00:00:00
somewhere around 70 000 or so people die
00:00:02
each and every year from an opioid
00:00:03
related overdose back in the early 2000s
00:00:06
the culprit was oxycodone an opioid that
00:00:08
most would probably recognize under the
00:00:10
name of Oxycontin but in 2013 or so it
00:00:13
was fentanyl that overtook both
00:00:15
Oxycontin and heroin on the center stage
00:00:18
in the opioid epidemic as for who's to
00:00:20
blame well it's a combination of things
00:00:22
you have pharmaceutical greed and
00:00:23
malpractice you have health care
00:00:25
providers that are over and
00:00:26
misprescribing their patients and then
00:00:28
you have a flood of illicitly produced
00:00:30
fentanyl coming from China Mexico and
00:00:33
India all of those factors were working
00:00:35
together to create the current fentanyl
00:00:37
crisis these days fentanyl is being
00:00:39
disguised as legitimate medications and
00:00:41
then being smuggled into the United
00:00:42
States and many other countries some may
00:00:45
think they're getting Xanax or Adderall
00:00:47
but instead are getting a high dose of
00:00:49
fentanyl considering fentanyl is around
00:00:51
50 times more powerful than heroin and a
00:00:53
hundred times more powerful than
00:00:54
morphine and oftentimes only two
00:00:57
milligrams of fentanyl is enough to
00:00:58
deliver a fatal dose
00:01:00
dependence and accidental overdoses are
00:01:03
skyrocketing in today's video we're
00:01:05
going to discuss the legitimate uses for
00:01:06
Fentanyl and what happens to the body
00:01:08
when it's consumed we'll see why
00:01:10
withdrawals are so brutally difficult to
00:01:12
overcome and why overdosing is such an
00:01:15
easy thing to do
00:01:17
it's going to be an important one let's
00:01:19
do this
00:01:21
[Music]
00:01:25
before we start today's video if you or
00:01:28
someone you know is struggling with
00:01:29
opioid dependency or opioid use disorder
00:01:31
and you're looking for help we've added
00:01:33
some resources to the description of
00:01:34
this video that we strongly encourage
00:01:36
you to check out let's first discuss the
00:01:38
difference between an opiate and an
00:01:40
opioid because there is an actual
00:01:41
difference between the two opiates are
00:01:43
natural compounds that come from poppy
00:01:45
sap and poppy plant fibers so this would
00:01:48
include morphine and codeine for example
00:01:50
while opioids that's more of an umbrella
00:01:52
term and it's encompassing any compound
00:01:55
that is going to bind to and have an
00:01:57
action on opioid receptors in the body
00:01:59
so that would include the natural
00:02:02
opiates like morphine and codeine but
00:02:04
also semi-synthetic opioids so that
00:02:07
would include like heroin and then fully
00:02:09
synthetic which would be fentanyl for
00:02:12
example now you may be wondering why the
00:02:14
body has opioid receptors in the first
00:02:15
place well it comes down to the fact
00:02:17
that your body makes its own opioids to
00:02:20
bind to those receptors they're called
00:02:22
endogenous opioids and I guarantee
00:02:24
you've heard of one of them endorphins
00:02:27
endorphin stands for endogenous morphine
00:02:30
but it's only one example of these
00:02:32
opioids you also have what are called
00:02:34
encephalins
00:02:35
dinorphins
00:02:36
endomorphins
00:02:38
nociceptin or also called orphanine now
00:02:42
they'll bind to those receptors and they
00:02:43
have a whole wide variety of effects
00:02:45
that we're going to discuss in a moment
00:02:47
just understand the exogenous opioids or
00:02:50
coming from an external source so this
00:02:52
is going to be like heroin morphine or
00:02:54
fentanyl will bind to those receptors
00:02:56
right so they're taking advantage of
00:02:58
something that's already there and then
00:02:59
what they do is they cause an
00:03:01
exaggerated response now to best
00:03:03
understand how opioids work and why your
00:03:05
body even bothers making endogenous
00:03:08
opioids we first need to understand how
00:03:10
pain works and is processed now we've
00:03:13
already done an entire video on this so
00:03:14
we'll go ahead and Link that up above so
