I’ve written quite a bit about opioid addiction here. One of the main points I try to establish is that in order to effectively deal with this national epidemic, we must understand the problem and stop stigmatizing addiction. I’ve dealt with addiction in general since 1983 — opiate/opioid addiction is perhaps the most difficult to treat. The brain changes brought about by opioid addiction are difficult to overcome. This is an excerpt from an article published at NCBI, The Neurobiology of Opioid Dependence:
Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.
One reason the current problem with opioid addiction’s spiraling is that there’s a lack of quality treatment options. There are lots of doctors prescribing lots of medicine, but there’s very little long term treatment planning and delivery. Once the person dependent on opioids feels better by taking a medicine like Suboxone, they think they’re healed and can go on their way, but this is not the case. It takes a long time for the brain changes brought about by addiction to heal. Suboxone can give the person relief in order to treat the problem but Suboxone is not a panacea. If a person once physically, mentally and emotionally dependent on opioids is physically free of the opioid, it doesn’t mean they’re mentally and emotionally free. The mind can still crave the drug even after horrible experiences and many consequences. Obsession with a destructive drug is not rational, and herein lies the problem.
Those who don’t understand addiction apply rationality to the situation — if the drug is destructive, stop using it! Makes a lot of sense, right? To most people it does, and even to the person addicted it makes sense, and they’ll likely agree with the rational solution, even though they still crave the drug. Addiction is a medical condition that doesn’t always respond to rational solutions — I would say “never” but I’ll leave it open for other possibilities. You can compare it to a diabetic on a diet who breaks the diet even though it’s not rational. We can crave and indulge in things that are bad for us. Addiction to opioids and the craving for the drug is a very powerful craving, often overriding judgement, even after the opioid is out of the body.
To be free of the obsession and the emotional crutch of a drug like opioids, it takes time and help. Most people don’t get over the obsession by themselves. It takes a treatment plan and managed recovery. Once quality treatment’s readily available nationwide and standards of treatment are adopted based on best practices, maybe we can deal effectively with this problem and millions will know real freedom from opioid addiction.