Opioids A different thought on opioid addiction....

[JM357]

I was talking to my father yesterday on a way to a doctor's appointment (don't have my license right now and my wife couldn't take me) about heroin addiction. He isn't a doctor but is a trained scientist (physicist) and we were talking about opioid/heroin addiction (I have been addicted to opioids in some form of another for over a decade and am now on suboxone; his actual drug experience is that he smoked weed a couple of times in the 60s- but he has seen my addiction and that of other family members first hand as an impartial sober observer with an open mind (he is not some anti-drug person even though he has never used- his opinion is that doctor's should be allowed to dispense drugs to addicts to treat the disease- wither it means suboxone, methadone, or even heroin)). He stated that from his observation and from the research he has done into the subject he is starting to think that opioid abuse is a symptom and not the disease itself. He reminded me that correlation does not equal causation- even if the large majority of people that tried heroin got addicted (which maybe my friends are insanely lucky but that actually hasn't been the case- out of the friends I grew up with there was like 5 of us who tried it at least once, I am the only one who became addicted) that doesn't necessarily mean heroin causes it as in if you took someone and gave them heroin (a random person out of the population) that they would become addicted. It could be that there is some illness which makes people start using drugs (I've been using heroin for an example, but it could be other drugs as well) and inevitably become addicted.

I'm sort of starting to agree. I do think many many people who try strong opioids become addicted- but look at how heavy the stigma is, who tries it in the first place? I do feel like there was a factor in my neighborhood which would possibly explain why only 1 out of the 5 of us became addicted. I was an anti-drug war person, not just in the sense of not locking addicts up, but also that the drug war had demonized drugs. And I was thought of as highly intelligent by my peers, and at that time they looked to me for advice on anything dealing with science, pharmacology, etc. Then I had drugs as I got older because at first I had plenty of money, and therefore had them available, was considered the person who knew a lot about them etc. It was under these conditions they tried them. If they had gotten addicted I would feel tremendously guilty- but my point is I don't know they would have ever tried them on their own.

Is it possible that the reason we think of certain drugs as super addictive is that most well people don't want to try them in the first place? Just because we see most people that use heroin become addicted doesn't mean that it "caused" it. When they give powerful opioids to someone in the ER with a serious injury (often during their stay and an RX after) , although some people become addicted, it is actually a fairly low number. Do you think it is possible that there is an already present illness that causes people to seek out opioids and other drugs in the first place as opposed to a completely well person being given them becoming addicted?

 

[JM357]

I will say this too: this doesn't mean "great that means I can go out and try heroin!" It seems like most non-drug users don't want to try drugs in the first place (so they wouldn't be looking for a reason why they should try hard drugs) and even if it is a disease and use is the symptom it still makes things worse. So if you haven't used I'm not recommending you do.

 

[BeachBum4u]

I don't know if this is totally relevant but statistics I've seen have stated that something like 90% of chronic pain patients who take opiates for their pain will not meet the definition of "addiction". So, that means only 1 in 10 will actually become addicted to the opiates they take for their pain. Of course, understanding the definition of addiction vs. dependence, because I'd 100% will become dependent. I'd say that with only 10% becoming addicted is a pretty good statistic "for" opiate usage for pain patients.

 

[JM357]

I don't know if this is totally relevant but statistics I've seen have stated that something like 90% of chronic pain patients who take opiates for their pain will not meet the definition of "addiction". So, that means only 1 in 10 will actually become addicted to the opiates they take for their pain. Of course, understanding the definition of addiction vs. dependence, because I'd 100% will become dependent. I'd say that with only 10% becoming addicted is a pretty good statistic "for" opiate usage for pain patients.

Yeah- this is what I was talking about. If we just looked at people that tried street drugs the results would be skewed because maybe they are willing to use street drugs due to an underlying disease. Pain patients are more likely to be your average person who is exposed to opioids. They will become dependent (but that happens to some extent with a ton of medications- SSRIs which are not at all abusable cause some degree of dependence) but as you said dependence and addiction are two different things.

My father put it this way: he isn't judgmental about people using drugs, but on a personal level he says he can't see taking a drug he doesn't need and therefore the risks associated with it. He has taken a couple percs before due to shoulder pain/arthritis (he is elderly, but still in control of mental functions) and did say he enjoyed getting relief from the pain, being able to fall asleep, etc. He took them as needed when the pain was worst. He had a bottle of like 30x5 mg oxys which lasted him a few months (and he still had probably 1/4 left) and he got other treatment for pain which he felt worked as well.

 

[Pretty_Diamonds]

chicken or egg concept.