00:03:17
if you want a more robust understanding
00:03:18
I strongly encourage you to check out
00:03:19
that video but in a nutshell let's say I
00:03:22
Jam my pinky finger right so I hit it
00:03:25
and that's going to send obviously a
00:03:26
painful signal up a sensory neuron and
00:03:29
that neuron is going to travel from my
00:03:30
pinky through my arm and up towards my
00:03:33
spinal cord but when it gets into the
00:03:34
spinal cord this is where it's going to
00:03:36
synapse or communicate with a secondary
00:03:39
neuron so this first neuron we call the
00:03:41
presynaptic neuron then the one that it
00:03:44
synapses with or communicates with in
00:03:47
the spinal cord is the postsynaptic
00:03:49
neuron and what will happen is this
00:03:51
postsynaptic neuron will now take the
00:03:53
signal up the spinal cord let me go
00:03:55
ahead and grab this brain here
00:03:57
and it's going to take it to the brain
00:03:59
so you're looking at the right
00:04:00
hemisphere of the brain as seen from the
00:04:02
sagittal or midline view now
00:04:05
grab my probe so what's going to happen
00:04:07
is the signal is going to travel up the
00:04:09
brain stem and it's going to go to this
00:04:10
area here called the thalamus
00:04:13
the thalamus is I you can think of it as
00:04:15
like a hub right it's going to direct
00:04:18
signals to where they need to go so what
00:04:20
will happen is a Thalamus will send the
00:04:22
signal into this region here which which
00:04:24
is called the primary somatosensory
00:04:26
cortex and this is where you are going
00:04:28
to be made aware of the fact that you
00:04:31
have a problem now some data does
00:04:33
suggest that the thalamus has some
00:04:34
awareness but if it does this is still
00:04:36
going to be where the majority of your
00:04:38
awareness is going to be but it's also
00:04:40
going to send a signal to a structure
00:04:41
that's deeper down in here that we can't
00:04:43
see called the amygdala the amygdala is
00:04:46
responsible for processing negative
00:04:47
emotions so this is what makes you not
00:04:49
very happy about the fact that you just
00:04:51
jams your finger right so that's what we
00:04:54
call the ascending pain pathway but the
00:04:57
brain or the body I should say also has
00:04:59
a descending pain pathway because think
00:05:02
about it after you've jammed your finger
00:05:04
you don't need to have that same pain
00:05:06
level as long as the stimulus is gone
00:05:09
right the painful that noxious stimulus
00:05:11
is gone
00:05:12
so what will happen is your body wants
00:05:15
to start numbing the pain with those
00:05:16
endogenous opioids so again grab the
00:05:19
brain here
00:05:20
the thalamus will send a signal and
00:05:23
it'll go down into this area here this
00:05:26
is called the midbrain of the brain stem
00:05:28
and in the midbrain is what is called
00:05:31
gray matter gray matter is just a
00:05:33
location where cells are synapsing with
00:05:35
each other but this gray matter is
00:05:37
called the peri-aqueductal grain you're
00:05:39
not really going to be able to see that
00:05:40
all that much in this this section here
00:05:42
but from there a signal is going to be
00:05:45
sent down the brain stem down the spinal
00:05:48
cord and go to that location in the
00:05:51
substantia gelatinosa where those two
00:05:53
neurons were communicating with one
00:05:55
another and it's at this site that the
00:05:58
endogenous opioids will be secreted and
00:06:01
it does this to modulate the pain and I
00:06:03
say modulate on purpose it's not like
00:06:05
it's getting rid of the pain right just
00:06:07
if you jam your finger and then wait two
00:06:10
minutes it's not as though the pain is
00:06:11
just completely gone they're still going
00:06:13
to be pain there and depending on how
00:06:15
bad you jammed your finger the pain
00:06:16
could be much worse so this is where the
00:06:18
opioids will bind to receptors that that
00:06:20
we're about to discuss and changes your
00:06:23
perception of the pain which is
00:06:26
absolutely fascinating now without
00:06:28
getting too far into the weeds when it
00:06:30
comes to how this synapse and Signal
00:06:32
