by Kay Miller
Back to What's MAT
Got to Do with It? Medication-Assisted Treatment for
Opioid Use Disorder in Rural America.
What Is Pain?
pain definition comes from the International
Association for the Study of Pain: “Pain is
an unpleasant sensory and emotional experience
that is associated with actual or potential tissue damage
or described in such terms.”
Experts agree pain has no objective measure and no easy
How Do Opioids Work?
Opioids don't have any direct impact on the body area
that hurts or is injured. They don't attach to a broken
bone, or to a decayed or infected tooth, or the incision
from an operation. Unlike medications such as ibuprofen,
they don't decrease inflammation that often causes pain.
Instead, when an opioid is taken as a pill, injected into
a vein, or even smoked, it travels through the blood
stream and relieves pain by acting on the brain. Once in
the brain, opioids influence the way the brain thinks and
feels about an unpleasant sensation. According to the
National Institute on Drug Abuse (NIDA), here are three
specific brain areas where opioids have
Transmits sensations from different body areas to
Dulls the pain sensation once it reaches the
Controls the body's automatic functions like
breathing, the heartbeat, and even some elements
Slows or even stops breathing. Lessens coughing.
But, here is where opioids can even stop the
brain from registering an unpleasant sensation.
Controls positive and negative emotions, mood,
learning, and memory; it also houses the brain's
circuit”: structures that
control and regulate pleasant feelings.
Creates feelings of pleasure, relaxation,
The National Institute on Drug Abuse's
Brain Disease Model of Opioid Use Disorder: Reward
Dopamine is a brain chemical that
influences the brain's reward circuit. This circuit
craves behaviors that give pleasure, like engaging with
friends, or behaviors that keep us alive, like eating.
Opioids trigger a “dopamine
flood,” and the reward circuit experiences an
intense, exaggerated sense of well-being, called
euphoria. With continued opioid use, the reward circuit
doesn't want anything to stop that dopamine flood.
Meanwhile, the brain realizes it can't tolerate that
constant dopamine flood. Eventually it decreases dopamine
production: less dopamine, less flooding, less pleasure.
The brain becomes depressed, flat, and lifeless. But the
reward circuit still craves euphoria. The new norm? A
brain that can't experience joy, euphoria that can't be
reproduced, and craving in the reward circuit that has no
brakes: the reward circuit gone wrong, creating the brain
disease that is opioid use disorder, a complex disorder
that is also influenced by various genetic and
Who is at highest risk for opioid
- Family and personal history of substance
- Those age 16 to 45
- History of preadolescent sexual abuse*
- Personal diagnosis of mental health
(Ex: Attention Deficit Disorder, Obsessive
Compulsive Disorder, Bipolar Disorder,
childhood experiences are also recognized as
a significant risk factor for developing
substance use disorders.
Opioid Risk Tool
Other drug misuse risk factors:
- Aggressive behavior in childhood
- Lack of parental supervision
- Poor social skills
- Drug experimentation
- Illicit drug availability
- Community poverty
NIDA's Science of Addiction
According to the Substance
Abuse and Mental Health Services Administration (SAMHSA),
“in 2014, an estimated 1.9 million people had
an opioid use disorder related to prescription pain
It's difficult to determine the exact number of rural
residents with OUD, but experts say there are proxy data.
Proxy measures might be found in 2013-2017
county-level overdose data since those fatality
numbers perhaps represent many who might have benefited
from MAT. Proxy numbers could be found in nonmetropolitan
drug-related incarceration rates or patient numbers
presenting to emergency rooms requesting refills for lost
prescriptions. Proxy numbers can be tracked by using a
state drug monitoring program which collects opioid
dispensing information. Or maybe OUD patients are among a
clinic's established patients who present for pain out of
proportion to a normal physical exam, with vital signs
and history suggestive of opioid withdrawal. Proxy
numbers might even include patients who finally say
“I need help.”