Most People Don’t Feel Euphoric From Opioids

Most People Don’t Actually Feel Euphoric When They Take Opioids, Study Finds | Live Science –  By Nicoletta Lanese – Oct 2019

Opioids are known to spark feelings of euphoria in users, but does everyone really share the same experience?

Opioids jump-start the brain’s reward system, provoking a burst of pleasurable feelings along with a dizzying drug-induced high. At least that’s what scientists used to think

But mounting research suggests that the average person doesn’t actually reach this euphoric state on opioids, particularly not the first time they try it. In fact, people who are not addicted to opioids may feel subjectively worse after taking the drug, according to cognitive neuroscientist Siri Leknes.   

“I think that the notion that opioids [always] cause pleasure is a myth,” said Leknes, who is a principal investigator at the University of Oslo in Norway.

I’ve been complaining about this myth since 2017: Opioids + Pain != Euphoria

An individual’s reaction to opioids depends on many interwoven factors, such as where the person is, their mood, previous drug exposure, genetics and metabolism, she explained

Leknes presented her preliminary findings on Oct. 20 at the annual meeting of the Society for Neuroscience in Chicago. Specifically, her new work investigates the effects of the drug remifentanil, an opioid commonly given before minor surgical operations to relieve pain, ease anxiety and boost the effects of anesthetics, according to the Mayo Clinic.

Once administered, remifentanil flips switches in the body and brain known as mu-receptors, according to the U.S. National Library of Medicine

But cells bearing mu-receptors also link up to the brain’s reward system and can spark feelings of intense pleasure, or euphoria, according to the National Institute on Drug Abuse. Opioid users can get hooked on this euphoric experience, develop drug cravings and dependence over time, and continue taking the drug to avoid withdrawal symptoms as their tolerance builds. 

Brian Kiluk, a clinical psychologist and psychiatry professor at Yale School of Medicine, who was not involved with the new study.

Not everyone experiences the same level of euphoria from opioids, and not everyone that uses opioids will develop an addiction or opioid use disorder,” Kiluk told Live Science in an email. Scientists are still unpacking exactly why individuals react differently to the drugs, he said.

But so far, most opioid research has been conducted with current or former addicts as participants, Leknes said, with some studies going so far as to only include participants who say they enjoy taking the drugs.

Using such a strongly skewed group of participants for a scientific study on opioids assumes that addicted people take opioids for the same reasons, in the same amounts, with the same effects as pain patients.

It violates scientific methods to do a study based on such biased population samples, but with all the anti-opioid fever these days, researchers seem blind to their own bias.

That would certainly explain many of the strange and unfamiliar results I see in research on opioids.

This bias in the literature may make opioid-induced euphoria seem commonplace, Leknes said, but she wondered whether the average healthy person finds bliss while hooked to an opioid drip. 

So, Leknes and her colleagues studied how 160 patients reacted to remifentanil before undergoing minor surgery.  …asked the participants to rate how good and how anxious they felt before the drug was administered

One to 2 minutes after the infusion, the drug took full effect, and Ernst asked the same questions again, as well as how much the patients “liked” the drug effects, what level of drug-related discomfort they experienced and how high they felt. 

Across the board, the patients reported feeling high after receiving remifentanil, but on average, they actually felt 0.5 points worse on a 10-point scale after taking the drug

Both ratings of liking and disliking the drug effects hovered around 5 on the 10-point scale. 

A small subset of people did report feeling slightly better after the drug was administered, but even these participants still gave the experience a 5 out of 10 on the “liking” scale.

In other words, clearly no one reached euphoria on the operating table in the course of the study.

A 2008 study backs these preliminary findings, having found that infusions of remifentanil left healthy volunteers feeling negative and ill at ease rather than euphoric

Leknes’ lab found that the opioid morphine only modestly improves a healthy person’s mood — when it elicits any change at all.

When opioids improve a patient’s mood it’s because their pain decreases. This is why we “like” opioids: they reduce our pain which improves our mood.

I also find myself energized when the medications are working well and my pain is truly minimal. Normally, I have enough pain that it makes me reluctant to move and exhausts me, but during the rare times when I get “real relief,” I don’t notice the pain relief as much as I notice myself suddenly getting very busy and productive.

It’s only when I marvel at my energy that I realize my pain is gone.

The drugs also appear to suppress negative responses to stimuli while boosting positive ones, which “may be one of the reasons behind the first opioid experiences developing to an opioid use disorder,” the authors wrote.  

Going forward, Leknes aims to learn how the effects of opioids change, depending on a person’s current mood and setting. For instance, while some people first encounter opioids in a sterile, scary clinical setting, college students “generally seem to take opioids before going out,” she said. Both sets of people may run the risk of developing an opioid addiction, but their roads to dependence likely diverge. How does euphoria fit into each experience?  

“I think it’s especially important to point out that opioids do not reliably cause pleasure or relief of subjective stress and anxiety in the lab or in stressful clinical settings,” Leknes added

“The notion that people become addicted to drugs because they initially chose to take these drugs for pleasure is a belief that stems from a different time, in which we believed addiction to be a moral issue.

A belief is not a fact! Scientific folks should understand the difference and not assume that “if I believe it, it must be true”.

This sort of hubris seems like a job requirement for politicians and policymakers, but serious researchers should know better.

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