WEBVTT

00:00:07.293 --> 00:00:12.090
More than 3,000 years ago, 
a flower began to appear in remedies

00:00:12.090 --> 00:00:15.200
in Ancient Egyptian medical texts.

00:00:15.200 --> 00:00:17.780
Across the Mediterranean, 
the ancient Minoans

00:00:17.780 --> 00:00:21.930
likely found ways to use 
the same plant for its high.

00:00:21.930 --> 00:00:24.870
Both ancient civilizations 
were on to something—

00:00:24.870 --> 00:00:28.370
opium, 
an extract of the poppy in question,

00:00:28.370 --> 00:00:32.240
can both induce pleasure 
and reduce pain.

NOTE Paragraph

00:00:32.240 --> 00:00:35.078
Though opium has remained 
in use ever since,

00:00:35.078 --> 00:00:39.293
it wasn’t until the 19th century 
that one of its chemical compounds,

00:00:39.293 --> 00:00:44.083
morphine, was identified 
and isolated for medical use.

00:00:44.083 --> 00:00:48.300
Morphine, codeine, and other substances 
made directly from the poppy

00:00:48.300 --> 00:00:50.185
are called opiates.

00:00:50.185 --> 00:00:55.386
In the 20th century, drug companies 
created a slew of synthetic substances

00:00:55.386 --> 00:00:57.126
similar to these opiates,

00:00:57.126 --> 00:01:02.060
including heroin, hydrocodone, 
oxycodone, and fentanyl.

00:01:02.060 --> 00:01:04.820
Whether synthetic or derived from opium,

00:01:04.820 --> 00:01:08.581
these compounds 
are collectively known as opioids.

00:01:08.581 --> 00:01:12.911
Synthetic or natural, legal or illicit, 
opioid drugs

00:01:12.911 --> 00:01:17.548
are very effective painkillers,
but they are also highly addictive.

00:01:17.548 --> 00:01:19.548
In the 1980s and 90s,

00:01:19.548 --> 00:01:24.711
pharmaceutical companies began 
to market opioid painkillers aggressively,

00:01:24.711 --> 00:01:27.406
actively downplaying 
their addictive potential

00:01:27.406 --> 00:01:30.311
to both the medical community 
and the public.

00:01:30.311 --> 00:01:34.101
The number of opioid painkillers 
prescriptions skyrocketed,

00:01:34.101 --> 00:01:40.243
and so did cases of opioid addiction, 
beginning a crisis that continues today.

NOTE Paragraph

00:01:40.243 --> 00:01:43.223
To understand why opioids 
are so addictive,

00:01:43.223 --> 00:01:48.048
it helps to trace how these drugs affect 
the human body from the first dose,

00:01:48.048 --> 00:01:53.111
through repeated use, 
to what happens when long-term use stops.

NOTE Paragraph

00:01:53.111 --> 00:01:55.911
Each of these drugs 
has slightly different chemistry,

00:01:55.911 --> 00:02:02.824
but all act on the body’s opioid system by
binding to opioid receptors in the brain.

00:02:02.824 --> 00:02:07.645
The body’s endorphins temper pain signals 
by binding to these receptors,

00:02:07.645 --> 00:02:12.226
and opioid drugs bind 
much more strongly, for longer.

00:02:12.226 --> 00:02:17.478
So opioid drugs can manage much more 
severe pain than endorphins can.

NOTE Paragraph

00:02:17.478 --> 00:02:22.940
Opioid receptors also influence everything
from mood to normal bodily functions.

00:02:22.940 --> 00:02:27.050
With these functions, too, 
opioids’ binding strength and durability

00:02:27.050 --> 00:02:30.250
mean their effects 
are more pronounced and widespread

00:02:30.250 --> 00:02:34.070
than those of the body’s 
natural signaling molecules.

NOTE Paragraph

00:02:34.070 --> 00:02:38.825
When a drug binds to opioid receptors, 
it triggers the release of dopamine,

00:02:38.825 --> 00:02:42.265
which is linked to feelings of pleasure 
and may be responsible

00:02:42.265 --> 00:02:46.630
for the sense of euphoria 
that characterizes an opioid high.

00:02:46.630 --> 00:02:50.745
At the same time, opioids suppress 
the release of noradrenaline,

00:02:50.745 --> 00:02:56.590
which influences wakefulness, breathing, 
digestion, and blood pressure.

