Two μ-opioid receptors dimerize (blue and purple), according to an X-ray crystal structure.

Opioid Addiction and the Myth of Powerlessness

There is a belief that those of us with an opioid addiction, that we are powerless over our addiction. That is a myth. We are not powerless. But we appear powerless because the prohibition laws of this country rob us of our power.

I began shooting heroin and Dilaudid in 1976 and I used for 35 years. During the first 13 years I used occasionally, never enough to develop a problem. The last 22 years I was strung out, living an addiction. And the world we live in, those of us with an opioid addiction, is very different from the world of “normal” society. The norms by which we live are very different from the norms of that society. They must be. We live in a world where to get what we need we must buy and sell in a black-market while being hunted by people that want to put us in a cage for being who and what we are. The rules we live by are forced on us by prohibition, criminalization, and stigmatization. We are robbed of our autonomy. We are robbed of our power. We behave exactly as we are forced to behave, and we are then punished for doing so.

People say we are powerless over our addiction because we continue to use even while experiencing negative consequences. But we don’t continue to use because we are powerless, but because we are starving. We are all born with an endogenous (from within) opioid system which means that you have opioids in your brain and body. These are the opioid neuropeptides: Endorphins, Enkephalins, Dynorphins, and Endomorphins. One of the most important of these is beta-endorphin as it is the opioid neuropeptide that activates the mu-opioid receptor site. The mu receptor mediates, among other functions, those of analgesia and euphoria (which is why there has yet to be an opioid analgesic that doesn’t also produce euphoria. The same receptor site mediates both functions). These opioid neuropeptides bind with (activate) opioid receptor sites (the mu, delta, and kappa receptor sites) that exist along neurons that are located in distinct regions of our brain and body (For review see Here and Here). This endogenous opioid system regulates many functions that are necessary for our survival. Among others, these include ionic homeostasis, pain modulation, emotions, feeding, respiratory control, cardiovascular regulation, immune function, social motivation, social bonding, our stress-response, as well as pleasure and euphoria. Obviously, this endogenous opioid system isn’t in our brain and body just to take up space. It mediates many functions that are necessary for our survival.

For people like me, those who develop an opioid addiction, we have shut our endogenous system down by continually flooding our brain with increasing amounts of these exogenous (from without) opioids, e.g., heroin, oxycodone, fentanyl, morphine, etc. These exogenous opioids bind with the opioid receptor sites and over-activate this endogenous system. In response to this overactivation, our opioid receptor sites become downregulated and desensitized (Here and Here) and less of our naturally occurring beta-endorphin is produced (Here). For most of us, we reach a point where we are using massive doses of oxycodone, heroin, fentanyl, and other opioids not to feel good, not to be “high,” but to be normal. We have shut our endogenous opioid system down to the point that it is non-functional. We must continually flood our brain with these exogenous opioids to replace the beta-endorphin our brain is no longer producing and to bind with and continually activate our remaining functioning opioid receptors or we starve. This starvation, it’s called craving.

Craving serves a function. Its function is to force us to focus on what we need to survive. Let’s say that someone is starving for food. They’re going to be craving food. If someone is dying of thirst, they’re going to be craving water. If someone is freezing to death, they’ll be craving warmth. And that person starving for food, the greater their starvation the greater their craving for food. Everything else in their world, their home, job, family become less important as their need for food becomes more important. Their world collapses to where the only thing that matters is food.

Now let’s take this a step further. Let’s say that the only place you can get food is out of a black market where food is expensive and it is scarce. And it is illegal. It is illegal to buy out of this black market. But it’s the only place you can find food. If you were in this situation, what would you do? Would you starve? Or would you break the law and buy food, to eat and to live? Would you steal if you had to, to buy food? The answer to that would be yes. Because survival is not a choice.

I know people are saying, wait, we must have food to survive but those people don’t need opioids to survive. But that’s a misunderstanding. Our starvation for these opioids is far more intense than our starvation for food. If it’s a choice between buying food or buying heroin, then that’s not a choice. We’ll take that heroin. Every time. This is not a deficit in reasoning. This is not a failure in judgment or impulse control. It is a perfectly rational response to our starvation for these opioids. If someone who was starving for food ran into a store and stole a loaf of bread, would their behavior be deemed irrational?

