Your brain on drugs: Seeing addiction as a disease

As part of the Opioid Policy Fellows program presented by the National Conference of State Legislators, Arizona State University Professor Foster Olive presented about the current status of addiction as a disease of the brain in the context of the opioid epidemic to state legislators from 13 states. Olive is the lead investigator of the Addiction Neuroscience Laboratory, where he researches how abused drugs affect the brain on a neurobiological level and what brain changes contribute to addiction in the long term.

The Opioid Policy Fellows program is designed to support legislators who are experienced or emerging leaders on opioid addiction and overdose issues, providing research-based tools and evidence about how to better manage and deal with the crisis.

The Centers for Disease Control and Prevention reported that opioid use disorder and overdose now costs the U.S. taxpayer over $1 trillion annually, from either direct health costs, lost employment, crime or incarceration.

“We're in what is now becoming known as the fourth wave of the opioid epidemic. The first wave was the over-prescription of analgesics like oxycodone, morphine and hydromorphone, which led to  dependence and a false sense of security in terms of using them,” Olive said. ”This dependence led  people to turn to street heroin. From there, it's evolved into problems with fentanyl, which is a synthetic opioid drug that is so potent that it's life-threatening at even very small doses.”

As a result of the pandemic, there has been a massive spike in opioid-related deaths, due in part to people who previously had access to treatment facilities no longer being able to find care. According to the Substance Abuse and Mental Health Services Administration, in 2020, 41.1 million people needed substance use treatment, yet only 4 million received any type of substance use treatment, while only 1 million received treatment at a specialty facility.

While many people are aware of famous celebrities such as Mac Miller, Tyler Skaggs, Prince and Tom Petty all dying from accidental fentanyl overdoses, the lesser known fact is that approximately 9.5 million people abused opioids or prescription drugs in 2020, including 100,000 fatalities.

“The Opioid Policy Fellows program is tasked with educating and implementing policies related to opioids throughout the country at the state level. Every state has their own boards of certification of physicians and doctors, with licensing and oversight over pharmacies as well as recordkeeping. Additionally, they each have their own branches of the Drug Enforcement Administration. That’s a lot to juggle,” Olive said. “There’s a lot of things to do in terms of getting opioids to be up to the current level of control that we need."

Olive’s talk was called "The Brain Science of Addiction," and it was designed to inform the layperson about how drugs change the brain and to what degree, and also to inform them about the idea that addiction is becoming increasingly viewed as a disease or a disorder of the brain.

“Addiction really is a disorder of the brain, and not just a character flaw or a moral weakness,” Olive said. “Some people think by having a disease model of addiction that it absolves them of any accountability, which is also not the case. It is definitely a balancing act.”

During the hourlong presentation, Olive answered specific questions from state legislators that centered on the implications of state level policy, the history of opioid and fentanyl addiction, and considerations for future research.

One of the key benefits of treating addiction like a disease is the fact that coverage can fit under an insurance umbrella, where it would previously not be covered. Treatment facilities can cost as much as six figures, and the average person will likely not be able to afford that independently.

“A lot of people think that addicts are essentially junkies living in the street, but honestly, it affects all levels of society and is sometimes very hard to spot,” Olive said. “And when you view it as a medical disease, it provides context for these people who are taking drugs repeatedly in dangerous situations and ruining their lives, yet they still continue using. Viewing addiction as a brain dysfunction or disorder has led to a lot of advances in terms of how we think about it and not alienating people who are in need.”

Teaching 'Your Brain on Drugs'

Olive also teaches an upper division neuroscience course for undergraduates called Your Brain on Drugs, referring back to a 1980s public safety announcement of the same name. In the PSA, the brain was likened to an egg that was dropped into a skillet and fried. The commercial then ends with the speaker saying, “This is your brain on drugs. Any questions?”

This course was previously only available to students on campus, but is slated to launch as an online course as part of the online neuroscience bachelor’s degree.

“It has been an interesting challenge to reconfigure course content to fit the online modality, such as discussion groups and online tests, but I’m excited for it,” Olive said.

The curriculum focuses on what happens to the brain when it is exposed to specific drugs and informs students of the realities of the science, rather than resorting to scare tactics. Olive explores all the major categories of abuse drugs and how they affect the brain at a general biological level, but without extensive molecular and cellular detail.

“The course is designed to take people through how the brain works, how nerve cells work, how the chemical communication takes place between neurons and the how drugs actually interact with the chemistry of the brain to produce their effects, while also diving into the long-term effects of drug use,” Olive said.