- And I want you to think about
the worst flu you ever had and multiply that by 10,
body aches, chills, fever, shakes,
nausea, vomiting, diarrhea, sweats.
I want you to think of all of that physical sensation,
multiply it by 10 and know that every addict
that has a dependence is avoiding that feeling
every day of their life.
And the only way that they can avoid that feeling
is by taking another dose of the drug.
(upbeat music)
- Dr. Sportelli, when we talk about opioid addiction,
that's more specific.
We're talking about people who are addicted to opioids,
but on a bigger level, what is addiction?
- Yeah, so of course like the DSM has its criteria,
and we'll go through that, like for specific diagnoses,
but I'm just gonna make it as basic as possible.
Addiction is a chronic, long-term, relapsing illness.
Meaning just keeps happening over and over.
Very easy to relapse.
A chronic relapsing desire
to engage in a behavior compulsively,
despite the negative consequences.
I'm gonna simplify it right down to that.
So that makes sense, right?
You're engaging in a behavior:
gambling, sex, video games, drugs right?
So addiction can be very broad.
In a compulsive manner, you're doing it compulsively,
repeatedly, despite the negative consequences.
That's addiction.
- What I don't hear in there is the physical dependency.
So let's apply that definition to opioids.
How does it change?
- So what happens is when you are using an opiate, right?
(sighs) I wanna make this visual.
We have what's called endogenous opioids in our body.
We have natural opioids in our body, right?
We have opioid receptors. And guess what?
When you fall in love,
those opiates are flooding your brain.
When you exercise, those opiates flood your brain.
When you experience something pleasurable,
it's probably an endogenous opioid,
and we call them endorphins,
endogenous morphine, endorphins
- Okay, so is that different than dopamine or serotonin?
- It's different. - Okay.
- It's different, right?
So they're neuro-transmitters, so you're on the money,
serotonin, dopamine, those are neurotransmitters.
That's how these cells communicate. Right?
And we'll get into that with the neuroscience,
but the endogenous opiates,
these natural opiates bind to the neuron
and then secrete the dopamine or norepinephrine
to create an effect in your brain, right?
So you're on the right track for sure.
My point is that when you're using a substance
like an opiate, this is my analogy.
If your endogenous opiates are the whisper,
the opioids are a loudspeaker, they are so strong.
So if you take an exogenous, meaning from outside the body,
whether you inhale it, smoke it, inject it, swallow it.
You are fully flooding your brain with thousands of times
more potency than your endogenous opiates, right?
The brain is wired to feel pleasure.
It wants to feel pleasure.
So now what you're creating is this desire
to have that experience again, right?
So you took a substance that gave you an enormous high
compared to gambling or sex or the other addictions.
This is a substance now that's causing it
and causing it much more on an extreme level
in your brain, right?
But here's the problem,
is your brain is trying to balance this out.
So your brain goes, "Wait a minute.
I don't like a loudspeaker. I prefer a whisper.
So I need to tune this down."
So your brain down-regulates the receptors. So guess what?
You need more and more and more to get the same effect.
That's the difference with a substance.
I mean, that does happen with other types of addictions.
You need more to get that same pleasurable experience,
but with the substances, now you're seeking
this external thing you have to purchase
or take or inject to get the same feeling.
- So you're kind of fighting with your brain then.
- [Dr. Sportelli] You're fighting with your brain.
- [Kyle] Wow, I didn't realize that.
- You are fighting with your brain
because that primitive part of your brain is saying,
"I need this. I want this."
And now it's wired for this reward.
It bypasses the prefrontal cortex,
which is your decision-making ability.
It tunes down the amygdala.
We've talked about the amygdala before,
which is that stress response, that fear response,
it tunes that down.
It works in place called the basal ganglia
for this reward system.
But then at the same time, the brain is going,
"Whoa, this is too much. We need to put on the brakes here."
And that's how you develop what's called tolerance,
which means you need more to get the same effect
and also withdrawal, which means when you stop,
you have physical and psychological symptoms, right?
So that's like a big difference
with these exogenous substances that people take.
- What is an opioid?
- All right, so an opioid,
we talked about how your body has these
endogenous opioid receptors.
And basically it's a feel-good chemical,
that's the basics, right?