If you will understand that we are starving, then you will understand why we do the things we do in our addiction. We’re not bad people. We’re just people. Just like you. But unlike you, we’re starving. This is why we hock, sell, trade everything we have. This is why we do the things that hurt the people we love. Our loved ones will say that we love our drugs more than we do them, but that’s not true. Even if you’re starving, you still love. What it does mean is that we become so desperate in our starvation that we will hurt the ones we love to end that hunger. If you have had someone you love hurt you, steal from you, lie to you, please understand that they didn’t do those things so that they could “get high.” They did those things so that they could stop the starvation. If only for a little while.

We’re not narcissistic hedonists. When we hurt the ones we love, we hurt too. And what is sad is that we don’t understand why we can’t stop. We don’t understand why we do the things we do. We don’t understand why we hurt the ones we love. We don’t understand because no one has explained to us that the changes within the brain at a cellular, molecular, level, what we call opioid addiction, is an acquired disease of brain structure and, thus, function that is manifested not as compulsive drug seeking and use but, rather, as behavior directed towards the survival of the individual.

Disease, unlike what many will say, is not a dirty word. To say that someone has a disease does not mean they are powerless. What it does mean is that for them to express their power, they must have the opportunity to do so. If someone has diabetes, we provide them with syringes, insulin, glucometers; if someone has COPD we provide them with oxygen, with pulmonary therapy, with medications; if someone has Parkinson’s or Multiple Sclerosis we provide them with medications, with physical therapy, we give them motorized wheelchairs. Now, if we took those services away, wouldn’t they be powerless? Wouldn’t their disease be out of control?

Those of us with an opioid addiction, we are not powerless, but we are denied the opportunity to express our power. Through prohibition and criminalization, we are robbed of that opportunity. Harm Reduction, the antithesis of prohibition and criminalization, gives us back our power.

If we are provided with naloxone, we save our friends and they save us. That is power. If we have access to a syringe exchange program, we avoid contracting and spreading blood-borne illnesses. That is power. If we had access to Overdose Prevention Sites, we would use them and not die. Think about that. We have to find the money, we have to buy our drugs, then we have to make the rational decision that we’re not going to use until we know that we’re in a place where if we do overdose, we won’t die. A “dope fiend” “addict” “junkie” wouldn’t do that. They would use just as soon as they could with no thought as to the possible consequences of that use because those things, they are powerless. But we are not those things. Give us the opportunity, give us the power, give us the autonomy to make a rational decision and we will. There are approximately120 Overdose Prevention Sites in this world. And we use them.

If we could remove the barriers to methadone and buprenorphine, we would use those medications to control our hunger. If we had access to pharmaceutical heroin and hydromorphone, we could use those and lead a life free of the starvation that consumes us. Yes, these are opioids, but they must be if they are to activate and normalize our endogenous opioid system. As an example, in a study determining the effects of receptor binding of buprenorphine in subjects with an addiction to heroin, an inverse relationship was found. As the proportion of opioid receptors bound by buprenorphine increased there was a corresponding decrease in withdrawal symptoms and in craving. If we’re not craving, if we’re not starving, we can function and function well.

Give us the opportunity to act rationally and we will. Give us the opportunity to show that we are nor powerless and we will. Give us back our autonomy and this myth of powerlessness will be seen as just that. A myth.

One last point. For those of you who have lost someone you love to overdose, please understand there is no blame here. However you tried to help, whatever you did, you did your best. Because that’s what love does. But also understand that we aren’t the only ones robbed of our power by prohibition and criminalization. You were denied the power you needed to save the one you love. You were denied the information, you were denied the support, you were denied the services that you needed to keep the one you love alive. And you know this: They did not deserve to die.

Dr. Sam Snodgrass received a Doctorate in Biopsychology from the University of Georgia in 1987. He was then awarded a National Institute on Drug Abuse Post-Doctoral Fellowship in the Pharmacology and Toxicology Department at the University of Arkansas for Medical Sciences. After his Post-Doc, he was asked to remain as a faculty member in this department. In 1995 he lost his faculty position due to his opioid addiction. His use of heroin and Dilaudid began in 1976. For the first13 years, his use was occasional. In 1989 he developed an opioid addiction and did not stop for the next 22 years. He is currently a member of the Board of Directors of the 501 c3 non-profit Broken No More and its subsidiary organization, GRASP (Grief Recovery After a Substance Passing).

Worked and published in the field of Behavioral Pharmacology. He is a Board Member of Broken No More/GRASP. He has a 35 year history of opioid use/addiction.