modulation Works what's being
00:06:34
communicated between the pre and the
00:06:36
postsynaptic neuron are
00:06:37
neurotransmitters now there's a lot of
00:06:40
different types of neurotransmitters out
00:06:41
there but the ones that are going to be
00:06:42
interesting or important to us are going
00:06:45
to be glutamate and Gaba more so Gaba
00:06:48
than glutamate just think about it like
00:06:50
this a signal when it's being sent
00:06:52
between neurons can either be excitatory
00:06:54
or inhibitory if it's excitatory it's
00:06:57
just saying let's keep this signal going
00:06:59
if it's inhibitory it's same let's stop
00:07:01
this signal so if glutamate is released
00:07:05
between in the at the synapse that's an
00:07:08
excitatory signal but if Gaba is
00:07:11
released that's an inhibitory signal so
00:07:13
I want you to think about this for a
00:07:14
second
00:07:16
if you were able to prevent glutamate
00:07:19
from being released that would also
00:07:21
inhibit the signal or if you were to
00:07:25
prevent Gaba from being released that
00:07:27
would also excite the signal right and
00:07:30
continue the signal on and this is where
00:07:33
opioids are going to do their thing now
00:07:35
the way that opioids are able to have an
00:07:37
effect or modulate the signal at the
00:07:39
synapse is through those opioid
00:07:41
receptors now depending on where you
00:07:43
look you may see as many as five
00:07:44
different types of opioid receptors and
00:07:46
each of those have their own subtypes
00:07:48
but for our purposes today we're going
00:07:50
to focus on three of them and that's
00:07:51
going to be the MU receptor the Delta
00:07:54
receptor and the Kappa receptor although
00:07:56
we're primarily going to be focusing on
00:07:58
the mule receptor because that is the
00:07:59
most well studied and also happens to be
00:08:01
the receptor that fentanyl prefers
00:08:04
although fentanyl will definitely choose
00:08:06
all three of them but again it prefers
00:08:07
that mu receptor now you're going to
00:08:09
find the MU receptor and these other
00:08:11
receptors throughout the entire body but
00:08:14
they're going to be in different
00:08:14
densities so so with the MU receptor
00:08:17
you're going to find a lot of them in
00:08:18
the digestive system which actually
00:08:20
makes a ton of sense if you understand
00:08:22
that opioid usage comes with some pretty
00:08:24
intense constipation and peristalsis
00:08:26
type of issues
00:08:28
but when it comes to the nervous system
00:08:29
you're also going to find mu receptors
00:08:31
in the substantia gelatinosa right that
00:08:34
spinal cord where those two neurons are
00:08:35
communicating again makes a ton of sense
00:08:38
when it comes to the brain I'm going to
00:08:40
grab this hemisphere again
00:08:42
you're going to find mu receptors in the
00:08:44
brain stem which is one reason that
00:08:46
you're going to have issues with
00:08:48
breathing and we're going to see that
00:08:49
when we get to overdosing here in a
00:08:51
moment but you're also going to find new
00:08:53
receptors in the thalamus as well as the
00:08:56
cerebral cortex but the MU receptors
00:08:58
that are in the cerebral cortex are
00:09:00
primarily going to be associated with
00:09:01
pain processing which makes perfect
00:09:03
sense because one of the reasons or
00:09:05
actually the main reasons you take an
00:09:06
opioid is for analgesia but you're also
00:09:10
going to find mu receptors in another
00:09:12
pathway
00:09:13
and that is going to be What's called
00:09:16
the mesolimbic pathway the mesolimbic
00:09:18
pathway is right here actually so
00:09:20
there's a there's an area here in the
00:09:22
midbrain of the brain stem called the
00:09:24
ventral tegmental area
00:09:26
and the ventral tegmental area is
00:09:27
actually going to be communicating with
00:09:29
another area right about here again it's
00:09:31
going to be deep called the nucleus
00:09:33
accumbens
00:09:34
and what will happen is it will actually
00:09:36
be secreting Gaba to the nucleus
00:09:39
accumbens among other areas and if you
00:09:41
recall me saying Gaba is inhibitory so
00:09:45
when Gaba is being secreted it's telling
