Opioids mimic naturally produced endorphins to dull pain.

The story of Marie Nyswander, the woman who co-discovered methadone maintenance

Methadone, an opioid with distinct effects from heroin, revolutionized heroin addiction in the 1960s. Marie Nyswander was a psychoanalyst who helped discover the treatment process which is still in use today. Here's a podcast episode examining her life and role in the field of addiction treatment.

Naltrexone blocks the reward effects of alcohol and opioids

Naltrexone is used to treat alcohol and opioid dependence, blocking opioid receptors in the brain, reducing cravings, and preventing the euphoric effects of alcohol or opioids. It is nonaddictive and works best as part of a comprehensive treatment plan, including counseling or therapy, to support long-term recovery.

Fentanyl is better at crossing the blood-brain barrier than other opioids

Among opioids, fentanyl is uniquely adept at crossing the blood-brain barrier—the brain's security fence against harmful substances. This enables a lightning-fast high. It ends just as quickly, sometimes within minutes (where a heroin high lasts hours), and still results in the same withdrawal symptoms.

Opioids are a class of drugs including fentanyl, heroin, oxycodone, and more.

Why the human brain loves opioids

When opioids enter the brain, they dock in receptors, blocking electrical pulses such as those that communicate pain. They also trigger the release of dopamine, a neurotransmitter tied to motivation and associated with stress relief.

Narcan is an opioid antagonist that can rapidly reverse overdoses

Naloxone, also known by the brand name Narcan, is an opioid-overdose reversal medication that typically begins working within a few minutes. An opioid antagonist, the treatment attaches to opioid receptors without activating them, forcing opioid molecules out of their respective receptors and allowing users' breathing rates to normalize.

The body produces its own opioids that act on several receptor types throughout the body, triggering the release of dopamine and suppression of noradrenaline, neurotransmitters associated with reward and alertness, respectively.

Synthetic opioids: a historical and clinical review

In the 19th century, researchers began synthesizing and isolating poppy plant alkaloids, leading to the invention of morphine, codeine, heroin, oxycodone, and others. These highly addictive variants eventually gave rise to illicit use and a widespread underground market, laying the foundation for the current opioid crisis.

Overuse of opioids can lead to hypersensitivity to pain.

Fentanyl can be up to 100 times more potent than morphine

A synthetic opioid, fentanyl is highly addictive and incredibly fast-acting—a fatal dose is equal to a few grains of table salt. Once it enters the body, fentanyl floods naturally occurring opioid receptors, which can cause the body to shut down its breathing reflex, leading to a fatal overdose.

Opium is a milky liquid substance extracted from unripe poppy plant seeds

It's been used for ages to reduce pain and induce euphoria, both of which are side effects of the plant's alkaloids—nitrogen-based compounds with pronounced physical effects. Isolating and synthesizing derivatives of these naturally occurring chemicals enabled the invention of morphine, heroin, and other opioids.

Drug tolerance and withdrawals are consequences of overloading dopamine circuits

Addictive substances or behaviors will typically flood our brains with more dopamine than usual. In response to the overstimulation, our brains will decrease the number of available dopamine receptors. This results in the need for more stimulus for the same response (tolerance) and a rise in negative feelings when the stimulus is absent (withdrawal).

Morphine, heroin, codeine, and more were derived from opium

Opium reached the US at about the time early colonists were itching for ways to soothe aches and pains. The active ingredient in the substance was isolated in the early 19th century, eventually leading to the manufacture and commercial sale of morphine, heroin, and other opium-based drugs.

Why are drug dealers putting fentanyl in everything?

A few grains of fentanyl, a synthetic opioid far more potent than heroin or morphine, are enough to kill a typical adult human. It's made its way into other, less lethal street drugs, where it may be used to increase the highs experienced by unknowing users, increasing their likelihood of addiction and overdose.

Addictive drugs can cause dopamine levels to become ten times higher than normal.

Why is fentanyl poisoning street drugs?

A few grains of fentanyl, a synthetic opioid far more potent than heroin or morphine, is enough to kill a typical adult human. It's made its way into other, less lethal street drugs, where it may be used to increase the highs experienced by unknowing users, increasing their likelihood of addiction and overdose. This 39-minute podcast episode is the first half of a two-part series exploring fentanyl's rise.

From prescriptions to street drugs: Opioids trajectory across America

Exclusive data obtained by The Washington Post from the Centers for Disease Control and Prevention shows how individual counties moved through three waves of the opioid crisis, each wave paving the way for the next. Between 2011 and 2017, the drug responsible for the majority of overdose deaths shifted from prescription pills to heroin to fentanyl. Together, oxycodone, hydrocodone, heroin, and fentanyl have been major drivers in declining life expectancy in the US.

The three waves of the opioid crisis: overprescription, heroin, and fentanyl

The US opioid crisis has unfurled in three distinct waves, each spiraling into an epidemic that's killed millions. The first crested in the 1990s with the overprescription of opioids for pain relief. The second manifested as heroin overdoses in the 2010s. The third began in 2013 with the rise of deaths related to tramadol and fentanyl.

Fast, cheap, and deadly: How fentanyl replaced heroin and hooked America

This interactive article details how fentanyl has largely replaced heroin in the drug trade, with fatal results. Fentanyl was first developed in 1959 as an anesthetic for pain relief, but the drug took hold in the US black market in 2014 and has since exploded in the intervening decade.

