On average, 44 people in the United States die every day from an overdose of opioid prescription painkillers. These drugs — such as Vicodin, Percocet, codeine, and morphine — reduce the brain’s recognition of pain by binding to certain receptors in the body. With continued use, a person can develop a physical dependence on these drugs, such that withdrawal symptoms occur if the drug is stopped. These drugs can also cause a “high.” Both of these effects contribute to addiction — that is, the loss of control around the use of a drug, even though it causes harm to the person. Addiction to opioid painkillers is the biggest risk factor for heroin addiction.
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Substance use disorders affect millions of Americans, and overdose is now the leading cause of accidental death in the United States. The need for treatment and recovery services has never been greater. This increasing demand has led to rapid growth in the number of detox and treatment service providers, which has burgeoned into a $35 billion a year industry. Most of these service providers work hard to provide honest, quality care to save lives.
As we watch the devastation of the opioid crisis escalate in a rising tide of deaths, a lesser known substance is frequently mentioned: fentanyl. Fentanyl’s relative obscurity was shattered with the well-publicized overdose death of pop star Prince. Previously used only as a pharmaceutical painkiller for crippling pain at the end of life or for surgical procedures, fentanyl is now making headlines as the drug responsible for a growing proportion of overdose deaths.
So what is fentanyl and why is it so dangerous?
Fentanyl is a synthetic opioid, meaning it is made in a laboratory but acts on the same receptors in the brain that painkillers, like oxycodone or morphine, and heroin, do. Fentanyl, however, is far more powerful. It’s 50-100 times stronger than heroin or morphine, meaning even a small dosage can be deadly.
There are many good reasons to emphasize the biological underpinnings of substance use disorders. Perhaps most important, the biologic basis of this chronic disease is a strong argument for parity: that is, treating (and funding treatment for) addiction on par with other “biologic” diseases.
The stigma and shame of addiction has much to do with the perception that people with substance use disorders are weak, immoral, or simply out for a good time at society’s expense. Understanding that addiction impairs the brain in many important ways may reduce such stigma. What’s more, the specific type of brain dysfunction may help identify a range of effective interventions and preventions. For example, during adolescence, the brain is at its most plastic — and vulnerable. This is a time when caution and intervention may prove most valuable. The earlier the drug exposure or trauma to the brain, the greater the damage.