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The Science Behind Opioid Addiction

Elena Hill, MD, MPH profile image
By Elena Hill, MD, MPH • Updated Aug 13, 2023 • 4 cited sources

Understanding the scientific basis for opioid use disorder (OUD) is critical. Many assume those with OUD are somehow simply lacking willpower. In reality, people with OUD have a chronic but treatable condition stemming from brain chemistry changes. 

Prevalence of Opioid Addiction

More than 2.1 million people in the United States have opioid use disorders.[1] Addictions can strike people of any race, class, and geographic region. And the cost can be devastating. 

In 2020 alone, nearly 92,000 people in the United States died of a drug overdose, often involving prescription painkillers or illicit drugs like heroin.[2] Many more lost jobs, drained bank accounts, and ruined relationships due to compulsive drug use. 

What Causes Opioid Addiction?

OUD stems from an interplay of biological, psychological, and environmental factors. They all work together to cause compulsive drug use. These are some of those factors:

The Role of Biology

Every human has opioid receptors distributed throughout the body. When you take drugs like OxyContin or heroin, they latch onto those receptors and trigger chemical changes causing feelings of euphoria and relaxation. 

Variations in some genes can change how people react to opioids and how much they need to take in order to feel the effects of the drug.[3] Variations like this could lead to a higher risk of addiction in certain individuals, although not enough is yet known about this to reliably predict which individuals are at higher risk for addiction/dependency. 

The Role of Psychology 

How you think, react, and understand your life could also influence addiction risk. People with certain mental health disorders such as depression, anxiety or other psychiatric disorders have a higher rate of OUD as compared to the general population. [3] 

The Role of Environment

Traumatic experiences (including sexual abuse, childhood neglect, poverty, and growing up around other drug users) have all been correlated with increased risk of developing an addiction disorder. 

Factors That Determine Addiction: Is It Nature or Nurture?

Why do some people develop OUD and others do not? Researchers aren’t sure. It seems likely that multiple factors working together — including your genes as well as influences from your upbringing and current environment — are to blame.

As the chief medical officer of Bicycle Health, Dr. Brain Clear, explains, “We see an array of patients who come in struggling with an addiction to opioids and requesting help. Some patients grew up in a household with substance abuse, others tell me they had ‘the perfect childhood.’ Some personally struggle with mental health conditions like anxiety and depression, while other patients do not have any mental health history. Some patients’ addiction started off after receiving pain medications prescribed by their doctor after an injury; others started off getting heroin on the street.”

The bottom line is that addiction can affect anyone from any background — any age, gender, ethnicity, educational background, and socioeconomic status. There is no way to know for sure who is at greatest risk, as every individual is different. 

Opioid Addiction vs. Dependence: What’s the Difference?

While addiction to opioids does usually involve dependence, the two are technically different.

Dependence implies physiologic dependence. It means that someone’s body becomes used to taking opioids daily. If that person goes without opioids, their body will feel symptoms of opioid withdrawal, such as these:

  • Agitation
  • Body aches
  • Diarrhea
  • Nausea and vomiting
  • Sweating

Dependence could happen to any daily opioid user, even if that person takes medications as prescribed by a doctor.

Addiction refers to when the individual continues to use a drug or substance despite negative consequences to their life or to their health. 

A person can be “addicted” without being physically “dependent”. A person can also be dependent physically but not “addicted”. 

Dr. Clear explains how addiction is different than dependent: “With addiction, there is a level of dysfunction that impedes on one’s life. Patients are spending all their time, energy, and money on getting opioids.

As a result, they might deplete their bank accounts, they might fail to meet their responsibilities like going to work or caring for their families, they might lie to friends and family. They lose control and the addiction takes over their lives.”

Treatment for Opioid Addiction

The most effective way to address OUD is to combine medications with behavioral treatment. Medication for Addiction Treatment (MAT) can help people amend chemical imbalances while they learn how to build a life without drugs. 

As Dr. Clear explains, “At Bicycle Health, we prescribe buprenorphine to our patients. This prevents them from having cravings and withdrawal and blocks other opioids so they do not overdose. Our providers also support patients in developing healthy behaviors so they are able to manage life’s stressors without using opioids to cope.”

Medications such as buprenorphine/naloxone (Suboxone), methadone, and naltrexone have been proven to cut rates of early death from any cause, including overdose.[4]

“What is also gratifying,” Dr. Clear explains, “is to watch patients’ lives improve once they are treating their addiction. They enter a life of recovery where they are able to reconnect with their personal values and goals.”

To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment compared to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Opioid Use Disorder. StatPearls. June 2022. Accessed January 2023.
  2. Overdose Death Rates. National Institute on Drug Abuse. January 2022. Accessed January 2023.
  3. Opioid Addiction. National Library of Medicine. November 2017. Accessed January 2023.
  4. Mortality Risk During and After Opioid Substitution Treatment: Systematic Review and Meta-Analysis of Cohort Studies. BMJ. April 2017. Accessed January 2023.

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