Drugs 101: An interactive guide

What's the difference between opioids and psychedelics? This guide details specific drugs and their various associated effects. Drugs in this wheel fall into seven categories: stimulants, depressants, empathogens, psychedelics, dissociatives, cannabinoids, and opioids.

DBS effectiveness in treating addiction remains uncertain amid inconsistent results

Critics argue that deep brain stimulation should be considered a last resort and not a scalable solution, given its high costs and trials limited to small samples. However, it has helped some patients manage severe opioid use disorder when conventional methods didn’t work.

Learn about the US opioid crisis in this free course

Where did the US opioid crisis come from, and how did it spread? Learn this and more in this free, online Harvard University course. Learn about the disease model of addiction treatment and management, and get up-to-date with public health and law enforcement's current harm reduction practices. This free resource gives users a greater understanding of opioid addiction and the epidemic still haunting the US.

Opioid prescription rates by states and counties

The origins of the US' ongoing opioid crisis are typically traced to the more than 1 billion prescription pain pills that flooded medicine cabinets between 2005 and 2019. This prescription opioid epidemic resulted in more than 210,000 fatal overdoses and set the stage for the ongoing crisis fueled by heroin and fentanyl.

Ibogaine is being investigated for treating mental health issues and substance abuse

This compound, which is illegal to use in the US, has had promising results for patients who have tried it in other countries for substance abuse and mental health concerns. This psychoactive substance is not without risks, however; this TED talk points out it's also caused fatal cardiac arrhythmias and shouldn't be taken without medical supervision.

Evidence of opium use dates to as early as 5000 BCE

Archaeological evidence shows the use of the poppy plant for its pain-killing properties likely originated in the Mediterranean before making its way to the East and West via trade. It has since inspired two eponymous wars, and highly addictive derivatives of the naturally occurring substance have led to an ongoing overdose crisis.

Addiction develops when the pleasure circuits in the brain get overwhelmed

Normal pleasure circuits become overwhelmed by addictive substances, triggering dopamine floods many times stronger than those induced by everyday reward experiences. The understanding of addiction as a brain disease has led to treatments pairing medication and counseling.

Drug trafficking in the MENA

The Middle East and North Africa is a major source, transit point, and consumer of illicit drugs. Despite having some of the harshest penalties for drug-related crimes, the region both influences and is negatively impacted by illicit substance abuse...

One person dies from opioids every 7 to 8 minutes

This collection of infographics by the National Institute for Health Care Management helps put the crisis into perspective. The opioid epidemic has had three waves. Opioid-related deaths increasingly involve synthetic versions of the drug class, contributing to 83 percent of all opioid-related deaths in 2020. Use these infographics to learn more about the crisis.

The Cincinnati Enquirer's Pulitzer-winning look at the opioid epidemic

Synthetic opioids kill someone in the US every 16 minutes. Communities across the country have been ravaged by deaths, overdoses, jail time, and babies born with drug-related medical problems as opioid abuse became a typical feature of many American towns. This seven-part exposé provides an inside look at the effect in southern Ohio and northern Kentucky.

Mifepristone, approved in 2000, is used to end early pregnancies

The drug works by blocking progesterone, a hormone that is needed to support pregnancy. Mifepristone is typically used in combination with a second drug, misoprostol, because this regimen often causes less cramping and bleeding than just using misoprostol alone.

Opium's history traces from religious use to mass-market commercial products

Religious or medical use of opium was present across Europe and Asia as early as 5000 BCE. By the 16th century, humanity had come to see opium as more than medicine: It was a marketable product. This perspective also defines today's relationship with opioids, highly addictive painkillers at the heart of an ongoing drug crisis.

This is the human brain on the world's strongest psychedelic

Within seconds of inhaling a high dose of vaporized synthetic 5-MeO-DMT—a lab-produced substance that otherwise is naturally derived from the glands of the Colorado River toad—it induced slow brain waves. Such waves are typically associated with unconsciousness due to a coma or anesthesia, perhaps explaining why users describe feeling like everything falls away. The compound is currently in clinical trials for treating depression.

How the Myanmar coup fueled a rise in illegal drugs

According to the UN, Myanmar remains the world’s second-largest producer of heroin. Inside Myanmar, almost all the drugs come from one place: Shan state in the Golden Triangle region, south of China, where Myanmar meets Thailand and Laos. The...

​Why heroin became associated with the grunge world

The drug was popular with several Seattle acts in the early 1990s, with artists like Hole's Courtney Love even publicizing her use in a magazine profile. A 1992 New York Times story on Seattle said the city's principal drugs were "espresso, beer, and heroin."

Anesthetics slow brain activity by promoting inhibitory neurotransmitters

Drugs like propofol and isoflurane increase activity at the GABA receptor, which opens chloride channels. These ions enter neurons and hyperpolarize them, making them less likely to fire. Dexmedetomidine instead blocks norepinephrine receptors in the brainstem to sedate patients.

Ibogaine, a psychedelic substance, can be used to treat mental illness

Although the substance is banned in the US, it's legal in Mexico. Americans who have traveled there for treatment, including the NFL's Braden Smith, say the drug helps deal with conditions like obsessive-compulsive disorder.

Psychedelic DMT—part of ayahuasca—shows antidepressant promise in small clinical trial

Proponents say this short-acting psychedelic, formally known as dimethyltryptamine, could be particularly promising for medicinal use because longer-acting psychedelics can sideline someone for hours after a treatment with hallucinations. DMT is the primary psychoactive ingredient in ayahuasca, a psychoactive brew used across various South American cultures for spiritual, social, and medicinal purposes.