 

[crzydiamond]

When I first used I felt like I took something that was missing all along. I wouldn't be surprised at all if the people susceptible to addiction have lower levels of dopamine or something like that

 

[burn out]

youre far from the first person to point out the idea that psychologically unhealthy/unhappy people are more likely to become drug addicts.

 

[SluttyPeach]

When I first used I felt like I took something that was missing all along. I wouldn't be surprised at all if the people susceptible to addiction have lower levels of dopamine or something like that

Theres talk of a newly discovered disorder having to do with dopamine deficiency. I think of it like how you crave certain food when your body needs a specific nutrient in that food item. Not a difficult concept to grasp but the hard part is figuring out how and why this happens.

 

[hydr0m0rph]

Its becoming a well known theory, and I also agree with it.
I believe some people are predisposed to addiction, especially to opiates, because they have a condition like low dopamine/endorphin production, depression, severe social anxiety, etc.
I have relaized thats why I started using opiates in the first place. I was immediately hooked, because my brain, my mind, and even myself, realized, wow.. this is what I have been missing. I finally felt like myself. I could communicate with my friends, be social, confident, my awkwardness vanished.. I was finally comfortable in my own skin. Once you feel that way, how could you ever go back to being deficient again?
Thats why some people are hyper-sensitive to opiates, meaning they cant handle them, and hate them. I know people that take them, and hate them. also people that take them, and are just like "meh.. its alright i guess" why are some people instantly in love, while some people sut dont seem to get the attraction, and never really like them? because some people NEED them, and always have. thats why when i quit, cold turkey, i never felt right, even after more than 6 weeks sober. i eventually got back on subutex, which made me normal again, and myself. i think i will need it for the rest of my life.

 

[JM357]

youre far from the first person to point out the idea that psychologically unhealthy/unhappy people are more likely to become drug addicts.

No, I know that. But I guess I'm not so much saying that someone has some other previously identified illness such as depression, anxiety, bipolar, etc. because a lot of people have those illnesses but do not become addicts even when exposed to addictive substances (I'm pretty sure they do believe that those diseases increase the risk of addiction). I guess I'm thinking maybe there is a more specific disease of addiction (for lack of a better term) that is already present. And I feel like that this has been suggested before too, but it seems like the more common thought in the current day is other illnesses and past trauma may increase the risks of addiction and then once you use your brain chemistry changes and you become an addict. Yet, I've also heard, in regards to pain patients, that if the disease causing the pain is cured (say cancer- that is probably the disease with the heaviest opioid prescribing and is in a class of its own (like you have chronic non-cancer pain and chronic cancer related pain), most people (while they will be physically dependent and go through withdrawal symptoms or have to have their dose slowly lowered) are then able to stop using pain medication.

I guess I'm not talking about anything new, but how specific is the disease of addiction if it is present beforehand? Is it simply other illnesses causing a higher risk or has it already decided before they use the first time wither or not they are an addict?

Is it even important? I think it could be because it would probably change the way you treat the disease in some instances. Also, if the drugs themselves do turn people into addicts then that is probably justification for being more careful in the sense of exposing people (I still wouldn't believe in the drug war it doesn't help anything) but if they don't does that mean it is safer to prescribe addictive drugs to non-addicts (and maybe even addicts if the drugs aren't specifically causing their illness and they need them; but I guess I do support the prescribing of drugs to treat addiction (as a form of harm reduction) as well) than is currently though.

 

[JM357]

Its becoming a well known theory, and I also agree with it.
I believe some people are predisposed to addiction, especially to opiates, because they have a condition like low dopamine/endorphin production, depression, severe social anxiety, etc.
I have relaized thats why I started using opiates in the first place. I was immediately hooked, because my brain, my mind, and even myself, realized, wow.. this is what I have been missing. I finally felt like myself. I could communicate with my friends, be social, confident, my awkwardness vanished.. I was finally comfortable in my own skin. Once you feel that way, how could you ever go back to being deficient again?
Thats why some people are hyper-sensitive to opiates, meaning they cant handle them, and hate them. I know people that take them, and hate them. also people that take them, and are just like "meh.. its alright i guess" why are some people instantly in love, while some people sut dont seem to get the attraction, and never really like them? because some people NEED them, and always have. thats why when i quit, cold turkey, i never felt right, even after more than 6 weeks sober. i eventually got back on subutex, which made me normal again, and myself. i think i will need it for the rest of my life.

