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Understanding the Agent, Part I: Opioid Biology and Basic Pharmacology

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Opioid Dependence

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Abstract

Safe, ethical, and effective prescription of opioids is predicated upon a thorough understanding of the biologic systems wherein/upon which they act.

Endogenous opioids are produced by the body and act as part of a comprehensive homeostatic self-preservation effort geared toward the well-being of the organism. The most salient aspect of this system is acute pain relief, but within seconds, modulating and counter-regulatory effects are initiated to balance pain relief with perception of danger thus facilitating help.

Therapeutic (exogenous) opioids exist within nature as well (e.g., opiates) and have been modified and copied pharmaceutically to harness the potent analgesic qualities of this system. Unlike the endogenous system, however, the only limitation upon exogenous opioid exposure is volitional (or imposed) discretion on the part of the consumer, and in a situation of excess exposure—whether by quantity or chronicity—both tolerance and adverse effects reduce analgesic efficacy and tip the balance of risk: benefit away from the positive. The body is prepared to some extent to reduce these potential threats by eliminating the agent metabolically. Genetic factors play an increasingly appreciated role in varying efficiency of this process from individual to individual.

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  1. Northern Anesthesia & Pain Medicine, LLC, Eagle River, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

  2. WWAMI Program, University of Washington School of Medicine, Anchorage, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

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McAnally, H.B. (2018). Understanding the Agent, Part I: Opioid Biology and Basic Pharmacology. In: Opioid Dependence . Springer, Cham. https://doi.org/10.1007/978-3-319-47497-7_2

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