Opioid Brain Changes &

Long-Term Treatment

 

Staff at Marina Medical in Normandy Park, WA, headed by Michael Brown, MD, have over a decade of experience caring for people throughout the greater Seattle-Tacoma area who have become dependent on or addicted to opiate drugs. Following is information about brain changes and treatment that many patients and their families find useful.

Can long-term opioid use cause significant changes to the brain?

 

Medical research has well described the brains of people who have used opioids over a prolonged period of time. Certain structural and functional changes are observed. Stated differently, certain “hard wiring” changes have taken place:  opioid receptors have actually increased both in number and in level of activity.

 

Think of Pacman. We are born with a certain number of these receptors which have been identified and named “mu”, “kappa”, and others.  Think Pacman. They are generally happy interacting with our own opioid-like molecules called endorphins which are naturally produced by the body.  Then one day – suddenly – opioid drugs or medications are taken. Our Pacmen are “overfed” and we feel “high”. If this happens only once in awhile, things quickly go back to normal as the body detoxifies the foreign opioid.  On the other hand, imagine it happens again, and again, and then continuously. Our Pacman guys can’t handle all of the opioid molecules, so they quickly recruit more of themselves. The Mu and kappa receptors become more numerous in response to the high levels of opioids with which they are interacting. They also become more active, more ‘hungry’ if you will. Part of our brain structure actually changes; this is what we call a “change in your hard wiring.” It is this change that makes it so difficult to stop opioids and, moreover, to stay stopped. In other words, the difficulty we experience in staying “clean” is not a character defect or a moral problem. It is a brain problem and needs to be recognized as such. Click here for more information on the neurobiology of opioid dependence.

 

Many addictionologists now feel that the high relapse rate of opioid use, in spite of various treatment programs, is because of this brain change. The greatly increased number of receptors (the Pacman guys) make life miserable until they die down naturally, which takes a long time and which may never return to a normal level. An untreated person with this condition will have reduced emotional reserves for dealing with stress. He or she may experience higher than normal levels of anxiety and fears of all kinds. These individuals simply seem unable to enjoy life or to feel normal. Meanwhile, in the back of their minds, they know that opioids would offer immediate – albeit temporary – relief. It is no wonder that relapse is always ready and waiting to happen.  For most people with addiction or dependency disorders, relapse is the rule, not the exception. Addiction is often called “a disease of relapse”. However, relapse on opioids is also dangerous for all the obvious reasons. Click here for more information on the risks of relapse.

Is it best for medically assisted treatment to be short-term or long-term?

 

With better understanding of the brain changes caused by opioids our understanding of medically assisted treatment* of opioid addiction and dependency has also improved. More and more we are coming to understand that treatment is often needed long term, meaning many months to many years. Unfortunately, however, most inpatient detox centers use a very rapid detox process for 5-6 days followed by sudden total cessation of the medication prior to discharge. In other words, it is very short-term treatment.

 

Not only is there a very high rate of relapse after these short-term detox programs, but one study showed that during the first month following discharge from short-term detox, persons were 27 times more likely to die from overdose than a ‘normal’, practicing addict. Why? Because a person who goes through rapid, short-term detox followed by no medication (namely buprenorphine or methadone) still has highly active and numerous opioid receptors (Pacman) screaming away. The person feels horrible, as though life is not worth it.  This can quickly lead to the dealer. Keep in mind that this person has not used for, let’s say, two weeks. If he or she is a long term (or even short term) user he thinks the dose used before detox is the dose needed now.  Using the same dose as before can easily be an overdose amount due to loss of “tolerance” present before detox.. And too often, friends and family are soon arranging a burial or life-commemoration service.

 

Therefore, treatment needs to be provided long-term and, for some, life-long. By so doing, people are allowed time to literally rebuild their lives. Accomplishments such as securing more schooling or skills training, settling down with a family, buying a home or owning a car with appropriate insurance coverage – all unthinkable while dependent on illicit drugs – now begin to happen. When a patient tells us “I feel like I have my life back” we take that quite literally. This is what recovery looks like – far more than mere cessation of a drug.

 

Buprenorphine and methadone are currently the most studied and successful medications in use for long-term recovery. Buprenorphine is the active medication in all forms of what are commonly referred to as “Suboxone” and is discussed in some depth in "The Role of 'Suboxone' Medications in Treatment of Opiate Addiction". Methadone, when used to treat opioid dependence, can only be legally obtained at one of the several methadone clinics. Daily appearance is mandatory to receive the methadone dose for that day. Most people find this inconvenient at best, and demeaning at worst. Buprenorphine, however, is more widely available and can be obtained at any pharmacy with a prescription issued by an office-based physician certified to prescribe buprenorphine for treatment of opioid dependence. Depending on a patient’s treatment status and the policy of the individual provider, office visits may range from monthly to every two months. Most people find this a much more convenient and much less demeaning experience than standing in line every day for a daily dose of methadone.

*meaning use of buprenorphine or methadone for treatment

 

How can I learn more about treatment for opioid dependence or addiction?

 

To learn more, call the clinic at (206) 878-8600 and speak with a staff person.  If questions remain, consider making a “Meet and Greet” appointment with Drs Brown or Steneker.  This initial appointment is free of financial risk (no out-of-pocket payment from you). It will give you an opportunity to meet us, and give us an opportunity to learn about your particular situation and determine how best we may help you with treatment using buprenorphine. You can expect an attentive and compassionate conversation.  No treatment will be started until you commit to starting the program, however.

 

For more information about proceeding with treatment, read "Steps to Deciding and/or Beginning Treatment".

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19901 First Avenue South Suite 409, Normandy Park, WA 98148

(206) 878-8600

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2018 Created for Marina Medical by

Newfangled Commerce

19901 First Avenue South Suite 409,

Normandy Park, WA 98148

Tel: 206-878-8600

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