Yeah, it is also interesting that different people sometimes get addicted to different drugs. For me, while I have actually taken them before after surgery and not used them illicitly after, opioids are the most addictive (to have any chance of success in situations like previously mentioned a prescribing doctor, my family, etc. has to take steps to monitor my usuage (as is frequently done when addicts are prescribed pain meds- pill counts, urines, etc.)) then somewhere in the middle you have depressants with benzos being a little more risky to me than alcohol (I think it would be hard for me to become physically dependent on alcohol just due to the negative sides) then on the other end you have stimulants. I saw my psychopharmacologist and I am prescribed adderall for ADHD; I also talked to him about anxiety from using fentanyl last spring (I feel like even on suboxone I am having some level of PAWS due to how extreme the tolerance, agonist, etc was- when I said to him it had been fentanyl instead of the normal H he cringed like someone who had seen something painful). But even though we are well aware of my past addiction we feel amphetamines are very low to no risk- my family (wife, parents, etc.) actually have to fight with me to take them b/c while they do help me focus and accomplish things I don't really like the effects of stimulants unless they are part of a speedball. They simply make me more nervous, and my doctor said rarely does he see opioid addicts have problems with stimulants.

 

[Burnt Offerings]

In regards to people with real chronic pain (like from cancer, lets say), the idea that they can stop the medication makes a lot of sense, because their already in a deficit of pain...pain killers just brings them up to a normal level.

people with severe pain: -3 without painkillers, 0 with painkillers
people without pain (before addiction): 0 without painkillers, +3 with painkillers

 

[mysafehome01]

Several trips to the er over a yearly period and 30+ high strength injections of Morphine pretty much changed my life. The absolute feeling of pure bliss even while my arm was hanging out of its socket was something I've only felt close to with MDMA.


ever since that moment I've seeked out painkillers in the Opiate/ Opioid regions, always chasing that feeling of total content.

Now I have to settle with Codeine/ Dihydrocodeine and Tramadol. I dread to think (althugh it's highly unlikely) I'll ever get to try the 'real' stuff again outside of a medical setting.

It's a cray world, and sometimes that release is just too overwhelming.

 

[Speed King]

JM357,You've put together a great thread. Very impressive. I agree 100%. I'm going to just highlight the stigma attached and mind set in general. If coffee was illegal, how many people would be labelled addicts with disorders? Making people feel bad about what they are doing or what they are using is a form of condemnation . The condemnation can lead to a form of self inflicted punishment, including addiction. That being said, there are many other reasons for addiction. Mindset is a big part of both sides of the equation. The people getting pain treatment, are usually under a doctors care, not violating some form of man made law, usually do not have people or society telling them, they a wrong. There is a pattern here. This is a real deep post, that I hope to contribute more to it.

 

[belfort]

When I first used I felt like I took something that was missing all along. I wouldn't be surprised at all if the people susceptible to addiction have lower levels of dopamine or something like that

This is what I am leaning toward as well..when I first took opiod, I felt 'normal' and many addicts say the same thing..I didn't even notice euphoria, I just felt in tune ..it's hard for me to explain but many addicts know what I'm talking about..also, I do believe that addicts have a broken hedonic center, aka please center to begin with..they basically need drugs to feel any pleasure...neuro scientist James Fallon goes into depth on this ..Google james Fallon YouTube...

 

[belfort]

Several trips to the er over a yearly period and 30+ high strength injections of Morphine pretty much changed my life. The absolute feeling of pure bliss even while my arm was hanging out of its socket was something I've only felt close to with MDMA.


ever since that moment I've seeked out painkillers in the Opiate/ Opioid regions, always chasing that feeling of total content.

Now I have to settle with Codeine/ Dihydrocodeine and Tramadol. I dread to think (althugh it's highly unlikely) I'll ever get to try the 'real' stuff again outside of a medical setting.

It's a cray world, and sometimes that release is just too overwhelming.

Same here, opiates make me feel 100% content but what I don't understand is none of my immediate family members get any sort of contentment or fulfillment from opiates..in fact, they say opiates make them feel irritable, tired etc etc..this is what is strange..

 

[crzydiamond]

I think it's almost like when you talk about benzos. Those who need them (who have anxiety issues) say that taking them is more a "relief" than a high. That they feel good because it "fixes" the anxiety issue. Which is probably due to something in the brain chemistry that is out of whack

That is also how i see opiates. For me, like I said and as another poster also agreed with, from the first use I felt like I had taken something that was missing.

I don't like benzos; they don't do anything for me. Lots of people do like them because they feel better on them. Same with opiates--some people don't like them. Some people find nothing enjoyable in them. Others, like myself, feel more normal once they take them.