00:02:56.590 --> 00:03:00.920
A therapeutic dose decreases noradrenaline
enough to cause side effects

00:03:00.920 --> 00:03:03.366
like constipation.

00:03:03.366 --> 00:03:09.184
At higher doses opioids can decrease heart
and breathing rates to dangerous levels,

00:03:09.184 --> 00:03:11.964
causing loss of consciousness 
and even death.

NOTE Paragraph

00:03:13.684 --> 00:03:18.038
Over time, the body starts 
to develop a tolerance for opioids.

00:03:18.038 --> 00:03:21.167
It may decrease its number 
of opioid receptors,

00:03:21.167 --> 00:03:24.103
or the receptors may become 
less responsive.

00:03:24.103 --> 00:03:29.031
To experience the same release of dopamine
and resulting mood effects as before,

00:03:29.031 --> 00:03:32.381
people have to take 
larger and larger doses—

00:03:32.381 --> 00:03:36.143
a cycle that leads to physical dependence 
and addiction.

NOTE Paragraph

00:03:36.143 --> 00:03:39.663
As people take more opioids 
to compensate for tolerance,

00:03:39.663 --> 00:03:42.763
noradrenaline levels 
become lower and lower,

00:03:42.763 --> 00:03:46.303
to a point that could impact 
basic bodily functions.

00:03:46.303 --> 00:03:50.844
The body compensates by increasing 
its number of noradrenaline receptors

00:03:50.844 --> 00:03:54.604
so it can detect much smaller amounts 
of noradrenaline.

00:03:54.604 --> 00:03:57.213
This increased sensitivity 
to noradrenaline

00:03:57.213 --> 00:04:00.283
allows the body 
to continue functioning normally—

00:04:00.283 --> 00:04:05.289
in fact, it becomes dependent on opioids 
to maintain the new balance.

NOTE Paragraph

00:04:05.289 --> 00:04:10.454
When someone who is physically dependent 
on opioids stops taking them abruptly,

00:04:10.454 --> 00:04:12.524
that balance is disrupted.

00:04:12.524 --> 00:04:17.258
Noradrenaline levels can increase 
within a day of ceasing opioid use.

00:04:17.258 --> 00:04:19.531
But the body takes much longer 
to get rid of

00:04:19.531 --> 00:04:22.928
all the extra noradrenaline receptors 
it made.

00:04:22.928 --> 00:04:24.848
That means there’s a period of time

00:04:24.848 --> 00:04:28.078
when the body is too sensitive 
to noradrenaline.

00:04:28.078 --> 00:04:31.338
This oversensitivity causes 
withdrawal symptoms,

00:04:31.338 --> 00:04:35.368
including muscle aches, stomach pains, 
fever, and vomiting.

NOTE Paragraph

00:04:35.368 --> 00:04:39.999
Though temporary, opioid withdrawal 
can be incredibly debilitating.

00:04:39.999 --> 00:04:43.799
In serious cases, someone in withdrawal 
can be violently ill

00:04:43.799 --> 00:04:46.688
for days or even weeks.

00:04:46.688 --> 00:04:50.358
People who are addicted to opioids 
aren't necessarily using the drugs

00:04:50.358 --> 00:04:54.328
to get high anymore, 
but rather to avoid being sick.

00:04:54.328 --> 00:04:58.148
Many risk losing wages or even jobs 
while in withdrawal,

00:04:58.148 --> 00:05:02.208
or may not have anyone to take care 
of them during withdrawal.

00:05:02.208 --> 00:05:05.123
If someone goes back 
to using opioids later,

00:05:05.123 --> 00:05:08.258
they can be at particularly high risk 
for overdose,

00:05:08.258 --> 00:05:12.258
because what would have been a standard 
dose while their tolerance was high,

00:05:12.258 --> 00:05:14.448
can now be lethal.

NOTE Paragraph

00:05:14.448 --> 00:05:18.368
Since 1980, accidental deaths 
from opioid overdose

00:05:18.368 --> 00:05:21.388
have grown exponentially 
in the United States,

00:05:21.388 --> 00:05:25.368
and opioid addictions have 
also exploded around the world.

00:05:25.368 --> 00:05:29.529
While opioid painkiller prescriptions 
are becoming more closely regulated,

00:05:29.529 --> 00:05:32.899
cases of overdose and addiction 
are still increasing,

00:05:32.899 --> 00:05:35.639
especially among younger people.

