I met a young man in his early 20s who was seeking help for his opioid addiction. He had started with prescription opioids because they were easily available. His friend gave them to him.
He said he used them because his friends were using them. He wanted to fit in. Unfortunately he really liked the effect and rapidly increased the frequency and amount of “Oxy’s.” When pills became too expensive, he moved to heroin.
He began to find himself always looking for the next fix. Initially he tried to balance work and his social life with using drugs, but the juggling act soon became difficult to continue. He sought treatment but had no insurance and was told to pay $3,000 or no treatment.
I hear this type of story almost weekly. This young man really loved the feeling of the first pill, describing it as “wonderful.” His destiny was determined after his first exposure not just because of the addictive properties of Oxy but because of something over which he had no control — genetics.
According to results of research conducted at Stanford University and published last week inAnesthesiology, genes determine if a person will experience nausea, itchiness or respiratory depression after taking an opioid. The influence of genetics on opioid response explains why one opioid works for some and not others. The research also showed that liking for an opioid is partly an inherited trait. These results are relevant to the study of how addiction forms.
It has long been known that there is tremendous variability in response to an opioid from individual to individual. Previous research has blamed genetics for about 50% of the vulnerability to opioid addiction with the rest due to environment.
Environmental factors can be divided into two primary areas: in home and out of home. This means that the family dynamics beyond the genetic contribution can increase the risk of addiction or be protective. In the case of this young man, his mother was an addict, and he didn’t know his birth father.
Parents who abuse drugs create an environment that is more permissive toward drug use than non-using parents. This doesn’t mean that one is sentenced to addiction if one or both parents have a substance-abuse problem, nor does it mean that a child in a home where illicit drug use would be considered a moral outrage is totally protected.
There are seemingly an infinite number of in-home environmental factors that can influence the expression of addiction, including physical or emotional child abuse. Pre-adolescent sexual abuse has been shown to increase the risk of substance abuse by 300%. Severe emotional abuse can also contribute to development of addiction in a vulnerable person. One study reported 100% of women admitted for substance-abuse treatment had experienced physical or severe emotional abuse as children.
Friends and life experience also present factors – in this case out of home – that can be protective or increase the risk.
The expression of the addiction disease is very individual, and some people have much more serious problems than others. Think of the variability we see with alcohol. While some people can consume alcohol in moderate amounts their whole lives, others rapidly become alcoholics after their first drink. The development of opioid abuse or addiction can occur along a similar continuum.
The Stanford study may suggest why some people who use opioids for recreational purposes to get high prefer one type of opioid over another. This is fascinating stuff. One day we may be able to identify individuals who won’t tolerate opioids or whose risk for addiction is too high to be placed on opioids.
Meanwhile, we need to understand that the mere exposure to an opioid for some people may trigger an addiction. If we can identify those who are at risk, like the young man I treated last week, then we could prevent some of the tragedies that occur from the drugs and retain the ability to use them for people who suffer from pain and are not vulnerable to the disease of addiction. Hopefully, this occurs sooner rather than later. The disease of addiction is devastating. Any science that helps us prevent its development cannot occur soon enough.