Cross-section of a brain on a pale blue background. Opioids and the brain

Opioids & the Brain: All You Need To Know

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This is Your Brain on Opioids

Part 1: A Frying Pan of Reward and Pleasure

In the late eighties, the Partnership for a Drug-Free America released its now-iconic series of public service announcements featuring the infamous “This is your brain on drugs” tag line. The basics of the spots were this: an egg is your brain, a hot frying pan represents drugs. Someone cracks the egg into the frying pan. It, well, fries. “Any questions?” a man asks.

Yes. In fact, tons of them, especially since the addiction landscape has changed so much in the last two decades. Still, it was a good start and the heart of the message remains true: simply put, drugs alter your brain. Obviously it’s a little more complicated than the ads implied, and as the opioid epidemic grows and treatment modalities evolve, it’s more important than ever to understand what, exactly, opioids do to our brains–and the long-term effects of opioid use.

Turns out, it’s all about neurotransmitters, which is incredibly helpful unless you fell asleep in science class and don’t remember what a neurotransmitter is. Really a neurotransmitter is just a chemical that controls communication in your brain. Your brain releases neurotransmitters from a nerve cell and transfers it to another nerve cell and so on, sort of like a brain game of telephone except the message remains the same. All of our basic functions require neurotransmitters to do their jobs, as nerve cells communicate with one another and share information.

“Your brain releases neurotransmitters from a nerve cell and transfers it to another nerve cell and so on, sort of like a brain game of telephone except the message remains the same.”

In fact, you’re probably at least familiar with the names of two of our neurotransmitters: serotonin and dopamine. The first helps control important functions like mood, sleep, and appetite. That’s why a lot of antidepressants are designed to increase our serotonin levels. Dopamine is also linked to how we think and feel, as well as to our brain’s pleasure and reward centers.

In our systems, we also have neurotransmitters that are called endogenous opioids, which just means opioids that our body produces internally. You’ve probably heard of endorphins, especially in reference to exercise or a runner’s “high.” (Here’s an interesting fact: the term endorphins actually comes from “endogenous morphine.)

These neurotransmitters are our natural stress and pain fighters, but our bodies can’t produce enough of these organic opioids to save us from feeling severe or chronic pain or from suffering from extreme stress. Which is where taking opioids comes in. Opioids basically act like those naturally-occurring neurotransmitters but in much larger quantities. They attach to your brain’s natural opioid receptors and go to town. Opioids flood the brain’s reward and pleasure systems, signaling our brains to block out the pain, lower our stress, and calm us down.

“Opioids flood the brain’s reward and pleasure systems, signaling our brains to block out the pain, lower our stress, and calm us down.”

Over time, adding these opioids –whether in the form of heroin or morphine or codeine– actually alters our brain chemistry. According to the Journal of Neuroscience, “the repeated use of opiates induces alterations in neurotransmitter and neuropeptide systems that regulate incentive–motivation and stress–responsiveness. Increasing evidence indicates that the dysregulation of these systems underlies the compulsive use and loss of control of drug-taking that characterizes opiate and other addictions.” Got that?

Just in case that wasn’t clear, here’s the bottom line: repeated opioid use changes our brains at the cellular level. Once altered, our brains literally respond differently to stress and pain. We need more. Our natural opioids aren’t nearly enough. Long-term opioid use also alters the way our brains respond chemically to triggers. We can be triggered to use simply by being around the people, places and/or objects associated with our drug use. So it’s not a matter of willpower or character weakness that we’re triggered when we get around old haunts–it’s an actual alteration in our brains as a result of sustained opioid use.

It’s all pretty daunting, but the good news is that just as opioids have changed our brains, we have the ability to heal them. And that’s what we’ll explore next.

Your Brain on Opioids, Part 2: Walking on the Wild Side With Neuropathways

Opioids change the brain, but the good news? Your brain can heal.

Now that we’ve taken a look at how opioids affect the brain in the long run, let’s focus a bit on the good news–we have the ability to help our brains heal and to develop new healthy, habits. It’s time to talk neuroplasticity.

While we might associate the word “plastic” with hardness and durability, in the scientific sense it really means that something has the ability to flex and change. So when scientists talk about neuroplasticity, they’re talking about how much our brain remains changeable. It’s about the flexibility we have to develop new skills, acquire new knowledge, and create new habits. Neuroplasticity is how we learn to speak a new language or play a new instrument–and it’s also what recovery from opioids depends on.

“Neuroplasticity is how we learn to speak a new language or play a new instrument–and it’s also what recovery from opioids depends on. ”

It all comes down to neuropathways, or neural pathways. These are actual trails created in our brain over time by repetition and habit. When we roll out of bed and sleepwalk through our morning routine almost automatically, that’s thanks to the neuropathways we’ve created by doing the same thing every morning.

A common analogy is to think of neuropathways as actual walking paths or hiking trails. It’s easy to imagine how walking the same path over and over becomes so familiar that you can do it with hardly any conscious thought. When we abuse opioids over a period of time, through sustained use, we create a well-worn pathway in our brain so that it becomes almost an unconscious habit to use. Your brain knows this route. It knows the twists and turns. It’s easy to follow.

When we choose recovery, and we choose to do something other than using drugs, we are actually attempting to change our brain structure. Recovery requires us to create new neuropathways in our brain, but the cool thing is we can do it. Just as we changed our brain through the habit of addiction, we can help heal it through sustained and repeated healthy recovery habits. Which, frankly, is about as rad as it gets.

“Recovery requires us to create new neuropathways in our brain, but the cool thing is we can do it.”

Waking up each day and deciding not to use is a brand new way of doing things for your brain. To go back to the walking path analogy, you’re forging a brand new trail in the wilderness. The ground is rocky and uncertain, there are discouraging obstacles in the way, and everything is unfamiliar and uncomfortable.

In short, it’s hard. We’re rewiring our brains and it’s tough work. (Especially when our brains keep reminding us how much easier it would be just to fall back on that old neuropathway of addiction.) It takes time and practice to really form that new path, to make it clearer, more familiar, and less uncomfortable to navigate.

But if we stick with it–especially if we can just get through those first difficult days when our brain is frustrated and confused–it gets easier over time because those recovery neuropathways get stronger and deeper every time we choose not to use.

So how do we do it? How do we start to change our brains? Next time, we’ll take a look at some specific tips and tools that can help us heal our brains and create those neuropathways that can carry us away from opioid addiction and into a new, healthy way of living.

Ready to get building new neuropathways? Check out the next section of this series:

Your Brain on Opioids, Part 3: Yes, Your Brain Can Change

This blog has been reviewed for medical accuracy by Paul Leonard, MD.

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