Trigger Warning: This article discusses the opioid crisis, addiction, and substance use disorders, which may be triggering for some readers. If you or someone you know is struggling with substance use, please know that help is available.

If you're in London, Ontario, here are some resources that can provide support:

Merrymount Family Support and Crisis Centre: Offers various services for individuals and families dealing with addiction. Call 519-432-1112 or visit their website for more information

London InterCommunity Health Centre: Provides harm reduction services and addiction support. Call 519-660-0874 or check their website for details
Ontario Addiction Treatment Centres (OATC): Offers a range of treatment options for opioid addiction. Visit their website or call 1-877-329-0003 for assistance
Crisis Services Canada: If you need immediate support, you can call 1-833-456-4566 for 24/7 crisis support
UWO Mental Health Support - Health & Wellness: Book an appointment here with a counselor for a personalized care plan which can include referral to specialized service, outpatient/inpatient hospital referral, etc. ‘

Please take care of yourself, and remember that you are not alone in this.

How Did It All Start?

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In a quest for profit, greed and cutting corners cost lives—a truth that lies at the heart of the opioid crisis. When people say the opioid crisis began with one family, they’re not mistaken. The Sackler family, particularly Richard Sackler, was at the center of the Purdue Pharma story. Initially focused on laxative cookies, Richard Sackler grew frustrated with the slow progress of his company. This frustration fueled his desire to find an alternative to MS Contin, a prescription opioid medication that was used to treat severe pain, as their patent was about to expire. One thing led to another, and OxyContin was created, with physicians prescribing doses as high as 100 mg of oxycodone—far exceeding the 5 mg in Percocet, which contained a combination of acetaminophen and a milder painkiller.

The narrative promoted against skeptics, including some medical experts who worried about addiction risks, was that Purdue's proprietary slow-release formulation reduced the risk of addiction. However, we now know that any substance affecting the central nervous system carries a risk of addiction. The claim that this slow-release formulation sufficiently mitigated addiction potential was both unsubstantiated and overly simplistic. This ultimately snowballed into the synthesis and illicit distribution of highly potent opioids like fentanyl, giving rise to the ongoing opioid crisis—a tragic situation that continues to affect communities worldwide, especially in Canada and increasingly in London, where homelessness is a growing issue.

Why Is It So Bad—What’s the Status Quo?

The opioid crisis includes both the illicit use of drugs and the addictions that arise from medical prescriptions of opioids, typically intended for pain management. Opioids like morphine, oxycodone, hydrocodone, and fentanyl bind to μ-opioid receptors in the brain, inhibiting synaptic transmission. This inhibition helps manage pain signals from the body, such as post-surgical pain. However, due to dopaminergic modulation throughout the brain, there is a significant risk of addiction to any drug that acts centrally.

Illicit opioids, such as heroin, create intense highs and severe withdrawal symptoms. Their relatively short half-lives lead to frequent cravings—often occurring within six-hour intervals. Previously, a common method to manage opioid addiction involved prescribing other opioids with longer half-lives, like methadone. While these longer-acting opioids reduced withdrawal symptoms, they still created dependency, offering only a temporary solution.

It's also crucial to recognize that overdose clinics that provide naloxone—a receptor antagonist used to prevent opioid overdose—are still in operation today. These clinics aim to minimize preventable deaths from opioid overdoses and promote sterile practices among those struggling with opioid use disorders (OUDs), such as offering sterile needles to prevent sharing. Currently, the standard treatment for OUDs includes buprenorphine, a partial agonist combined with naloxone. Research indicates that this combination represents the most effective approach to managing OUDs to date.

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Research Spotlight: Neural Stimulation x Pharmacotherapy for OUDs

An intriguing area of research in addiction management is the use of neural stimulation techniques, such as Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), in conjunction with pharmacotherapies like methadone. Cravings are a significant symptom of both OUDs and substance use disorders (SUDs). The best-documented research in this area involves a three-month intervention using repetitive TMS (rTMS) for tobacco addiction, which demonstrated a substantial reduction in cravings.

The most common stimulation method targeted the dorsolateral prefrontal cortex (DLPFC), which is involved in executive control and impulse regulation—factors critical for resisting drug-related urges. Increased activity in this area is hypothesized to enhance executive control, thereby indirectly reducing cravings. This approach aims to manage discomfort and negative symptoms alongside pharmacotherapy, which helps mitigate severe withdrawal responses.

As TMS induces an action potential from the DLPFC, it is expected to upregulate excitatory neurotransmitter receptors, such as glutamate, in connected brain regions. The focus of ongoing research lies in exploring the synergy between pharmacological treatments and neural stimulation, including work by Dr. Martel and my forthcoming thesis project in Dr. Schabrun’s neuroscience of pain lab.

Where Do We Go from Here?

The implications of this research are significant for improving treatment strategies for opioid addiction, whether through gradual or abrupt dose reductions, managing cravings, or even addressing anxiety via DLPFC long-term potentiation (LTP) or medial prefrontal cortex (mPFC) long-term depression (LTD). There is also considerable potential for the continued development of these stimulation methods, either alone or in combination with other medical interventions. Unique intersections in research fields like this pave the way for innovative solutions to complex conditions like OUDs, particularly given the intricacies of the brain.

For more information on the opioid crisis, addiction literature, and research at the intersection of these areas, check out the following resources:

American Scandal podcast series on the Opioid Crisis