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It is time for someone to say this out loud. “We should not use opioids for back pain.”

Back pain is a common and sometimes disabling condition that af...

No Opioids for Back Pain. Period.

August 16, 2016

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Oz and the Opium Trip

July 26, 2016

L. Frank Baum published The Wonderful Wizard of Oz in 1900. I'm sure a few people reading this have read the book and I know that most have seen the movie classic with Judy Garland. 


I think Mr. Baum was a genius. Three quarters of a century prior to the discovery of the opioid receptor he perfectly portrayed the purpose of those receptors. 


You remember the scene: Dorothy and her friends have been through a very difficult time in the woods. They have faced one challenging situation after another. Suddenly, they emerge from the woods and see beautiful Oz (and the opium-filled poppies). They become energetic, excited, and confident that they will soon be reaching their goal. They immediately begin skipping and singing as together they head toward Oz with renewed energy, a new confidence, and an elevated mood. 


Their opioid receptors are saturated with opium. These are also the feelings produced by our own endorphins acting on our opioid receptors. In this case, however, it was caused by the opium in the poppies. 


Opioid receptors are vitally important but often misunderstood. We think of them as the mechanism activated by opioid pain medications to help reduce our sensation of pain. But that is actually a minor role for them. 

Opioid receptors help us to achieve a goal.


To do that, they give us motivation, energy, confidence, social connectedness, a warm and contented feeling and a sense of joy. All of these help us to achieve a goal. They help us to be successful. 


Dorothy and her friends soon discover (as do people taking opioid medications) that this feeling is short lived. Soon Dorothy, the cowardly lion, and Toto all begin to slow down and soon they cannot function. (Remember that the tin man and scarecrow were not affected as they are not mammals and do not have opioid receptors. The scarecrow doesn't even have a brain!)


Fortunately for Dorothy and her friends, Glenda (the good witch) comes to their rescue with snow! When Frank Baum wrote his book, snow was - and still is - a nickname for cocaine. In those days, it was common to take opium or morphine and if too much was consumed, the overdose was reversed with cocaine! 


When we use opioids, they initially activate these opioid receptors making people feel good -whether taking them for pain or pleasure. Our bodies react to these abnormal, external substances by inactivating opioid receptors and soon we are incapable of experiencing those same feelings. That is why people using opioids long-term have higher rates of depression, anxiety, isolation, and lack of pleasure. 


As Oz taught us, those things that initially look beautiful and exciting can ultimately become frightening and destructive. Our opioid receptors are important for us to experience a happy and productive life. We must learn to protect them.

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