00:09:47
the other neuron to not secrete what
00:09:49
it's going to secrete well in this case
00:09:51
the nucleus accumbens secretes dopamine
00:09:55
so right now right unless you're doing
00:09:58
something very pleasureful and joyful
00:09:59
you're probably not secreting dopamine
00:10:01
but let's say you enjoy some chocolate
00:10:03
right we all know chocolate's amazing so
00:10:05
if you were to consume some chocolate
00:10:06
what's going to happen is the ventral
00:10:08
tegmental area will say let's we can
00:10:10
enjoy this moment and it's gonna and
00:10:12
it's gonna stop secreting Gaba which
00:10:14
will then allow this neuron the neurons
00:10:16
here to start secreting dopamine well
00:10:19
opioids are going to do the same thing
00:10:20
what's going to happen is they are going
00:10:22
to bind to new receptors in the ventral
00:10:25
tegmental area which will then stop Gaba
00:10:28
secretion which will then cause dopamine
00:10:30
release and flooding into the nervous
00:10:33
system and this is the basis of
00:10:35
addiction
00:10:36
right because it feels amazing and this
00:10:38
is what you'll see pretty much anyone
00:10:40
who consumes opioids in their fur when
00:10:41
they're beginning to consume opioids is
00:10:43
that it feels fantastic the problem is
00:10:46
that you're gonna have to start taking
00:10:48
more and more of the substance whatever
00:10:50
it is and again it's not just opioids
00:10:52
that do this right there's a vast array
00:10:53
of substances that will affect this
00:10:55
mesolympic or this reward pathway but
00:10:58
when you start to you know getting tons
00:11:01
and tons of dopamine surges you're gonna
00:11:03
have to start taking more and more to
00:11:04
get the same dopamine surges and that is
00:11:08
the basis of addiction at least in terms
00:11:10
of pleasure joy and eventually just
00:11:13
outright need now you may be wondering
00:11:15
why fentanyl is even available given how
00:11:17
extremely powerful it is if you recall
00:11:19
me saying earlier it's around 100 times
00:11:22
more powerful than morphine although I
00:11:23
have seen some texts suggest that it
00:11:25
could be as high as 400 times as
00:11:27
powerful although they weren't perfectly
00:11:29
clear if that was fentanyl or
00:11:30
derivatives of fentanyl because as
00:11:32
depressing as this is there are even
00:11:34
more powerful synthetic opioids than
00:11:36
fentanyl out there and they are on the
00:11:38
street just as fentanyl is but you have
00:11:41
to understand that fentanyl is supposed
00:11:42
to be administered under very specific
00:11:44
circumstances and so like think like
00:11:46
extreme pain maybe someone has been
00:11:49
taking morphine a lot of morphine for
00:11:51
their pain eventually they become
00:11:53
tolerant to it they need something
00:11:55
stronger maybe they have cancer pain
00:11:58
right because cancer can be
00:11:59
extraordinarily painful fentanyl has
00:12:02
some great usage for that you'll also
00:12:04
see fentanyl be administered by
00:12:05
anesthesiologists maybe someone's going
00:12:07
under the knife or maybe they're having
00:12:09
an epidural for some for some reason so
00:12:11
there are plenty of use cases for
00:12:14
Fentanyl and they have been used in very
00:12:17
good ways right and very controlled and
00:12:20
proper ways but it's just not meant to
00:12:22
be where it is today and you can see why
00:12:24
that is such a problem because of that
00:12:26
right it's so easy to overdose on
00:12:28
fentanyl like extremely easy to overdose
00:12:30
if you recall me saying
00:12:32
opioids can actually have an effect on
00:12:34
the respiration centers of the body so
00:12:36
in the brain stem but also into an area
00:12:38
called the hypothalamus so you have to
00:12:40
understand that right now as you're
00:12:41
breathing your body is you know like
00:12:44
monitoring everything right you have
00:12:46
respiratory rhythms going from to your
00:12:49
diaphragm coming from the brain stem
00:12:51
same Breathe In Breathe Out breathe in
00:12:54
breathe out right your brain is
00:12:56
monitoring how much carbon dioxide is
00:12:58
actually in your bloodstream and so then