00:05:35.639 --> 00:05:38.724
Many of the early cases of addiction 
were middle-aged people

00:05:38.724 --> 00:05:42.209
who became addicted to painkillers 
they had been prescribed,

00:05:42.209 --> 00:05:45.619
or received from friends 
and family members with prescriptions.

00:05:45.619 --> 00:05:50.997
Today, young people are often introduced 
to prescription opioid drugs in those ways

00:05:50.997 --> 00:05:55.884
but move on to heroin or illicit 
synthetic opioids that are cheaper

00:05:55.884 --> 00:05:58.094
and easier to come by.

00:05:58.094 --> 00:06:00.949
Beyond tighter regulation 
of opioid painkillers,

00:06:00.949 --> 00:06:05.540
what can we do to reverse the growing 
rates of addiction and overdose?

NOTE Paragraph

00:06:05.540 --> 00:06:10.425
A drug called naloxone is currently 
our best defense against overdose.

00:06:10.425 --> 00:06:15.101
Naloxone binds to opioid receptors 
but doesn’t activate them.

00:06:15.101 --> 00:06:18.151
It blocks other opioids 
from binding to the receptors,

00:06:18.151 --> 00:06:22.839
and even knocks them off the receptors 
to reverse an overdose.

00:06:22.839 --> 00:06:26.109
Opioid addiction 
is rarely a stand-alone illness;

00:06:26.109 --> 00:06:29.246
frequently, people with opioid dependence 
are also struggling

00:06:29.246 --> 00:06:30.936
with a mental health condition.

00:06:30.936 --> 00:06:34.409
There are both inpatient 
and outpatient programs that combine

00:06:34.409 --> 00:06:38.266
medication, health services, 
and psychotherapy.

NOTE Paragraph

00:06:38.266 --> 00:06:41.026
But many of these programs 
are very expensive,

00:06:41.026 --> 00:06:44.277
and the more affordable options 
can have long waiting lists.

00:06:44.277 --> 00:06:48.667
They also often require complete 
detoxification from opioids

00:06:48.667 --> 00:06:50.927
before beginning treatment.

00:06:50.927 --> 00:06:55.167
Both the withdrawal period and the common 
months-long stay in a facility

00:06:55.167 --> 00:07:00.752
can be impossible for people who risk 
losing jobs and housing in that timeframe.

NOTE Paragraph

00:07:00.752 --> 00:07:04.732
Opioid maintenance programs aim 
to address some of these obstacles

00:07:04.732 --> 00:07:08.022
and eliminate opioid abuse 
using a combination

00:07:08.022 --> 00:07:10.987
of medication and behavior therapy.

00:07:10.987 --> 00:07:14.257
These programs avoid withdrawal symptoms 
with drugs

00:07:14.257 --> 00:07:18.407
that bind to opioid receptors 
but don’t have the psychoactive effects

00:07:18.407 --> 00:07:23.552
of painkillers, heroin, 
and other commonly abused opioids.

00:07:23.552 --> 00:07:25.532
Methadone and buprenorphine

00:07:25.532 --> 00:07:29.101
are the primary opioid maintenance 
drugs available today,

00:07:29.101 --> 00:07:32.161
but doctors need a special waiver 
to prescribe them—

00:07:32.161 --> 00:07:34.911
even though no specific training 
or certification

00:07:34.911 --> 00:07:38.001
is required to prescribe 
opioid painkillers.

00:07:38.001 --> 00:07:40.201
Buprenorphine can be so scarce

00:07:40.201 --> 00:07:43.481
that there’s even 
a growing black market for it.

NOTE Paragraph

00:07:43.481 --> 00:07:46.621
There’s still a long way to go 
with combating opioid addiction,

00:07:46.621 --> 00:07:50.581
but there are great resources 
for making sense of the treatment options.

00:07:50.581 --> 00:07:55.040
If you or someone you know is struggling 
with opioid use in the United States,

00:07:55.040 --> 00:07:57.490
the Department of Health 
and Human Services

00:07:57.490 --> 00:08:02.446
operates a helpline: 800-662-4357

00:08:02.446 --> 00:08:07.596
and a database of more than 14,000 
substance abuse facilities in the US:

00:08:07.596 --> 00:08:12.476
www.hhs.gov/opioids