I'm currently on methadone, and have been at other times in my life. I have also had a long period (close to 9 years) completely clean. I actually feel more myself on the methadone. I don't like how it slows my metabolism though. But I am less hyper, able to relax, I used to feel uncomfortable sitting, always had to crack my back and such, would feel restless mentally and physically. Methadone I'm more like an average person.

I would find it interesting to see what they could do with dopamine therapy or something?

 

[Picnic_Johnson]

I have suffered from dysthymia since my early teens. Which is a constant low grade depression, lasting more than a year, twenty so far in my case. I didn't know what feeling normal was like until I discovered various opioids. I think pre existing mental illness is a huge factor to consider.

There was study done, don't know where I read it, about Heroin addiction in Vietnam. The sum of the study was that a majority of the soldiers , upon reintegrating with their families / lives were able to put it down with little withdrawal and cravings.

It depends on what you have going on in your head.

I've been in rehabs where I noticed the younger drug naive peeps would be able to eat, sleep, laugh and have a great time within just a few days of initial withdrawal, where the older, really fucking dope sick bunch would still be sick as hell for two weeks or longer - never ending PAWS.

O. addiction is very subjective

 

[burn out]

No, I know that. But I guess I'm not so much saying that someone has some other previously identified illness such as depression, anxiety, bipolar, etc. because a lot of people have those illnesses but do not become addicts even when exposed to addictive substances (I'm pretty sure they do believe that those diseases increase the risk of addiction). I guess I'm thinking maybe there is a more specific disease of addiction (for lack of a better term) that is already present. And I feel like that this has been suggested before too, but it seems like the more common thought in the current day is other illnesses and past trauma may increase the risks of addiction and then once you use your brain chemistry changes and you become an addict. Yet, I've also heard, in regards to pain patients, that if the disease causing the pain is cured (say cancer- that is probably the disease with the heaviest opioid prescribing and is in a class of its own (like you have chronic non-cancer pain and chronic cancer related pain), most people (while they will be physically dependent and go through withdrawal symptoms or have to have their dose slowly lowered) are then able to stop using pain medication.

I guess I'm not talking about anything new, but how specific is the disease of addiction if it is present beforehand? Is it simply other illnesses causing a higher risk or has it already decided before they use the first time wither or not they are an addict?

Is it even important? I think it could be because it would probably change the way you treat the disease in some instances. Also, if the drugs themselves do turn people into addicts then that is probably justification for being more careful in the sense of exposing people (I still wouldn't believe in the drug war it doesn't help anything) but if they don't does that mean it is safer to prescribe addictive drugs to non-addicts (and maybe even addicts if the drugs aren't specifically causing their illness and they need them; but I guess I do support the prescribing of drugs to treat addiction (as a form of harm reduction) as well) than is currently though.

My opinion: a lot of factors contribute to what causes some people to get addicted to drugs and others not. The reductionist approach misses the bigger picture. People have always wanted to pin it down to one thing, like the AA idea that alcoholics are just born alcoholics and cannot drink like normal people. Experience will prove this false. Plenty of people drink like normal people (whatever that means, since "normal" people are far from immune to drinking in excess) and then after having trauma in their life, like a divorce or serious illness, they will become alcoholic. This is because how much you drink or use drugs depends not on just your brain chemistry or your genetics, but also on your environment, your social status, your beliefs, your conditioning, etc. In short, people have relationships with substances just like they have relationships with other people. You wouldn't say this person always gets into co-dependent relationships because they have the co-dependent relationship gene, so why are you tempted to say something like that about someone's relationship with a substance?

 

[Wants2Nod]

When I first used I felt like I took something that was missing all along. I wouldn't be surprised at all if the people susceptible to addiction have lower levels of dopamine or something like that

This is it, for me. It's something unique about our brain chemistry.

It's not just the euphoria, it's the persistent mood lift, too. It took me a few years to figure that out. The older I've gotten, I've found that I don't even care about being 'intoxicated' anymore, I just want the euphoria and mood lift of opiods. In and out of habits when I was younger, I was put on several different antidepressents, treated for anxiety with benzos and beta blockers, and none of them, even when I tried to hang in there with them for the long term, did anything positive for me.

The first time I dabbled with pain pills as a young teenager was the first time I felt actually 'right'. I remember the intense euphoria from a single percocet or vicodin. The first time I injected dope, I literally felt perfect.

This is why I've been using opiods for 20+ years. When I was younger, the more intoxicated I became the more euphoric I felt, so I'd push the envelope. Now, I like feeling the mood boost and mild euphoria of kratom, which isn't intoxicating to me at all (unless combined with other stuff - which I occasionally do in moderation; ie kratom and a few beers).