Pleasure into pain: the consequences of long-term opioid use

Addictive Behaviors
J M White

Abstract

One consequence of repeated drug administration is the development of adaptations in the nervous system, sometimes termed 'drug-opposite' responses. During administration, the effects of the drug are diminished by these adaptations (tolerance), while cessation of drug use results in the emergence of these drug-opposite responses as the withdrawal syndrome. Recent evidence on pain responses challenges this simple notion of withdrawal and suggests that aversive drug-opposite states may play a more important role in drug dependence than previously thought. While opioids such as heroin produce analgesia, people with a history of opioid self-administration are hypersensitive to certain kinds of pain during the time they are under the influence of the analgesic drug. This suggests that in pain systems, the drug-opposite response exceeds the pain inhibiting effect of the drug itself. This hyperalgesia is evident in people with a history of heroin use and is not modified by methadone or buprenorphine treatment but is reduced by long-term abstinence from opioids. This same pattern of the drug-opposite response exceeding the drug effect may also occur for mood. While opioids cause elevation of mood, commonly described as euphoria and red...Continue Reading

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