- Yeah, but I drink a Diet Coke and feel pretty good.
(indistinct) Why is... - This is euphoria
and pleasure a million times better than a Diet Coke, right?
What scientists realized was that there's a plant out there,
a plant called the poppy plant
and the poppy plant makes an opiate.
It secretes this milky substance
that when you look at it under a microscope,
it looks very similar to what we create in our own bodies
and binds to those receptors, but much stronger, right?
So most opiates that are prescribed out there by medicine,
by doctors, by pain management docs, by whoever,
are derived from that poppy plant, right?
The thing is science progresses.
And we sort of get that chemical structure, and we're like,
"Okay, well, we can make this."
And that's why there are what's called the natural opiates,
like heroin, which comes from the plant itself, right?
And then you have the synthetics
and the synthetic just means manmade.
So we have the synthetics, right?
So you have the naturals and the synthetics.
- So heroin comes from a plant.
- Yeah.
- So is true, organic, authentic heroin
better for you than a synthetic?
- You know, honestly, you're playing with fire
with this chemical, no matter what.
And I can't even, I don't think the words
could come out of my mouth to say that heroin is better
than a Percocet or an oxycodone or a fentanyl, right?
I can't say it because it's all just incredibly dangerous.
- This plant exists in nature, and I'm wondering,
what's its purpose?
Are animals eating this, like how...
Why does this exist?
- And I'm sure that there are hundreds of ethnobotanists
out there that are trying to answer that same question.
And there probably is some evolutionary reason for it.
Right? Who knows? - Yeah.
- But it helped us in medicine tremendously
because now we can do interventional procedures
for surgical things and things like that so it helps us.
So it's an amazing discovery,
but yet misused
and leading to an enormous dangerous crisis.
- Yeah. Absolutely.
Are there different types of opioid addictions?
- Right, so when you look at the...
We go back to the DSM a lot,
the Diagnostic Statistical Manual, right?
And MedCircle users are probably really used to that term
by now, that's our Bible of definitions.
So we like to use that because it allows doctors
to communicate well.
So if we say this is a substance use disorder, moderate,
right, an opioid substance abuse disorder
in a moderate fashion,
then two doctors know where we stand, right?
We understand that.
So different types, meaning in the DSM-5,
we got rid of substance dependence and substance abuse.
Now it's just termed substance abuse disorder. Okay?
And under that heading,
depending on how many criteria you hit,
it's either mild, moderate, or severe.
And we'll go through those criteria and you'll see that,
you know, there are 11 criteria.
If you are five or more then it's severe.
If you're one to three, it's pretty mild.
So there are different levels and the levels
are based on how significantly it's affecting your life
in a negative way.
So, yeah, so we do have some delineation,
but the truth is I will honestly say
there is no safe level of opioid use.
- No safe level of opiate.
Do you think people shouldn't be allowed to use opioids?
- I think there's a place for it,
but I think that for chronic pain, no.
- For chronic pain, no?
What else are they being used for or prescribed for?
- Acute pain.
So if you have a surgical procedure and you have
a 12 inch incision and they just cut through
muscle and bone and tissue,
that recovery is gonna be horrifying.
- Yes. - You need to treat that pain.
- Got it, got it. - To walk and to move
and to get things-
- But if your lower back hurts, that's different.
- If you have chronic low back pain
and you are taking, and we keep using the term Percocet,
let's just say oxycodone, just for a different name.
If you're taking an oxycodone three times a day,
that's gonna work for your back pain this week.
But next week, you're gonna have to take it
five times a day and the following week
you're gonna have to take it 10 times a day.
And then when you stop, you're gonna get sick.
So it's not good for chronic pain then, Kyle.
- I get that.
In our next episode, we're gonna talk about
the slang terms that are used
in the world of opioid addiction.
Not only from the actual opioids themselves,
but also for the quantities, how you buy them,
all of this stuff you need to know the language
in order to be able to properly spot the signs
of someone that you know who may have an addiction.
We'll do that in our next episode.
Thanks for watching.
Check out the links below for more information
on how to access this full series
and subscribe to our YouTube channel
to watch new mental health videos every week.
Did you like what you heard in this video?
If you wanna ask a MedCircle doctor
a question directly, you can.
Learn how by visiting the links in the description below.
(upbeat music)