Why is Opiate Addiction so Difficult to Quit?

America is in the midst of an opioid epidemic that has affected communities throughout the nation without regard to racial or socio-economic status. Opioid overdose deaths have skyrocketed in the last several years and our state and federal governments have begun to treat the opioid epidemic as a public health concern, focusing on treatment rather than criminalization and incarceration.

However, opiate addiction is extremely difficult to treat because opiates hijack the brain’s pleasure center, changing the structure of the brain, and creating a life-or-death need for the drug. Without the use of Medication-Assisted Treatment (MAT), an overwhelming majority of opiate addicts will relapse and a significant number of those folks will overdose and some will die.

Opiates Hijack the Brain’s Pleasure Center Creating a Powerful Addiction

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Opiates activate opioid receptors in the brain’s pleasure center that regulate pain, reward, and pleasure. When activated these receptor cells release the neurotransmitter dopamine creating an intense sense of pleasure (“Effects of Specific Drugs on the Brain – Heroin,” National Institute on Drug Abuse (NIH), http://www.drugabuse.gov/publications/research-reports/heroin).

According to Dr. Seddon Savage, an addiction and pain specialist at Dartmouth College, the brain’s pleasure center, the limbic system, connects areas of the brain that control emotions “such as pleasure of eating, drinking, and sex” (“Anatomy of Addiction: How Heroin and Opioids Hijack the Brain, Rodolico, Jack,  http://www.npr.org/sections/health-shots/2016/01/11/462390288/anatomy-of-addiction-how-heroin-and-opioids-hijack-the-brain, January 11, 2016). The limbic system “is a very ancient part of the human brain that’s necessary for survival,” says Dr. Savage, and opiate addiction hijacks it into believing the drug is needed for survival (Id.). Furthermore, long-term opiate use can actually cause physical changes in the “structure and physiology of the brain” creating neurological imbalances that are difficult to reverse (Id.).  Opiate addicts will go to any length to secure the drug because the limbic system becomes hardwired to seek opiates for survival.

Opiate Treatment in the United States is Highly Ineffective – Only Works for 10% of Addicts

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Stripped of his or her will to say no to opiates because taking the drug is a matter of life or death, the addict requires medication and counseling as the most effective form of opiate addiction treatment according to the medical establishment (“Dying to be Free,” Cherkis, Jason,http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment?utm_source=scoopinion). However, most addiction treatment in the U.S. stubbornly adheres to the outdated 12-step model and eschews fact-based, scientific treatment practices.

One-size-fits-all is the dominant model in addiction treatment in the U.S. despite the obvious differences among different addictions. Heroin is treated the same as alcohol and methamphetamine the same as marijuana because addiction treatment is largely unregulated and the 12-step one-size-fits-all model is the most cost effective.

In fact, the abstinence model that may work for alcoholics “only works in under 10 percent of opiate addicts,” according to Dr. Mary Jeanne Kreek, head of the Laboratory of the Biology of Addictive Diseases at Rockefeller University in New York City.

U.S. Could be Years Away from Addiction Treatment Reform

Given the powerful nature of opiate addiction, with its record levels of overdose deaths across the country, government at all levels has begun to pay attention to the problem. And, some inpatient treatment centers have recognized the efficacy of MATs and changed long-standing policy.

However, it may be years before adequate opiate treatment is available for most addicts because current abstinence-based 12-step treatment programs are deeply entrenched and stand to lose billions of dollars in treatment revenue.

Moreover, if the Affordable Care Act is repealed, there is no indication whether addiction treatment will be covered by insurance companies. The next few years will determine the direction the U.S. takes in dealing with the opiate epidemic. Opiate addicts could be facing a catch-22: get ineffective treatment now or no treatment in a year or two.

 

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