Let’s dive in and start with a brief overview of the current state of affairs related to the opioid crisis. Some of these number will shock you and some will be hard to believe. As an addiction counselor working exclusively with opioid dependent individuals I can tell you these number don’t surprise me at all. Having worked in this field for a few years now I can attest to the growing number of opioid users, especially among the populations listed below. We’ve also seen a growing number of overdose related deaths due to opioid use. To those of us working in the field, it feels like the problem is growing faster than we can treat it. If this were the Ebola virus and that was happening, we would do everything we could to contain its spread without hesitation.


Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014. From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. Four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013. 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”


In 2014, 467,000 adolescents were current nonmedical users of pain reliever, with 168,000 having an addiction to prescription pain relievers. In 2014, an estimated 28,000 adolescents had used heroin in the past year, and an estimated 16,000 were current heroin users. Additionally, an estimated 18,000 adolescents had heroin a heroin use disorder in 2014. People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative. The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007.


Opioids are a powerful class of drug that includes the illicit drug heroin as well as the licit pain relievers, such as; oxycodone, hydrocodone, codeine, morphine, and fentanyl.

Our brains have natural opioid receptor hardwired within it. Opioid receptors interact with nerve cells in the brain and nervous system, controlling pain and delivering pleasure. Everyone on the planet does this naturally through our endorphin system.

When we engage in pleasurable activities the brain releases these feel good chemicals (dopamine/serotonin) and we experience them as a reward. These chemicals are the drive behind every habit we have. We will almost always do what that which gives us the greatest pleasure or has the greatest potential for removing pain or discomfort. We are hedonic seeking creatures. It’s why we eat when we’re hungry, have sex when we’re horny, and take medicine when we’re sick.

Our natural endorphin system has three primary functions; stabilize mood, provide energy/motivation, and control pain. All necessary to live a functional, normal life. Opiate dependent individuals ALL report they stopped using heroin and pain pills to get high within months of starting. They report primarily using just to feel normal, just to get up and go to work, take care of the kids, and not be sick.


When we are prescribed or illicitly take opiates our brains hit the jackpot! Not only does this medication already belong in our systems, it’s much more powerful than the stuff we make naturally. If we take the medication or heroin long enough our brain, being a very efficient organ, will reduce or just stop manufacturing the naturally occurring chemicals and rely on you to provide it via drugs. It’s like the brain lays off all the workers and shuts down the factory.

Opiates are highly addictive because the chemical already belong there. The brain would fight off other foreign chemicals such as cocaine or methamphetamines because it sees them as a threat. But with opiates it just says, “Back that truck up and give me as much as you’ve got!” This is called dependency.

Unfortunately, the longer you use opiates the stronger the neural pathways get that support their use. Consequently, the lesser use natural pathways get weaker and less used neural pathways have a tendency to prune themselves to make room for more frequently used neurons/pathways. The brain, fueled by illicit or licit opiate use creates a superhighway that supports that drug use and he old, natural pathways are like rural back roads that aren’t driven anymore, overgrown and broken down. Even if you tried to take the old rural road it would be hard to traverse because of a lack of use.

So, now an individual is completely dependent on opiates and the brain structure has changed to accommodate this drug use. Paying for daily drugs gets expensive quickly as tolerance to the medication increases. This often leads a moral, kind, good person to do awful things they never imagined doing, such as stealing from grandmother, taking money from their kids piggy banks, selling the family jewelry, or robbing someone using physical force. All just to avoid feeling violently ill. All with the intent to make right as soon as they’re feeling better. But, that never comes. There’s always tomorrow and more sickness. The hole just gets deeper. Add to that the growing sense of shame, guilt, and remorse and you have a desperate, self-loathing person and the perfect antidote for feeling sick and hating yourself…use more drugs. Repeat. Repeat. Repeat.

If a person began using prescription pain medication and developed a dependency, it’s a short jump to heroin. Maintaining a pill addiction is very expensive and heroin is a cheaper, more powerful alternative. Once you use a needle to inject heroin, there’s no going back from there. Your life becomes a hopeless cycle of using drugs, getting high, hustling for money, getting high. Repeat. Repeat. Repeat.

Opiate use now becomes the only way for a person to function as a human. Most of the public lacks this understanding and perpetuates the false belief that if someone really wanted it bad enough they’d just stop using. Science tells us it simply does not work that way.

Tune in to the YOUTH SPECIALTIES FACEBOOK PAGE for a Facebook Live Q+A on September 26th at 3:00pm CST. We will talk about addiction and answer questions from you regarding addiction among youth and what our ministries can do to help address this growing problem.

chrisChris Schaffner is a certified addictions counselor working with chemically dependent ’emerging adults’ and is also the founder of CONVERSATIONS ON THE FRINGE. CotF is an organization seeking creative and innovative ways to bridge the gap between the mental health community and those entities (particularly schools and churches) that serve youth in contemporary society.