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

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in Ancient Egyptian medical texts.

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Across the Mediterranean, 
the ancient Minoans

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

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Both ancient civilizations 
were on to something—

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opium, 
an extract of the poppy in question,

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can both induce pleasure 
and reduce pain.

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Though opium has remained 
in use ever since,

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

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morphine, was identified 
and isolated for medical use.

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Morphine, codeine, and other substances 
made directly from the poppy

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are called opiates.

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

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similar to these opiates,

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including heroin, hydrocodone, 
oxycodone, and fentanyl.

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Whether synthetic or derived from opium,

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these compounds 
are collectively known as opioids.

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Synthetic or natural, legal or illicit, 
opioid drugs

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are very effective painkillers,
but they are also highly addictive.

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In the 1980s and 90s,

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pharmaceutical companies began 
to market opioid painkillers aggressively,

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actively downplaying 
their addictive potential

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to both the medical community 
and the public.

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The number of opioid painkillers 
prescriptions skyrocketed,

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

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To understand why opioids 
are so addictive,

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

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

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Each of these drugs 
has slightly different chemistry,

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

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

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and opioid drugs bind 
much more strongly, for longer.

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

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

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With these functions, too, 
opioids’ binding strength and durability

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mean their effects 
are more pronounced and widespread

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than those of the body’s 
natural signaling molecules.

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

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which is linked to feelings of pleasure 
and may be responsible

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for the sense of euphoria 
that characterizes an opioid high.

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At the same time, opioids suppress 
the release of noradrenaline,

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which influences wakefulness, breathing, 
digestion, and blood pressure.

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A therapeutic dose decreases noradrenaline
enough to cause side effects

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like constipation.

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

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causing loss of consciousness 
and even death.

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

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It may decrease its number 
of opioid receptors,

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or the receptors may become 
less responsive.

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

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people have to take 
larger and larger doses—

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a cycle that leads to physical dependence 
and addiction.

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As people take more opioids 
to compensate for tolerance,

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noradrenaline levels 
become lower and lower,

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to a point that could impact 
basic bodily functions.

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The body compensates by increasing 
its number of noradrenaline receptors

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so it can detect much smaller amounts 
of noradrenaline.

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This increased sensitivity 
to noradrenaline

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allows the body 
to continue functioning normally—

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

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

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that balance is disrupted.

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

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But the body takes much longer 
to get rid of

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all the extra noradrenaline receptors 
it made.

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That means there’s a period of time

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when the body is too sensitive 
to noradrenaline.

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This oversensitivity causes 
withdrawal symptoms,

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including muscle aches, stomach pains, 
fever, and vomiting.

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Though temporary, opioid withdrawal 
can be incredibly debilitating.

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In serious cases, someone in withdrawal 
can be violently ill

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for days or even weeks.

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

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to get high anymore, 
but rather to avoid being sick.

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Many risk losing wages or even jobs 
while in withdrawal,

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

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If someone goes back 
to using opioids later,

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they can be at particularly high risk 
for overdose,

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

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can now be lethal.

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Since 1980, accidental deaths 
from opioid overdose

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have grown exponentially 
in the United States,

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and opioid addictions have 
also exploded around the world.

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While opioid painkiller prescriptions 
are becoming more closely regulated,

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cases of overdose and addiction 
are still increasing,

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especially among younger people.

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Many of the early cases of addiction 
were middle-aged people

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who became addicted to painkillers 
they had been prescribed,

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or received from friends 
and family members with prescriptions.

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

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

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and easier to come by.

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Beyond tighter regulation 
of opioid painkillers,

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

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

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

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It blocks other opioids 
from binding to the receptors,

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

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Opioid addiction 
is rarely a stand-alone illness;

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frequently, people with opioid dependence 
are also struggling

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with a mental health condition.

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There are both inpatient 
and outpatient programs that combine

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medication, health services, 
and psychotherapy.

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But many of these programs 
are very expensive,

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and the more affordable options 
can have long waiting lists.

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They also often require complete 
detoxification from opioids

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before beginning treatment.

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

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

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Opioid maintenance programs aim 
to address some of these obstacles

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and eliminate opioid abuse 
using a combination

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of medication and behavior therapy.

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These programs avoid withdrawal symptoms 
with drugs

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

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of painkillers, heroin, 
and other commonly abused opioids.

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Methadone and buprenorphine

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are the primary opioid maintenance 
drugs available today,

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but doctors need a special waiver 
to prescribe them—

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even though no specific training 
or certification

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is required to prescribe 
opioid painkillers.

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Buprenorphine can be so scarce

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

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

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

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

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the Department of Health 
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 
substance abuse facilities in the US:

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www.hhs.gov/opioids