Just like we go to the hospital is effective at helping the effects of heart disease or diabetes. Just like diabetes, heart disease or any other chronic disease may reach a point of severity that you must have in-patient treatment in a hospital or nursing rehab, once that episode is over, that person will still need close medical care from an outpatient primary care physician for a longer period afterwards to fully recover and become healthy. However, because these diseases are long lasting, problems will begin to merge within weeks to months after these patients have left these treatments These neurological pathways are what create our automatic responses in our body to stressful situations. We call these stressful situations triggers. Triggers are any life situation that makes us feel stressed out, angry, bored, lonely, afraid, jealous, vulnerable, etcetera. The automatic response will be to seek relief by taking opioids, we call these cravings.
Our goal with treatment is to calm and sooth these receptors for 18 months while the neuropathways are changing to new automatic responses that are healthy. Then to continue provide 6 months of supporting these receptors until the changes have become stable for the long-term.
