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What HBO’s Euphoria Teaches Us About Opioid Use

Naloxone is an over-the-counter first aid tool that is helping to fight the opioid epidemic. Here’s how it works and why we need it.

When season two of HBO’s Euphoria came out earlier this year, it painted a vivid picture of the chaotic lives of a group of high school students. From relationships, social media, to drug use and abuse, the show covers it all. The audience witnesses the main character, Rue, taking a number of drugs that drive her opioid addiction. While some have criticized the show for glorifying drug use in adolescents, what it does get right is that substance use is a reality for millions of teenagers in North America.

In fact, the opioid crisis continues to exacerbate to this day. Health Canada estimates that in 2017, there were 11 lives lost each day due to opioid overdose, with young Canadians (age 15 – 24) being the fastest-growing population requiring hospital care for substance use related emergencies.

In Euphoria, Rue’s drug use starts at age 13, following her father’s cancer diagnosis. As he undergoes treatment, Rue’s father is prescribed pain medication to be taken at home. The challenge of seeing her parent suffer, coupled with her own mental health struggles, drives Rue to steal medication in an attempt to escape her reality. She becomes quickly hooked on the feeling of euphoria that the medication provides. How does this work?

Numerous cells in the body and the brain are involved in pain signalling. These cells have receptors to which opioids can bind and act as an agonist (or activator), resulting in analgesia and sedation. Different receptor types, namely mu, kappa, and delta, have specific affinities for different opioids, and are responsible for different physiological effects. For example, the mu-opioid receptor is triggered by most opioids (morphine, codeine, fentanyl) and is responsible for feelings of euphoria and serenity. As such, this is the receptor most commonly implicated in opioid misuse. In tandem to pain relief, opioids are central nervous system depressants; they slow respiration, lower blood pressure, and decrease the user’s responsiveness. By slowing everything down, untreated opioid poisoning can potentially lead to lethal respiratory and cardiac arrest. This possibility is often overlooked by users itching for the high.

A dual effect makes opioids so addictive. When opioids reach the brain, they switch off GABAergic neurons that normally control the release of dopamine, the “happy hormone” in the brain. This means that there is a greater influx of dopamine, causing feelings of happiness while simultaneously relieving fear and anxiety. All that to say, overuse of opioids rewires the brain into thinking that these are “feel-good” drugs, telling the body to find more. This state of euphoria is where the show gets its name.

Pharmaceutical opioids like codeine, morphine, and oxycodone are commonly prescribed for pain relief. While these prescription painkillers play a role in the opioid crisis, the main driver is the widespread use of illegal street drugs that can be easily tainted with powerful opioids such as fentanyl (100x more powerful than morphine). Drugs like heroin and cocaine can be cut with fentanyl, or simply be cross contaminated from unsafe and illegal production. And since fentanyl isn’t discernable through appearance, taste, or smell, it’s often hard to recognize the danger until it’s too late.

Early on in the show, Rue is pressured into trying fentanyl during an unfortunate run-in with a drug kingpin. Rue passes out and her friend (and dealer), Fezco, mentions they should, “go grab the Narcan, just in case.” NARCAN® is a common name for naloxone, a medication used to reverse the effects of opioid poisoning. It acts as an opioid antagonist, meaning that it occupies opiate receptors and prevents opiates from binding. The key, though, is that while naloxone can occupy opiate receptors, it does not activate them, meaning that opioid effects can be reversed.

First designed as a prescription medication for opioid abusers, naloxone became more widely available as an over-the-counter medication in North America starting in 2016. It can be administered either through injection or as a nasal spray, both of which are FDA and Health Canada-approved methods of delivery. NARCAN® and KLOXXADO® are common brands of naloxone (the only difference is that Kloxxado contains a higher dose). It’s important to note that Naloxone produces no effects if there are no opioids in the system. As such, it cannot be used improperly and cannot create dependence. So, if opioid poisoning is suspected, administering naloxone “just in case” can’t do any harm.

In response to the opioid epidemic, Health Canada has been encouraging the distribution of naloxone for free in pharmacies across the country with hopes of curbing the consequences of opiate abuse. This first aid tool is reliable, safe, and can be life-saving. You can pick up a kit today!


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