OpioidsNovember 15, 2019 - 6 min read 🍵🍵🍵🍵
Life bites in you in the butt when you least expect it. When your health takes a hit through uncontrollable circumstances, there are only a few things you can do: trust the medical professionals, take your medication and rest as much as you can.
So with all the antibiotic posts, now comes the opioids experience post which conveniently counteracted the diarrhea side-effects that antibiotics had.
For post-surgery, they are generally prescribed together to manage pain and to prevent infection. I figured I’d leave the interesting research for last.
Throughout my recovery, my experience with codeine, morphine, tramadol and Dilaudid inspired me to research and write about the opioids I was using.
What are opioids?
Opioids are a family of drugs that are medically prescribed to treat severe pain. They are the oldest drug known to mankind and have been used for thousands of years. Opioids come from a natural extract of a poppy plant called Papaver omniferum, which is a gummy substance that is collected from the seed of the poppy .
How do they work?
There are many different opioid receptors; the opioid system is a very complex system that play a role in various biological processes and are involved in many different physiological functions such as pain, respiratory depression, constipation, sedation and euphoria .
Opioids work by binding to opioid receptors found throughout the body. The opioid receptors are categorized into 3 major groups: mu, delta, kappa. These receptors mediate spinal analgesia (inability to feel pain).
Opioid receptors belong to a family of 7-transmembrane G-protein-coupled receptors and they are made up of 3 subunits, alpha, beta and gamma .
Many different types of opioids work on different opioid receptors, so, unfortunately, the answer to this can’t be easily summarized into a bite-sized paragraph.
Codeine is a weak opioid. It is the methylated version of morphine, meaning it has an extra CH3 group. For codeine to work, it must undergo demethylation to be converted to morphine and thus have a similar mode of action .
Morphine binds to the mu receptor in the central and peripheral nervous system. It is also considered a classical opioid analgesic .
When a classical opioid binds to its receptor, it inhibits adenylyl cyclase which causes a reduction of the intracellular cyclic-AMP levels and increases potassium out of the cell. The increase in potassium out of the cell decreases the calcium conductase and reduces the neuronal firing rate and therefore reducing neurotransmitter release .
Pain is associated with increase activity in the sensory neurons induced by strong stimuli from chemicals released by damaged tissue or inflammation, with the decrease in neuotransmitter activity, the signaling systems for pain are blunted and reduced .
My hospital stay gave me IV morphine every 3 hours, however, as my pain got significantly worse, the doctor had to prescribe IV hydromorphone. Hydromorphone is commonly viewed as the second line of defence after morphine which is about about 5-7 times more potent .
Hydromophone, also known as Dilaudid, is used to treat severe acute pain, severe chronic pain and cancer-related pain. It is the hydrogenated ketone of morphine and thus have a similar analgesic characteristic to morphine .
Summer was a bad time, I was on IV opioids around the clock and receiving IV antibiotics. I’m glad to be out and properly recovering at home.
A few weeks after my hospitalization, I came in for another surgery which led me to my second experience with propofol. I was prescribed tramadol, another opioid that selectively binds to a different opiate receptor in the central nervous system.
It does not bind as strongly to the mu-receptor compared to morphine, therefore, is much less potent and comes with a relatively low risk of addiction or withdrawal.
Why do opioids cause constipation? 💩
One of the unwanted side effects of opioid use is constipation. The stimulation of mu-opioid receptors found in the myenteric plexus inhibit gastric emptying and reduces peristalsis (the contraction of the digestive system that forces food through) .
Why do you feel so good taking them? 😊
Morphine and other opioids act on the reward center of the brain (mesolimbic pathway). This area is what makes eating and other essential processes feel pleasurable .
Ironically, while I was recovering on my bed with tramadol in my system, I started an HBO series called Euphoria, a show that follows a troubled teenager with opioid addiction.
The euphoric effect occurs when opioids bind to mu and delta-receptors; it causes the ion channels in our brain to open and reduce the excitability of neurons.
While this happens, a side-effect of opioids causes another mechanism that prevents the release of GABA neurotransmitters. These neurotransmitters are responsible for controlling dopamine levels. Therefore with the inability to control and reduce dopamine levels, we experience euphoria..
Opioids are safe when used properly in the prescence of pain. However, when they are abused and used without pain, they can motivate the repeated use of the drug simply for pleasure and this is what causes addiction .
At first, I was hesitant about opioids because of the news revolving the dangers of addiction and overdose. However, after some research, when opioids are taken properly it’s completely fine. I quickly realized I’d rather feel comfortable than to suffer in pain😅.
I was constantly bothered by the fact that opioids made me sleepy all the time which hindered my ability to be productive and do other things, but I guess thats just life sometimes.
As long as you are properly using them as prescribed, they are a great addition to the medical arsenal in improving quality of life✌.
Disclaimer: All mentioned opioids were prescribed and taken as directed by my doctor and pharmacist. Under no circumstances were these drugs misused or abused. My experience led to my understanding of opioids through a biochemical perspective which inspired me to write about my personal experience.