What causes opioid addiction, and why is it so tough to combat? - Mike Davis

Prevoditelj: Neda Vrkic Recezent: Sanda L

More than 3,000 years ago, a flower began to appear in remedies

Prije više od 3000 godina, jedan se cvijet počeo pojavljivati u lijekovima

in Ancient Egyptian medical texts.

u drevnim egipatskim medicinskim tekstovima.

Across the Mediterranean, the ancient Minoans

Diljem Sredozemlja, drevni Minojci

likely found ways to use the same plant for its high.

vjerojatno su pronašli načine za upotrebu iste biljke radi njenog podizanja.

Both ancient civilizations were on to something—

Obje drevne civilizacije bile su na tragu nečemu --

opium, an extract of the poppy in question,

opijumu, ekstraktu dotičnog maka,

can both induce pleasure and reduce pain.

koji može izazvati zadovoljstvo i smanjiti bol.

Though opium has remained in use ever since,

Iako je opijum ostao u upotrebi od tada,

it wasn’t until the 19th century that one of its chemical compounds,

tek je u 19. stoljeću jedna od njegovih kemijskih sastavnica,

morphine, was identified and isolated for medical use.

morfin, postao identificiran i izoliran za medicinsku upotrebu.

Morphine, codeine, and other substances made directly from the poppy

Morfin, kodein i druge supstance izravno izrađene od maka

are called opiates.

zovu se opijatima.

In the 20th century, drug companies created a slew of synthetic substances

U 20. stoljeću, farmaceutske tvrtke stvorile su mnoštvo sintetskih supstanci

similar to these opiates,

sličnih ovim opijatima,

including heroin, hydrocodone, oxycodone, and fentanyl.

uključujući heroin, hidrokodon, oksikodon i fentanil.

Whether synthetic or derived from opium,

Bilo da su sintetičke ili se dobivaju iz opijuma,

these compounds are collectively known as opioids.

ove sastavnice su zajednički poznate kao opioidi.

Synthetic or natural, legal or illicit, opioid drugs

Sintetski ili prirodni, legalni ili nelegalni, opioidni lijekovi

are very effective painkillers, but they are also highly addictive.

vrlo su učinkoviti analgetici, ali stvaraju i veliku ovisnost.

In the 1980s and 90s,

U 1980-im i 90-im,

pharmaceutical companies began to market opioid painkillers aggressively,

farmaceutske tvrtke agresivno su počele plasirati opioidne analgetike na tržište,

actively downplaying their addictive potential

aktivno ublažujući njihov ovisnički potencijal,

to both the medical community and the public.

i medicinskoj zajednici i javnosti.

The number of opioid painkillers prescriptions skyrocketed,

Broj recepata za opioidne analgetike naglo je porastao,

and so did cases of opioid addiction, beginning a crisis that continues today.

kao i slučajevi ovisnosti o opioidima, započinjući krizu koja se nastavlja danas.

To understand why opioids are so addictive,

Da bismo razumjeli zašto opioidi stvaraju ovisnost,

it helps to trace how these drugs affect the human body from the first dose,

pomaže pratiti kako ovi lijekovi utječu na ljudsko tijelo od prve doze,

through repeated use, to what happens when long-term use stops.

kroz ponovljenu upotrebu, i na to što se događa kad dugotrajna upotreba prestane.

Each of these drugs has slightly different chemistry,

Svaki od ovih lijekova ima ponešto različitu kemiju,

but all act on the body’s opioid system by binding to opioid receptors in the brain.

ali sve djeluju na opioidni sustav tijela vezanjem na opioidne receptore u mozgu.

The body’s endorphins temper pain signals by binding to these receptors,

Endorfini tijela umanjuju signale boli vezanjem na ove receptore

and opioid drugs bind much more strongly, for longer.

i opioidni lijekovi vežu se jače, duže.

So opioid drugs can manage much more severe pain than endorphins can.

Dakle, opioidni lijekovi mogu upravljati mnogo jačom boli nego što mogu endorfini.

Opioid receptors also influence everything from mood to normal bodily functions.

Opioidni receptori također utječu na sve,

od raspoloženja do normalnih tjelesnih funkcija.

With these functions, too, opioids’ binding strength and durability

Uz ove funkcije, također, jačina i trajanje vezanja opioida

mean their effects are more pronounced and widespread

znači da su njihovi učinci izraženiji i rašireniji

than those of the body’s natural signaling molecules.

nego onih prirodnih signalizirajućih molekula tijela.

When a drug binds to opioid receptors, it triggers the release of dopamine,

Kad se lijek veže na opioidne receptore, pokreće otpuštanje dopamina,

which is linked to feelings of pleasure and may be responsible

koji je povezan s osjećajima zadovoljstva i može biti odgovoran

for the sense of euphoria that characterizes an opioid high.

za osjećaj euforije koji karakterizira opioidnu ugodu.