00:13:00
that when carbon dioxide starts to
00:13:02
increase it'll actually reflexively
00:13:04
cause you to inhale oxygen or exhale the
00:13:07
carbon dioxide and inhale oxygen but if
00:13:10
you have if you're going if you're
00:13:12
overdosing on an opioid that can get so
00:13:14
saturated by the opioids themselves that
00:13:17
you can't overcome that and so what will
00:13:19
happen is you will actually die from
00:13:21
respiratory depression right you
00:13:23
literally cannot breathe because the
00:13:25
opioids have completely saturated the
00:13:28
those areas right the opioid receptors
00:13:30
on those areas and the only way out of
00:13:32
that
00:13:33
is with another opioid called naloxone
00:13:35
also sometimes people call it Narcan
00:13:37
that's a brand of it so what they'll do
00:13:39
is by administering Narcan or naloxone
00:13:42
what will happen is those will actually
00:13:43
bind to those same receptors and prevent
00:13:46
fentanyl morphine or any of the other
00:13:48
opioids from getting there and it will
00:13:51
actually so then what will happen is the
00:13:53
person will come out of it they'll be
00:13:54
able to breathe again and typically
00:13:56
they'll go immediately into withdrawals
00:13:58
and that will make them very
00:14:00
uncomfortable you have to understand
00:14:02
withdrawals are
00:14:04
um from what I hear unbearable right I
00:14:07
mean from any opioid right this isn't
00:14:09
just fentanyl exclusive because when
00:14:10
you're withdrawing withdrawing from it
00:14:13
you have to understand that the the
00:14:14
nerves right that that loss of pain you
00:14:17
get so used to it it's not just the
00:14:19
dopamine all right it's not just the
00:14:21
dopamine the euphoria that you have to
00:14:22
overcome the addiction on that end it
00:14:24
becomes excruciatingly painful because
00:14:27
your neurons are used to not sending
00:14:29
painful signals and now all of a sudden
00:14:31
when there's no opioids to tell them not
00:14:34
to send signals any sensitization of
00:14:36
those neurons even if it's not painful
00:14:39
think about this right if you're so used
00:14:41
to not feeling pain when that fully
00:14:44
comes online your shirt itself can
00:14:46
become painful because the neurons are
00:14:48
just not used to processing that pain it
00:14:52
makes withdrawal symptoms
00:14:53
excruciating and so someone who actually
00:14:55
will take naloxone or Narcan can
00:14:57
actually kick right into one of those
00:15:00
withdrawals it is absolutely awful in
00:15:03
fact everything about it is absolutely
00:15:05
awful you know opioids are one of those
00:15:07
things that you know I am just deathly
00:15:09
afraid of and I tell everyone that I
00:15:11
come into contact with who's going into
00:15:12
the hospital it's like if you're going
00:15:14
to be taking any kind of opioids you
00:15:15
need to be very careful with that right
00:15:18
um I remember when I was in the hospital
00:15:19
for some of my gut issues and they were
00:15:21
telling me hey we're going to be giving
00:15:22
you this and that I I was very resistant
00:15:25
to taking any opioid in any capacity and
00:15:27
it's because I'm afraid of them
00:15:29
um it's not to say that they can't be
00:15:31
beneficial I know they can it's just I
00:15:33
literally live in fear because I know
00:15:35
what it can do to even the best of and
00:15:37
most well-intentioned to people and
00:15:39
that's what's so unfortunate and
00:15:40
heartbreaking for me you know seeing so
00:15:43
many people out there you know I'm a
00:15:44
veteran and I have friends who have
00:15:46
actually Fallen victim right to opioid
00:15:49
abuse right they have opioid use
00:15:51
disorder they have opioid dependence
00:15:52
right I mean living in North America I
00:15:56
don't know how you can drive on the
00:15:58
freeway without seeing Billboards just
00:16:00
saying get help for your opioid
00:16:01
addiction right it is it's such a
00:16:04
horrifying problem that is happening so
00:16:06
it's my hope is that we can find a way
00:16:09
out of this and I'm not going to pretend
00:16:10
as though I have a way out of it I don't
00:16:12
want you to think that the anatomy guy
