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Introduction to the Opioid Crisis: Why Are Opioids So Addictive?

Maile ShoulMaile Shoul, Project Manager, Opioid Task Force of Franklin County and the North Quabbin Region

First in a three-part series.

OxyContin. Percocet. Heroin. Fentanyl. What do these substances have in common and how have they contributed to the phenomenon known as the “opioid crisis?”

For most aches and pains, over-the-counter pain relievers such as Tylenol or Advil are adequate. For more severe pain, such as the pain that may occur after surgery, a stronger class of medications called opioids may be prescribed to provide comfort. Opioids work by attaching to the pain receptors in the brain and blocking them from feeling pain. They have provided much-needed pain relief to millions of people. Unfortunately, they can also be highly addictive.

In addition to relieving pain, opioids can also cause feelings of intense euphoria and calm. The “high” caused by drugs is simply a more intense version of the good feelings we get when we do things like eat delicious food, spend time with loved ones, or have sex. Our brains are designed to reward us when we do things that give us pleasure. This pleasure feedback loop is necessary for our survival. It helped ensure that ancient humans stayed motivated to seek out food, create cohesive societies, and reproduce.

“Across the country, tens of thousands of people were over-prescribed medications and became physically dependent on them.”

When taken properly, prescription opioids safely relieve pain. However, taken improperly, opioids can overwhelm the pleasure receptors in the brain, causing a very intense high. If this is done repeatedly, the brain will become accustomed to the substance and will need more and more in order to feel the same “high.” When the brain is repeatedly overwhelmed by too many opioids, this leads to chemical changes in the brain where the number of receptors that receive pleasure are reduced. This means that, in the absence of opioids, a person may experience strong feelings of depression. They will also experience strong physical symptoms of opioid withdrawal such as diarrhea, nausea, vomiting, and chills. In addition, prolonged exposure to opioids can cause tiny structures in the brain called dendritic spines, which allow neurons to communicate with each other, to disappear. This can lead to trouble with reasoning and problem-solving. These changes to the brain can take months or even years to fully recover from, even after a person stops using drugs.

Once someone is physically dependent on opioids, they may use them not to get high, but to stop from feeling the negative symptoms of opioid withdrawal. Our ancient brains want to avoid pain as much as they want to seek pleasure. This is necessary for our survival and prevented our ancestors from sticking their hands in fire or running into a bear cave. This intense desire to avoid immediate pain (in this case, withdrawal from opioids), originates in the ancient part of our brain, which can unfortunately overwhelm the logical part of our brain, that tells us that drug use will lead to things like illness, broken relationships, and job loss.

In the 1980s and 1990s, the pharmaceutical companies that produced prescription opioids aggressively marketed medications such as OxyContin to doctors. The sales teams from the pharmaceutical companies claimed that these medications were “wonder drugs” that relieved pain but were not addictive. Unfortunately, the claim that these medications were not addictive was not true. At that time, very few limits were put on opioid prescriptions. Across the country, tens of thousands of people were over-prescribed medications and became physically dependent on them. The withdrawal from opioids, whether they are prescribed legally or are obtained illegally, can be so wretched, that, in a desperation to stave off the terrible side effects, people turned to illegal opioids, such as heroin. Heroin is not only much stronger and more dangerous than prescription opioids, it is also much cheaper.

Approximately two million people in the United States suffer from an opioid-use disorder related to the misuse of either prescription opioids or heroin. This has sadly resulted in thousands of deaths nationwide and in Massachusetts. According to the National Institute on Drug Abuse, Massachusetts has the seventh highest opioid-involved overdose death rate in the nation. While many people used to consider addiction to be a moral failure, medical research has given us a better understanding of how opioid addiction affects the brain. Research also shows that there is a strong genetic component to addiction, with some people being more susceptible to addiction than others, although more research is needed to fully understand why.

Because opioid misuse changes the chemical structure of the brain, recovery from addiction does not happen overnight. Thanks, in part, to the unrealistic portrayal of addiction recovery in popular culture, many people expect their loved ones to be able to ‘fix’ their addiction after 30 or 60 days. Research shows that it can take months or years for the brain to recover from opioid addiction. But with the right treatment and recovery resources, which must include social support, safe housing, and employment or other financial support, people heal and thrive. By understanding the complicated nature of addiction, we will be able to find real, long-lasting solutions to this epidemic.

If you or a loved one is suffering from addiction, contact the Massachusetts Substance Use Helpline at 800-327-5050 or at For family members impacted by addiction, contact Learn to Cope.