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This Is How Heroin Hijacks Your Brain

When Jack O'Connor was 19, he was so desperate to beat his addictions to alcohol and opioids that he took a really rash step. He joined the Marines.

"This will fix me," O'Connor thought as he went to boot camp. "It better fix me or I'm screwed."

After 13 weeks of sobriety and exercise and discipline, O'Connor completed basic training, but he started using again immediately.

"Same thing," he says. "Percocet, like, off the street. Pills."

Percocet is the brand name for acetaminophen and oxycodone. It's a synthetic opioid – a powerful narcotic. It's one of the most commonly prescribed painkillers, and is a key factor in one of the country's most pressing public health problems – an opioid addiction epidemic. It is a crisis that started with the over-prescription of painkillers, like Percocet, and then shifted to heroin, as people addicted to prescription drugs looked for a cheaper high.

O'Connor is one of 2.5 million Americans addicted to opioids. Over three years, he detoxed from heroin and prescription painkillers more than 20 times. Each time, he started using again. So why is it so hard for opioid addicts to quit? You can boil it down to two crucial bits of science: the powerful nature of opioids and the neuroscience behind how addiction hijacks the brain.

"The first recording of opioid use was 5,000 years ago," says Dr. Seddon Savage, an addiction and pain specialist at Dartmouth College. It was "a picture of the opium poppy and the words 'the joy plant.' "

It ruined me...but I loved it

Jack O'Connor says he ended his freshman year of college as an alcoholic. He went home that summer desperate to replace alcohol with something else. And it was not hard to do. In 2012, 259 million opioid pain medication prescriptions were written – that's enough painkillers for every American to have a bottle of opioids. O'Connor got his hands on some 30-milligram Percocet.

"I ended up sniffing a whole one, and I blacked out, puking everywhere," say O'Connor. "I don't remember anything. It ruined me that time. But I loved it."

Opioids got him higher faster than any drug he had tried. And even though different drugs produce different highs, they all have the same pathway in the brain.

Credit LA Johnson/NPR
Opioids increase the amount of dopamine in a part of the brain called the limbic reward system. Dopamine causes intense feelings of pleasure and that feeling is what drives users to seek out the drug again and again.

They release dopamine, which is a neurotransmitter that causes intense pleasure parts of the brain including the limbic system, according to Savage. It links brain areas that control and regulate emotions such as the pleasure of eating, drinking, and sex. "This is a very ancient part of the human brain that's necessary for survival," says Savage. "All drugs that people use to get high tickle this part of the brain."

And because opioids are so addictive, people become physically dependent on them very quickly. Breaking that physical dependence involves a five-day physical nightmare called detox, when the body gets used to being without the drug.

"It is an amazing thing to see to see someone basically vibrating in their chair, feeling nauseated, looking like hell," says Jeffrey Ferguson, a detox specialist at Serenity Place in Manchester, N.H.

Jack O'Connor put himself through detox 20 times, but it didn't stop his addiction. O'Connor's limbic reward system had hijacked other systems in his brain – systems that drive judgment, planning and organization – driving them all to seek that pleasure of getting high. This process can go on during years of sobriety, according to Savage.

"Addiction recruits memory systems, motivational systems, impairs inhibitory systems and continues to stimulate the drive to use," she says.

Somebody's telling me I need to get high

For O'Connor, all his decisions began to serve his addiction. When he is using, he says, everything is about getting the next drink or drug.

"Mentally ... [getting high] kind of straightens out my head – or spiritually, I guess, would be the better word that," says O'Connor.

Over a couple years, O’Connor switched from Percocet to Oxycodone to heroin to get higher cheaper – a choice lots of people make. O'Connor lied to his family and stole from his job – all while also trying to get sober. A year ago, he put himself through a five-day detox clinic and managed to get through five more days in the real world sober. Then he couldn't take it. One day he started obsessively searching his credit cards for drug residue. He found a bag of heroin in his wallet.

"Somebody's telling me I need to get high," he thought at the time.

And that's what he did. High on heroin, O'Connor went to a Christmas party with his family – high on heroin – O'Connor and got really drunk on wine, then beer, then whiskey.

Beating the odds

Feelings like joy and shame also play a role in addiction, and make it hard to quit. Practical issues are a challenge, too. "Finding the job, saving money, finding a place to live," says Ferguson. "Maybe they have some felony convictions. It's a lot."

And for those who want professional help getting sober, the country is facing a shortage of addiction specialists, a shortage that ranges wildly from one state to another, even from county to county in New Hampshire. True treatment for opioid addiction is a range of services: medication, talk therapy, job support, all stretched out over years. Detox isn’t enough, says Dr. Savage. 

"For people who don't get intensive treatment, people who are just detoxified [from opioids]," says Savage, "relapse rates can be above 90 percent."

Credit Greta Rybus for NPR
Jack O'Connor poses for a photo at Bonfire House in Dover, N.H.

O'Connor finally got sober and stayed sober – January 11 is his one-year sobriety date. In that time he's been in a non-medical residential treatment program in Dover, N.H. He has support – a girlfriend, his family, the Marines. And in the same way that he once replaced his coping skills with drugs, he has now rebuilt his coping skills around quitting drugs.

"I don't need it anymore," he says. "I literally, physically and emotionally don't need it." And as much as O'Connor loves the feeling of getting high on heroin, now there is something he loves more, "I love the way I feel sober," he says.

Before joining NHPR in August 2014, Jack was a freelance writer and radio reporter. His work aired on NPR, BBC, Marketplace and 99% Invisible, and he wrote for the Christian Science Monitor and Northern Woodlands.
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