At the same time, opioids suppress the release of noradrenaline,

U isto vrijeme, opioidi suzbijaju otpuštanje noradrenalina,

which influences wakefulness, breathing, digestion, and blood pressure.

koji utječe na budnost, disanje, probavu i krvni tlak.

A therapeutic dose decreases noradrenaline enough to cause side effects

Terapijska doza dovoljno smanjuje noradrenalin da izazove nuspojave

like constipation.

poput konstipacije.

At higher doses opioids can decrease heart and breathing rates to dangerous levels,

Pri većim dozama opioidi mogu smanjiti

brzinu otkucaja srca i disanja na opasne razine,

causing loss of consciousness and even death.

izazivajući gubitak svijesti, čak i smrt.

Over time, the body starts to develop a tolerance for opioids.

S vremenom, tijelo počinje razvijati toleranciju na opioide.

It may decrease its number of opioid receptors,

Može smanjiti broj opioidnih receptora,

or the receptors may become less responsive.

ili receptori mogu postati manje osjetljiviji.

To experience the same release of dopamine and resulting mood effects as before,

Da dožive isto otpuštanje dopamina

i rezultirajuće učinke raspoloženja kao i prije,

people have to take larger and larger doses—

ljudi moraju uzeti veće i veće doze --

a cycle that leads to physical dependence and addiction.

ciklus koji vodi do fizičke ovisnosti i navike.

As people take more opioids to compensate for tolerance,

Kako ljudi uzimaju više opioida da nadoknade toleranciju,

noradrenaline levels become lower and lower,

razine noradrenalina postaju sve niže i niže,

to a point that could impact basic bodily functions.

do točke koja može utjecati na osnovne tjelesne funkcije.

The body compensates by increasing its number of noradrenaline receptors

Tijelo to nadoknađuje povećanjem broja noradrenalinskih receptora

so it can detect much smaller amounts of noradrenaline.

tako da može pronaći mnogo manje količine noradrenalina.

This increased sensitivity to noradrenaline

Ova povećana osjetljivost na noradrenalin

allows the body to continue functioning normally—

dopušta tijelu da nastavi normalno funkcionirati --

in fact, it becomes dependent on opioids to maintain the new balance.

zapravo, postaje ovisno o opioidima da održi novu ravnotežu.

When someone who is physically dependent on opioids stops taking them abruptly,

Kad netko tko je fizički ovisan o opioidima, naglo ih prestane uzimati,

that balance is disrupted.

ta ravnoteža se naruši.

Noradrenaline levels can increase within a day of ceasing opioid use.

Razine noradrenalina mogu porasti u roku jednog dana od prestanka upotrebe opioida.

But the body takes much longer to get rid of

Ali tijelu treba mnogo više vremena da se riješi

all the extra noradrenaline receptors it made.

svih tih dodatnih receptora koje je stvorilo.

That means there’s a period of time

To znači da postoji razdoblje

when the body is too sensitive to noradrenaline.

kada je tijelo previše osjetljivo na noradrenalin.

This oversensitivity causes withdrawal symptoms,

Ova preosjetljivost uzrokuje simptome odvikavanja,

including muscle aches, stomach pains, fever, and vomiting.

uključujući bolove u mišićima, bolove u trbuhu, vrućicu i povraćanje.

Though temporary, opioid withdrawal can be incredibly debilitating.

Iako privremeno, odvikavanje od opioida može biti nevjerojatno iscrpljujuće.

In serious cases, someone in withdrawal can be violently ill

U ozbiljnim slučajevima, netko tko se odvikava može biti jako bolestan

for days or even weeks.

danima i čak tjednima.

People who are addicted to opioids aren't necessarily using the drugs

Ljudi koji su ovisni o opioidima ne koriste nužno lijekove

to get high anymore, but rather to avoid being sick.

da se podignu više, nego da izbjegnu biti bolesni.

Many risk losing wages or even jobs while in withdrawal,

Mnogi riskiraju da izgube plaću ili čak posao tijekom odvikavanja,

or may not have anyone to take care of them during withdrawal.

ili možda nemaju nekoga da se brine o njima tijekom odvikavanja.

If someone goes back to using opioids later,

Ako se netko kasnije vrati uzimanju opioida,

they can be at particularly high risk for overdose,

može biti izložen posebno visokom riziku od predoziranja,

because what would have been a standard dose while their tolerance was high,

jer ono što bi bila standardna doza dok je njihova tolerancija bila visoka,

can now be lethal.

sada može biti smrtonosna.

Since 1980, accidental deaths from opioid overdose

Od 1980. slučajne smrti radi predoziranja opioidima

have grown exponentially in the United States,

eksponencijalno su porasle u Sjedinjenim Državama

and opioid addictions have also exploded around the world.

i ovisnosti o opioidima također su eksplodirale širom svijeta.

