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More than 3,000 years ago, [br]a flower began to appear in remedies

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in Ancient Egyptian medical texts.

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Across the Mediterranean, [br]the ancient Minoans

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likely found ways to use [br]the same plant for its high.

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Both ancient civilizations [br]were on to something—

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opium, [br]an extract of the poppy in question,

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can both induce pleasure [br]and reduce pain.

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Though opium has remained [br]in use ever since,

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it wasn’t until the 19th century [br]that one of its chemical compounds,

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morphine, was identified [br]and isolated for medical use.

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Morphine, codeine, and other substances [br]made directly from the poppy

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are called opiates.

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In the 20th century, drug companies [br]created a slew of synthetic substances

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similar to these opiates,

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including heroin, hydrocodone, [br]oxycodone, and fentanyl.

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Whether synthetic or derived from opium,

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these compounds [br]are collectively known as opioids.

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Synthetic or natural, legal or illicit, [br]opioid drugs

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are very effective painkillers,[br]but they are also highly addictive.

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In the 1980s and 90s,

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pharmaceutical companies began [br]to market opioid painkillers aggressively,

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actively downplaying [br]their addictive potential

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to both the medical community [br]and the public.

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The number of opioid painkillers [br]prescriptions skyrocketed,

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and so did cases of opioid addiction, [br]beginning a crisis that continues today.

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To understand why opioids [br]are so addictive,

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it helps to trace how these drugs affect [br]the human body from the first dose,

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through repeated use, [br]to what happens when long-term use stops.

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Each of these drugs [br]has slightly different chemistry,

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but all act on the body’s opioid system by[br]binding to opioid receptors in the brain.

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The body’s endorphins temper pain signals [br]by binding to these receptors,

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and opioid drugs bind [br]much more strongly, for longer.

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So opioid drugs can manage much more [br]severe pain than endorphins can.

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Opioid receptors also influence everything[br]from mood to normal bodily functions.

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With these functions, too, [br]opioids’ binding strength and durability

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mean their effects [br]are more pronounced and widespread

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than those of the body’s [br]natural signaling molecules.

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When a drug binds to opioid receptors, [br]it triggers the release of dopamine,

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which is linked to feelings of pleasure [br]and may be responsible

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for the sense of euphoria [br]that characterizes an opioid high.

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At the same time, opioids suppress [br]the release of noradrenaline,

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which influences wakefulness, breathing, [br]digestion, and blood pressure.

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A therapeutic dose decreases noradrenaline[br]enough to cause side effects

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like constipation.

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At higher doses opioids can decrease heart[br]and breathing rates to dangerous levels,

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causing loss of consciousness [br]and even death.

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Over time, the body starts [br]to develop a tolerance for opioids.

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It may decrease its number [br]of opioid receptors,

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or the receptors may become [br]less responsive.

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To experience the same release of dopamine[br]and resulting mood effects as before,

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people have to take [br]larger and larger doses—

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a cycle that leads to physical dependence [br]and addiction.

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As people take more opioids [br]to compensate for tolerance,

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noradrenaline levels [br]become lower and lower,

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to a point that could impact [br]basic bodily functions.

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The body compensates by increasing [br]its number of noradrenaline receptors

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so it can detect much smaller amounts [br]of noradrenaline.

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This increased sensitivity [br]to noradrenaline

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allows the body [br]to continue functioning normally—

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in fact, it becomes dependent on opioids [br]to maintain the new balance.

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When someone who is physically dependent [br]on opioids stops taking them abruptly,

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that balance is disrupted.

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Noradrenaline levels can increase [br]within a day of ceasing opioid use.

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But the body takes much longer [br]to get rid of

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all the extra noradrenaline receptors [br]it made.

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That means there’s a period of time

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when the body is too sensitive [br]to noradrenaline.

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This oversensitivity causes [br]withdrawal symptoms,

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including muscle aches, stomach pains, [br]fever, and vomiting.

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Though temporary, opioid withdrawal [br]can be incredibly debilitating.

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In serious cases, someone in withdrawal [br]can be violently ill

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for days or even weeks.

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People who are addicted to opioids [br]aren't necessarily using the drugs

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to get high anymore, [br]but rather to avoid being sick.

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Many risk losing wages or even jobs [br]while in withdrawal,

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or may not have anyone to take care [br]of them during withdrawal.

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If someone goes back [br]to using opioids later,

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they can be at particularly high risk [br]for overdose,

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because what would have been a standard [br]dose while their tolerance was high,

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can now be lethal.

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Since 1980, accidental deaths [br]from opioid overdose

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have grown exponentially [br]in the United States,

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and opioid addictions have [br]also exploded around the world.

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While opioid painkiller prescriptions [br]are becoming more closely regulated,

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cases of overdose and addiction [br]are still increasing,

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especially among younger people.

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Many of the early cases of addiction [br]were middle-aged people

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who became addicted to painkillers [br]they had been prescribed,

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or received from friends [br]and family members with prescriptions.

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Today, young people are often introduced [br]to prescription opioid drugs in those ways

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but move on to heroin or illicit [br]synthetic opioids that are cheaper

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and easier to come by.

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Beyond tighter regulation [br]of opioid painkillers,

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what can we do to reverse the growing [br]rates of addiction and overdose?

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A drug called naloxone is currently [br]our best defense against overdose.

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Naloxone binds to opioid receptors [br]but doesn’t activate them.

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It blocks other opioids [br]from binding to the receptors,

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and even knocks them off the receptors [br]to reverse an overdose.

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Opioid addiction [br]is rarely a stand-alone illness;

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frequently, people with opioid dependence [br]are also struggling

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with a mental health condition.

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There are both inpatient [br]and outpatient programs that combine

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medication, health services, [br]and psychotherapy.

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But many of these programs [br]are very expensive,

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and the more affordable options [br]can have long waiting lists.

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They also often require complete [br]detoxification from opioids

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before beginning treatment.

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Both the withdrawal period and the common [br]months-long stay in a facility

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can be impossible for people who risk [br]losing jobs and housing in that timeframe.

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Opioid maintenance programs aim [br]to address some of these obstacles

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and eliminate opioid abuse [br]using a combination

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of medication and behavior therapy.

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These programs avoid withdrawal symptoms [br]with drugs

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that bind to opioid receptors [br]but don’t have the psychoactive effects

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of painkillers, heroin, [br]and other commonly abused opioids.

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Methadone and buprenorphine

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are the primary opioid maintenance [br]drugs available today,

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but doctors need a special waiver [br]to prescribe them—

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even though no specific training [br]or certification

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is required to prescribe [br]opioid painkillers.

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Buprenorphine can be so scarce

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that there’s even [br]a growing black market for it.

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There’s still a long way to go [br]with combating opioid addiction,

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but there are great resources [br]for making sense of the treatment options.

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If you or someone you know is struggling [br]with opioid use in the United States,

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the Department of Health [br]and Human Services

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operates a helpline: 800-662-4357

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and a database of more than 14,000 [br]substance abuse facilities in the US:

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www.hhs.gov/opioids