The scenario is all too familiar. Your son or daughter experiences an injury and immediately, your parental instincts kick in. A Rolodex of their facial expressions firmly imprinted in your brain immediately spins to the card for pain and you act…quickly.
In strict accordance with parental best practices, you take them to the emergency room, where your loved one is seen by a well-meaning provider who, much like you, wants to rid your child of the pain that is evident by your child’s face and demeanor. The provider prescribes an opioid medication—like Oxycodone—to treat the pain and soon enough, your child is somewhat more comfortable and you are relieved.
Opioids are commonly prescribed for pain because they reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodone, oxycodone, morphine, codeine and related drugs.
For a growing number of young people who find themselves in this scenario, the seemingly routine interaction between patient and healthcare provider leads to a far greater challenge: drug addiction. Across the country, people spanning a wide range of ages and socioeconomic classes are unwittingly finding themselves hooked on opioids. And, if you bother to ask, many will describe how it all started with a seemingly benign prescription to treat their pain.
Risk of rewards
Because prescription opioids, much like heroin and morphine, act on brain systems that reward the user with euphoria, they can lead to abuse and addiction, particularly if they are used for non-medical purposes. They are most dangerous and addictive when taken in a manner that increases these euphoric effects, such as snorting or injecting the drug, or combining it with alcohol or other drugs such as benzodiazepines, drugs widely prescribed for insomnia and anxiety.
The underlying question asks why adolescents are at a greater risk of becoming addicted than any other group when exposed incidentally to prescription opioid medication? The answer can be found in the developing brain of the adolescent.
Science has already elucidated the many changes to the brain that occur in preparation for adulthood. Particularly relevant are the changes that occur within the brain’s reward pathway, the same pathway that is acted on by medications like oxycodone (OxyContin) in producing a sense of well-being and pleasure. Apparently, the reward pathway increases production of dopamine receptors until mid-adolescence, after which the number of receptors for dopamine naturally declines. It is worth noting that it is the neurochemical dopamine that induces the euphoric state associated with reward.
Dangers of re-exposure
Research conducted at Rockefeller University demonstrated that early exposure and/or abuse of OxyContin during this developmental period leads to a surplus of dopamine receptors in the brain. If this surplus remains when the adolescent is re-exposed to the drug later in life, the resulting “high” caused by the drug may be more addictive than would be the case in someone who had never tried the drug before.
One Rockefeller researcher put it another way, “…adolescents who abuse prescription painkillers may be tuning their brains to a lifelong battle with opiate addiction if they re-expose themselves to the drug as adults.”
The key here is re-exposure to the drug. While possible, it is rare that an isolated exposure to oxycodone as an adolescent would result in addiction. The “trap,” in this case, reflects the subpopulation of individuals for whom re-exposure occurs. Interestingly, the documentary “The Oxy Trap” describes how, for some users, that first OxyContin was the high that surpassed all others, better than marijuana, LSD, Ecstasy, cocaine, methamphetamine, mushrooms and anything else that they had tried. This was the proverbial “dragon” worth chasing, worth committing crimes for, worth destroying lives for.
It would seem that despite our best intentions as parents, traps exist all around us, seen and unseen, known and unknown, preventable and—in this case, once armed with the requisite knowledge to act—preventable.
By // Ravi N. Chandiramani, ND