NEPA Vital Signs - Summer Fall 2018 - 40

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Wired for Addiction
"What were you thinking!!!?"
Every parent has asked this question to their child at some
point. The truth is... they weren't thinking. Although we are
born with our full complement of brain cells and the number of
connections (synapses) peaks at approximately age 3 years old,
the frontal lobe does not fully myelinate until around age 25
years old. That means the nerve cells in the frontal lobe are not
optimally connected to the rest of the brain. Since the frontal lobe
essentially controls our perception of right and wrong, teenagers
take risks that adults view as detrimental to their health and
wellbeing. When it comes to opiates, teenagers engage in risky
behavior which then affects other parts of the brain leading to a
cascade of changes that can lead to addiction.

The frontal lobe does not fully myelinate until
around age 25 years old. That means the nerve cells
in the frontal lobe are not optimally connected
to the rest of the brain. Since the frontal lobe
essentially controls our perception of right and
wrong, teenagers take risks that adults view as
detrimental to their health and wellbeing.

Opiates increase the amount of dopamine (the addiction
"hormone") in a part of the brain, the nucleus accumbens, that
results in an uncontrollable urge to use more of the drug. Add
other stresses associated with growing up and opiate use can
spiral out of control and lead to an overdose. Teenager's brains
are particularly susceptible to drug addiction which can occur
at a vulnerable time in their life.

Lastly, the concurrent use of medications that depress
brain function can lead to respiratory depression and
death. The most common example is use of narcotics and benzodiazepines (Xanax, Ativan, Valium,
Klonopin, Ambien, etc). Even at normal doses, the
combination can result in cessation of breathing and
a low heart rate. Avoid and be aware of use of this
combination of medications.

So now that we know that there is more to addiction than just
poor choices, there are steps that can be taken to reduce the risk
of addiction and overdose.

Unfortunately, there is an ample supply of illegal
opiates on the street and peer pressure and "growing
pains" along with lack of the ability to self-regulate can be a dangerous combination leading
to use of powerful opiates including heroin
and fentanyl. The potency of these particular opiates can lead to both intentional
and frequently unintentional overdose
and death. It is important that if you
suspect use of these drugs by someone
you know (or abuse of prescription opiates), you have access to
the antidote, Narcan, that can
reverse the effects and save an
individual's life.

First, avoid exposure to prescription opiates unless absolutely
necessary and only if other safer medications and interventions
have failed. NSAIDs (such as Motrin and Aleve) or Tylenol
should be considered first if there are no contraindications to
their use. Also, it is important to set expectations for relieving
pain. For example, after a traumatic injury, medications should
reduce pain to tolerable levels (rather than total elimination of
pain) along with other measures such as ice, elevation and rest.
Second, if necessary, opiate use should be limited to the minimal amount needed. The longer an opiate is used, the higher
the risk of becoming addicted. Frequently reassess use and try
other treatments in place of opiates, setting realistic expectations
of pain relief.

DR MICHAEL FOX M.D., is an Associate of Internal Medicine
at Mt. Pleasant Clinic and GIM Wilkes-Barre Outpatient.

N E PA

VITAL SIGNS

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Table of Contents for the Digital Edition of NEPA Vital Signs - Summer Fall 2018