The Social Life of Opioids

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In the story of America’s opioid crisis a recent tripling in prescriptions of the painkillers is generally portrayed as the villain. Researchers and policy makers have paid far less attention to how social losses—including stagnating wages and fraying ties among people—can increase physical and emotional pain to help drive the current drug epidemic.

But a growing body of work suggests this area needs to be explored more deeply if communities want to address the opioid problem. One studypublished earlier this year found that for every 1 percent increase in unemployment in the U.S., opioid overdose death rates rose by nearly 4 percent.

Another recent study from researchers at Harvard University and Baylor College of Medicine reported U.S. counties with the lowest levels of “social capital”—a measure of connection and support that incorporates factors including people’s trust in one another and participation in civic matters such as voting—had the highest rates of overdose deaths. That review of the entire U.S. mined data from 1999 through 2014 and showed counties with the highest social capital were 83 percent less likely to be among those with high levels of overdose. Areas with low social capital, in contrast, were the most likely to have high levels of such “deaths of despair,” with overdose alone killing at least 16 people per 100,000

Overdose is now the nation’s leading cause of death for people in the prime of life. And suicide- and alcohol-related deaths have also risen—most dramatically in regions with the highest levels of economic distress. “It will be hard to address the addiction and overdose crisis without better understanding and addressing the neurobiology linking opioids, pain and social connectedness," says Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School.

Connecting opioid use to social stress is not a new idea. Forty years ago the late neuroscience pioneer Jaak Panksepp first proposed the now widely accepted hypothesis that our body’s naturally produced opioids—endorphins and closely related enkephalins—are critical to the nurturing bonds that develop between parents and offspring and also between monogamous mates in mammals. Panksepp’s work and that of others showed that blocking one opioid system in the brain—which relies on the mu-opioid receptor—increased the distress calls of infants separated from their mothers in species as varied as dogs, rats, birds and monkeys. Giving an opioid drug (in doses too low to produce sedation) reduced such cries.

Panksepp also observed similarities between maternal love and heroin addiction. In each situation animals would persist in a behavior, despite negative consequences, in order to gain access to solace from the partner—or the drug. But, as Panksepp (who died in April) said in an interview several years ago, major journals rejected his paper in the 1970s because editors said the idea that motherly love was similar to heroin addiction was “too hot to handle.”