Opioids - Fentanyl Use, Overdose, and Withdrawal
In 2021, there was a 17.6% increase in drug overdose deaths, with the total number of male opioid death victims at 53,992 and female death victim number being 21,793. with 7 out of 19 preventable opioid overdose death in males compared to females. In the 2000s, Oxycodone which is recognized as Oxycontin was responsible for this death but in recent times, we have been having an increased rate in the use of fentanyl and although these deaths are painful, we could say that misprescription of drugs to patients, the greed of the pharmaceutical companies, malpractice, and illicit production of fentanyl and illegal imports into countries. According to the Centers for Disease Control and Prevention, Fentanyl which is a synthetic opioid is 50 times stronger than heroin and 100 times stronger than morphine. It is so powerful that about 2 milligrams of fentanyl can be a fetal dose to a person.
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Morphine, Heroin, and Codeines are Opiates which are natural chemical compounds extracted from plant poppy sap and fibers. Opioids are compounds that bind to opioid receptors. The body makes opioids naturally, known as endogenous opioids and endorphins are one of them, others are enkephalins, Dynorphins, nociceptins, and endomorphin's. Opioids work on pain, as pain triggers the sensory neurons which synapse with the neuron where is signal is now sent to the thalamus where it is sent to the primary somatosensory cortex and the amygdala causing the knowledge of pain and the sense of unhappiness. The thalamus sends signals to the periaqueductal gray matter in the midbrain of the brainstem. From the gray matter, the signal would be sent to the spinal cord and to the substantia gelatinosa where the endogenous opioids are released to help reduce the pain as it binds with opioid receptors. Neurons would either send excitatory or inhibitory signals. Glutamate is an excitatory signal and GABA is an inhibitory signal.
Opioid receptors include the Kappa, Delta, and Mu receptors but the Mu receptor is the receptor that Fentanyl binds to most although it binds to all the receptors and they are found everywhere in the body. With Opioids, they bind with the receptors in the ventral tegmental area stopping the secretion of GABA thereby causing the release of dopamine in the nervous system giving that pleasure feeling. This is what leads to addiction to Opioids as you would keep taking more of the opioids so as to meet the dopamine needs in case of resistance.
Drugs like fentanyl are to be prescribed in extreme cases such as cancer pain, Preoperative analgesia, Anesthesia adjunct, Postoperative pain control, Regional anesthesia adjunct, and other serious pains and since it is addictive, people can easily overdose on it. Overdose of Opioids can lead to respiratory depression and it can be fatal but Naloxone is a way out of this overdosing on Fentanyl as it would bind to the receptor, preventing the binding of morphine and fentanyl. Fentanyl or other opioid withdrawal can be unbearable, as there will be pain signals sent in the neuron since the neurons were in the past not used to pain.
Opioids cause reduced movement of food in the intestine which would lead to constipation. Misusing opioids can lead to opioid tolerance, dependence, addiction, and overdose. With tolerance, more opioids need to be taken to get the drug to function well. If this continues, it would lead to dependence, and opioid withdrawal can lead to anxiety, relentlessness, muscle aches, apnea, nausea and vomiting, stomach cramps, runny nose, and dilated pupils. Overdose can lead to confusion, constricted pupils, slow breathing, and death.
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