What’s the difference between buying a venti Pumpkin Spice Latte from Starbucks and buying heroin? The answer, which I learned at the opioid epidemic panel hosted by the Neuroscience Club last Thursday, is shocking.
Both items cost around $5 and are both addictive, yet—in Winston-Salem—one gets delivered to your house (hint: Starbucks doesn’t deliver). There’s something wrong with this picture, and—as the name of the event suggests—there is an opioid epidemic in our midst.
President and Vice President of the Neuroscience club, senior Kat Beck and sophomore Kate Cowie, hoped the panel would bring awareness to the opioid crisis, which is not discussed much on college campuses. The panel was comprised of professionals from many fields: Dr. Lack, a biology professor; Dr. Blumenthal, a psychology professor; Dr. Rukstalis, a psychiatrist; Dr. Sharpe, a family nurse practitioner; and Dr. Ferris, a drug addiction researcher.
This panel addressed the complex issue of addiction, which has multiple contributing factors. I think two factors that underlay much of the discussion are known as classical and operant conditioning. The audience learned frightening statistics about the crisis: almost one hundred people die every day from an overdose; 80% of opioid addicts are hooked because of prescribed pain medication; most drug abusers get their drugs for free and/or from friends. To better understand why addiction is so prevalent, let’s take the hypothetical example of a heroin addict named Mary Smith.
Mary has these receptors in her brain called μ-receptors These receptors have an inhibitory effect, and because outside opioids like heroin and fentanyl are extremely potent, taking these drugs can lead to inability to breathe and death. To understand why Mary is addicted to drugs, we need to examine operant conditioning, which is learning to associate a behavior with an outcome; and classical conditioning, which is learning to associate two stimuli to elicit a response.
Mary listens to Eminem and Rihanna as she shoots up. She feels fantastic! Why? Because drugs like heroin increase the production of dopamine, which is responsible for a feeling of reward. Mary loves this euphoria, and is then motivated to find more heroin and shoot up again—operant conditioning.
Unfortunately, Mary’s academic performance started slipping so her friends took her to rehab. She was fine for a while, but one day she saw her friend listening to The Monster by Eminem and Rihanna and felt the need to do heroin and relapsed. This happened because Mary had associated heroin with Rihanna and Eminem songs—classical conditioning. When Mary didn’t shoot up after hearing this song, she started feeling withdrawal symptoms and, to avoid the punishing feelings, bought more heroin and shot up—operant conditioning. Thus, Mary gets hooked on heroin again and this vicious cycle continues.
Understanding the process of addiction is important to understand that the opioid epidemic affects real people who aren’t always in control of their actions. Dr. Blumenthal seems to be a big proponent of realizing that drug addicts are people and, more importantly, we should treat them as people. In fact, there is a medicine he advocates for called naloxone (brand name Narcan®) that saves peoples’ lives by flushing out opioids. Blumenthal believes naloxone should be standard issue on ambulances, but clarified that the policy is not popular because it is expensive and people mistakenly think it will promote drug use. In reality, naloxone is “anti-fun” according to Blumenthal. He says it saves lives, and any life is worth saving.
Naloxone is usually a last resort. It’s used to help people who have overdosed and can’t breathe. Other treatment methods that are more preventative include buprenorphine. One panelist, Dr. Rukstalis, a board-certified addiction psychiatrist, was instrumental in the FDA’s approval of buprenorphine. Bupreneorphine is a safe medicine that can be taken in the office. It is a partial opioid-agonist, meaning it mimics certain effects of drugs like heroin, morphine, or oxycodone. Buprenorphine is weaker and less addictive than many drugs of abuse, which makes it an effective treatment for opioid addiction by suppressing withdrawal symptoms and reducing cravings when paired with counseling and other behavioral therapies.
Freshman Reed Fedowitz said he went to the panel for extra credit, not expecting to learn anything new, but was surprised by what he heard. He said that he thinks the panel discussed important information that people need to know about, and I couldn’t agree more. I think the take-home message of the panel is that drug addicts are people, too. We need to continue researching ways to help mitigate detrimental effects of opioids and work on policies that help keep everyone safe. As Dr. Blumenthal passionately communicated, political advocacy is a great way to do this. Writing letters to politicians about getting medicine like naloxone into the hands of first-responders is important because it will save lives, and I agree with Dr. Blumenthal: every life is worth saving.