Anatomy Of Addiction: How Heroin And Opioids Hijack The Brain
DAVID GREENE, HOST:
Addiction to painkillers, opioids, has become one of the country's most pressing public health problems. But no matter how Congress, health care providers and families approach this problem, recovery will not come easy. I'm joined on the line by New Hampshire Public Radio's Jack Rodolico to talk about why quitting is so difficult. And, Jack, welcome to the program.
JACK RODOLICO, BYLINE: Thanks, David.
GREENE: So two and half million Americans are addicted to opioids. And you sat down with one of them.
RODOLICO: That's right. His name is Jack O'Connor. He's at a recovery center here in New Hampshire. And O'Connor is an opioid addict and an alcoholic. And four years ago, he was just so desperate to beat his addictions that he took a really rash step. He joined the Marine Corps. And this is what he was thinking as he went to boot camp.
JACK O'CONNOR: This will fix me. I'm going to get cured by doing this - 13 weeks. It better fix me or I'm screwed.
GREENE: My god, he joined the Marines to try and get off alcohol and opioids. Did it work?
RODOLICO: Well, he was sober through boot camp. But as soon as he left, he started using again.
O'CONNOR: Same thing - Percocets, like, off-the-street pills.
RODOLICO: Over three years, he detoxed more than 20 times.
GREENE: So is it any different for, say, a cocaine addict than for someone addicted to opioids?
RODOLICO: Yes and no. Experts describe addiction - and that's all addiction - as hijacking the brain. But with these prescription painkillers and heroine, the hijacking can be particularly aggressive. And as I really dug into O'Connor's story, I talked with Dr. Seddon Savage, an addiction specialist at Dartmouth.
SEDDON SAVAGE: The first recording of opioid use was 5,000 years ago. And ironically it was two words - a picture of the opium poppy and the words the joy plant.
RODOLICO: So, David, let's return to Jack O'Connor's story now because he discovered that joy. He was an alcoholic during his freshman year of college. And he went home that summer desperate to replace alcohol with something else. And that was easy to do. In 2012, prescribers handed out enough painkillers for every American to have a bottle of opioids. O'Connor got his hands on some 30-milligram Percocet pills.
O'CONNOR: And I ended up sniffing a whole one. And I, like, blacked out, puking everywhere. I don't remember anything. It ruined me that time. But I loved it.
RODOLICO: Opioids got him higher faster than any drug he'd tried. And even though different drugs produce different highs, all drugs have the same pathway in the brain, says Dr. Savage.
SAVAGE: Ultimately, the released dopamine, which causes intense pleasure in a part of the brain that's called the limbic reward system. This is a very ancient part of the human brain that's necessary for survival.
RODOLICO: The intense pleasure of eating, drinking, sex - that's all driven by the limbic reward system.
SAVAGE: So all drugs that people use to get high tickle this part of the brain.
RODOLICO: But opioids are so addictive you become physically dependent on them very quickly. And breaking that physical dependence, that's called detox. Jeffrey Ferguson is a detox specialist at Serenity Place in Manchester, N.H.
JEFFREY FERGUSON: It is an amazing thing to see someone basically vibrating in their chair, feeling nauseated, looking like hell.
RODOLICO: This is the thing Jack O'Connor put himself through 20 times. It's a five-day physical nightmare. But when detox is over, addiction is still there. Dr. Savage says that's because in the addicted brain, the limbic reward system - that drive for pleasure - has hijacked other brain systems.
SAVAGE: Memory systems, motivational systems, judgment.
RODOLICO: The more Percocet O'Connor sniffed, the more getting high became his only coping skill in life. Everything drove him to get high - his stress, his joy, his shame.
O'CONNOR: Mentally somewhat it kind of straightens out my head - or spiritually I guess would be the better word for that 'cause, like, everything was about me until I get that next drink or drug.
RODOLICO: O'Connor switched from pills to heroin to get higher cheaper. In fact, 75 percent of prescription opioid addicts shift to heroin. Jeffrey Ferguson says that's because the addicted hijacked brain is singularly focused on getting high at all costs. [POST-BROADCAST CORRECTION: In the audio of this story, we incorrectly say that 75 percent of people addicted to prescription opioids switch to heroin. Actually, 75 percent of heroin users started out abusing prescription opioids.]
O'CONNOR: My morals, my standards, my ethics may start out like I would never steal money from my mom's purse. All of a sudden, click, that bar goes down. I'll never rob a store - click, click, click. I'll never be homeless. I'll never sell my body for drugs.
RODOLICO: Jack O'Connor lied to his family and stole from his job all while trying to get sober. In late 2013, he put himself through a five-day detox clinic. Then he managed to get through five more days in the real world sober. And then he found a bag of heroin in his wallet.
O'CONNOR: Somebody's telling me, like, I need to get high - cool. So I get high, go to a Christmas party, like, really ashamed of myself that I did that.
RODOLICO: Giving into his heroin craving was his addiction tipping point. At the Christmas party with his family, high on heroin, O'Connor got drunk - really drunk - wine then beer then whiskey.
O'CONNOR: It, like, sets off this thing where it's like, cool, I'm good now. But I could be better. Let's have some more.
GREENE: All right. That report coming to us from Jack Rodolico from New Hampshire Public Radio. And he's still on the line with us. And just listening to that voice there, clearly opioids are different. But this is not some big scientific discovery that people who are addicted are driven to use again and again. I mean, does it really involve a change in approach in some way?
RODOLICO: Well, it does in that what has changed is that tens of thousands of new people from all walks of life are now hooked on opioids. That's the change. We've got more people addicted to these drugs. And we don't have enough addiction specialists in the country to help those people. And detox isn't enough. For people who only detox from opioid dependence, relapse rates can be above 90 percent.
GREENE: OK, so where does this all leave this man you spent so much time with, Jack O'Connor?
RODOLICO: Well, so far, he's actually in the minority. Today is his one-year sobriety anniversary. He's been in rehab for that entire year. He has a job and a supportive family - all things that help people stay sober in the long-term. And in the same way he once replaced his coping skills with drugs, he has now rebuilt those coping skills by quitting drugs.
O'CONNOR: I don't need it anymore because what it essentially is is like, I like the way I feel when I put drugs or alcohol in my system. Now sober, I love the way I feel sober. I literally physically and, like, emotionally don't need it.
RODOLICO: O'Connor is optimistic for himself but not for everyone. Every hour two Americans die of an opioid overdose.
GREENE: Wow, that's a stunning number. We'll certainly be rooting for O'Connor. Jack Rodolico is a reporter for New Hampshire Public Radio. Jack, thanks a lot.
RODOLICO: Thank you, David.
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