While opioid painkiller prescriptions are becoming more closely regulated,

Dok recepti za opioidne analgetike postaju strogo regulirani,

cases of overdose and addiction are still increasing,

slučajevi predoziranja i ovisnosti i dalje se povećavaju,

especially among younger people.

posebice među mlađim osobama.

Many of the early cases of addiction were middle-aged people

Mnogi od ranih slučajeva ovisnosti bile su osobe srednje dobi

who became addicted to painkillers they had been prescribed,

koje su postale ovisne o analgeticima koji su im bili propisani,

or received from friends and family members with prescriptions.

ili su ih dobili od prijatelja ili članova obitelji s receptima.

Today, young people are often introduced to prescription opioid drugs in those ways

Danas, mladim su osobama receptni opioidni lijekovi prezentirani na te načine,

but move on to heroin or illicit synthetic opioids that are cheaper

ali prijeđu na heroin ili nelegalne sintetske opioide koji su jeftiniji

and easier to come by.

i jednostavnije je doći do njih.

Beyond tighter regulation of opioid painkillers,

Osim strože regulacije opioidnih analgetika,

what can we do to reverse the growing rates of addiction and overdose?

što možemo učiniti da preokrenemo rastuće stope ovisnosti i predoziranja?

A drug called naloxone is currently our best defense against overdose.

Lijek nazvan nalokson trenutno je naša najbolja obrana od predoziranja.

Naloxone binds to opioid receptors but doesn’t activate them.

Nalokson se veže na opioidne receptore, ali ih ne aktivira.

It blocks other opioids from binding to the receptors,

Blokira druge opioide da se vežu za receptore

and even knocks them off the receptors to reverse an overdose.

i čak ih izguruje s receptora da spriječi predoziranje.

Opioid addiction is rarely a stand-alone illness;

Ovisnost o opioidima rijetko je samostalna bolest;

frequently, people with opioid dependence are also struggling

često, osobe ovisne o opioidima, također se bore

with a mental health condition.

s mentalnim zdravljem.

There are both inpatient and outpatient programs that combine

Postoje bolnički i izvanbolnički programi koji kombiniraju

medication, health services, and psychotherapy.

lijekove, zdravstvene usluge i psihoterapiju.

But many of these programs are very expensive,

Ali mnogi od ovih programa su preskupi

and the more affordable options can have long waiting lists.

i povoljnije opcije mogu imate duge liste čekanja.

They also often require complete detoxification from opioids

Također često zahtijevaju potpunu detoksikaciju od opioida

before beginning treatment.

prije početka tretmana.

Both the withdrawal period and the common months-long stay in a facility

I period ustezanja i zajednički višemjesečni boravak u ustanovi

can be impossible for people who risk losing jobs and housing in that timeframe.

može biti nemoguć za ljude koji riskiraju gubitak poslova i smještaja u tom vremenu.

Opioid maintenance programs aim to address some of these obstacles

Programi opioidnog održavanja teže rješavanju nekih od tih prepreka

and eliminate opioid abuse using a combination

i eliminiranju zloupotrebe opioida koristeći kombinaciju

of medication and behavior therapy.

lijekova i bihevioralne terapije.

These programs avoid withdrawal symptoms with drugs

Ovi programi izbjegavaju simptome ustezanja lijekovima

that bind to opioid receptors but don’t have the psychoactive effects

koji se vežu za opioidne receptore, ali nemaju psihoaktivne učinke

of painkillers, heroin, and other commonly abused opioids.

analgetika, heroina i drugih često zloupotrebljenih opioida.

Methadone and buprenorphine

Metadon i buprenorfin

are the primary opioid maintenance drugs available today,

su primarni lijekovi opioidnog održavanja dostupni danas,

but doctors need a special waiver to prescribe them—

ali liječnicima treba posebno izuzeće da ih propišu --

even though no specific training or certification

iako nikakvo posebno usavršavanje ili potvrda

is required to prescribe opioid painkillers.

nije potrebna da se prepišu opioidni analgetici.

Buprenorphine can be so scarce

Buprenorfin može biti toliko deficitaran

that there’s even a growing black market for it.

da čak postoji rastuće crno tržište za njega.

There’s still a long way to go with combating opioid addiction,

Još je dug put suzbijanja ovisnosti o opioidima,

but there are great resources for making sense of the treatment options.

ali postoje sjajni načini koji daju smisao mogućnostima liječenja.

If you or someone you know is struggling with opioid use in the United States,

Ako se Vi ili netko koga poznajete bori s upotrebom opioida

u Sjedinjenim Državama,

the Department of Health and Human Services

Ministarstvo zdravstva i socijalne skrbi

operates a helpline: 800-662-4357

upravlja telefonskom linijom za pomoć: 800-662-4357

and a database of more than 14,000 substance abuse facilities in the US:

i bazom podataka za više od 14,000 ustanova za ovisnost o drogama u SAD-u:

www.hhs.gov/opioids

www.hhs.gov/opioids