00:16:13
who's teaching you on YouTube has the
00:16:15
solution to the opioid epidemic I just
00:16:17
am hoping that people can educate
00:16:19
themselves on it to make better
00:16:21
decisions about if they have an opioid
00:16:23
coming up maybe they have some kind of
00:16:25
procedure or something or maybe they can
00:16:27
just at least better understand someone
00:16:28
who has has already fallen into this
00:16:30
opioid trap because it is absolutely
00:16:34
horrifying and depressing now I want to
00:16:36
take a moment and thank the sponsor of
00:16:37
today's video brilliant brilliant is a
00:16:39
sponsor that we've been fortunate enough
00:16:41
to work with almost since the beginning
00:16:42
of this channel three years ago and
00:16:44
honestly this is 100 True John if I talk
00:16:47
about how much we love brilliant almost
00:16:49
on a day-to-day basis and that's because
00:16:50
I use brilliant on a day-to-day basis
00:16:52
you see brilliant helps you learn math
00:16:55
science logic computer science and they
00:16:58
do it in a really fun and interactive
00:17:00
way so I just use the brilliant app on
00:17:02
my phone and I love to play logic I
00:17:06
don't even really want to call it games
00:17:07
or puzzles that's not the right word for
00:17:08
it because they're lessons and they're
00:17:10
really fun to the point where I can even
00:17:12
get my four-year-old son to try and help
00:17:14
me especially when there's robots
00:17:15
involved he gets really excited with the
00:17:17
robots and you can just start moving
00:17:19
everything around but I personally think
00:17:22
logic is one of the most important skill
00:17:25
sets you can develop so I love chess I
00:17:27
love Sudoku I love anything that really
00:17:30
challenges my if this then that type of
00:17:32
thinking in my brain and that's
00:17:35
something I use brilliant every single
00:17:37
day I can't tell you how many times I've
00:17:39
recommended brilliant to my students
00:17:41
because brilliant what they do right is
00:17:45
that they they show you the benefit of
00:17:48
using not just logical type thinking but
00:17:50
just scientific thinking in general
00:17:52
mathematical thinking and they give you
00:17:54
real world examples right it's not just
00:17:56
like boring word problems it's not this
00:17:59
boring course that you're just sitting
00:18:01
there hoping is going to get over at
00:18:03
some point really soon instead they're
00:18:05
fun and interactive but they're in ways
00:18:07
that you can actually understand and
00:18:09
relate to in your real world life and
00:18:12
that bleeds into different aspects of
00:18:14
your life this is something I've been
00:18:15
telling my students for years right you
00:18:18
get better with chemistry I guarantee
00:18:19
you're going to start understanding
00:18:21
other things better it's just that's
00:18:24
just the way the world works and
00:18:25
Brilliant is my absolute favorite way
00:18:28
especially for those who may not be the
00:18:30
most scientific or mathematically minded
00:18:33
to start breaking into this head space
00:18:36
so utterly beneficial they have
00:18:38
thousands of courses these aren't really
00:18:40
games these are like full-blown courses
00:18:42
that are just so interactive they're
00:18:43
constantly updating them constantly from
00:18:46
creating new ones you you really can't
00:18:49
go wrong with just spending an hour or
00:18:52
so a day playing around with brilliant
00:18:54
because I guarantee it's going to help
00:18:55
you so if you're interested go ahead and
00:18:58
visit
00:18:59
brilliant.org Iha and the first 200
00:19:03
people there will get 20 off their
00:19:04
annual subscription I promise you you're
00:19:06
gonna in love brilliant absolutely love
00:19:09
them as a sponsor so
00:19:12
I hope you enjoyed today's video if you
00:19:14
did be sure to like comment subscribe
00:19:16
share this video with someone that maybe
00:19:18
you think they could benefit from it as
00:19:20
well but as always I appreciate you
00:19:23
watching and hanging out with me for a
00:19:24
little bit and I will see you in the
00:19:25
next video
00:19:26
[Music]
00:19:32
[Music]
