تدريب Shadowing: Why Fentanyl Is So Incredibly Dangerous - تعلم التحدث بالإنجليزية مع YouTube

Somewhere around 70,000 or so people die each and every year from an opioid-related overdose.

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Somewhere around 70,000 or so people die each and every year from an opioid-related overdose.

Back in the early 2000s, the culprit was oxycodone, an opioid that most would probably recognize under the name of OxyContin.

But in 2013 or so, it was fentanyl that overtook both OxyContin and heroin on the center stage in the opioid epidemic.

As for who's to blame?

Well, it's a combination of things.

You have pharmaceutical greed and malpractice, you have healthcare providers that are over and misprescribing their patients.

And then you have a flood of illicitly produced fentanyl coming from China, Mexico, and India.

All of those factors were working together to create the current fentanyl crisis.

These days, fentanyl is being disguised as legitimate medications and then being smuggled into the United States and many other countries.

Some may think they're getting Xanax or Adderall, but instead are getting a high dose of fentanyl.

Considering fentanyl is around 50 times more powerful than heroin and 100 times more powerful than morphine,

and oftentimes only two milligrams of fentanyl is enough to deliver a fatal dose, dependence and accidental overdoses are skyrocketing.

In today's video, we're going to discuss the legitimate uses for fentanyl and what happens to the body when it's consumed.

We'll see why withdrawals are so brutally difficult to overcome and why overdosing is such an easy thing to do.

It's going to be an important one.

Let's do this.

Before we start today's video, if you or someone you know is struggling with opioid dependency or opioid use disorder and you're looking for help,

we've added some resources to the description of this video that we strongly encourage you to check out.

Let's first discuss the difference between an opiate and an opioid because there is an actual difference between the two.

Opiates are natural compounds that come from poppy sap and poppy plant fibers, so this would include morphine and codeine for example.

While opioids, that's more of an umbrella term and it's encompassing any compound

that is going to bind to and have an action on opioid receptors in the body.

So that would include the natural opiates like morphine and codeine

but also semi-synthetic opioids so that would include like heroin and then fully synthetic which would be fentanyl for example.

Now you may be wondering why the body has opioid receptors in the first place.

Well, it comes down to the fact that your body makes its own opioids to bind to those receptors.

They're called endogenous opioids and I guarantee you've heard of one of them, endorphins.

Endorphin stands for endogenous morphine but it's only one example of these opioids.

You also have what are called enkephalins, dinorphins, endomorphins, nociceptin or also called orphanin.

Now they'll bind to those receptors and they have a whole wide variety of effects

that we're going to discuss in a moment.

Just understand that exogenous opioids or coming from an external source, so this is going to be like heroin, morphine or fentanyl, will bind to those receptors, right?

So they're taking advantage of something that's already there and then what they do is they cause an exaggerated response.

Now to best understand how opioids work and why your body even bothers making endogenous opioids, we first need to understand how pain works and is processed.

Now we've already done an entire video on this so we'll go ahead and link that up above.

So if you want a more robust understanding, I strongly encourage you to check out that video.

But in a nutshell, let's say I jam my pinky finger, right?

So I hit it and that's going to send obviously a painful signal up a sensory neuron

and that neuron is going to travel from my pinky through my arm and up towards my spinal cord.

When it gets into the spinal cord, this is where it's going to synapse or communicate with a secondary neuron.

So this first neuron we call the presynaptic neuron.

Then the one that it synapses with or communicates with in the spinal cord is the postsynaptic neuron.

And what will happen is this postsynaptic neuron will now take the signal up the spinal cord.

Let me go ahead and grab this brain here and it's going to take it to the brain.

So you're looking at the right hemisphere of the brain as seen from the sagittal or midline view.

Now, grab my probe.

What's going to happen is the signal is going to travel up the brainstem

and it's going to go to this area here called the thalamus.

The thalamus is, you can think of it as like a hub.

It's going to direct signals to where they need to go.

So what will happen is the thalamus will send the signal into this region here

which is called the primary somatosensory cortex

and this is where you are going to be made aware of the fact that you have a problem.

Now, some data does suggest that the thalamus has some awareness but if it does, this is It's still going to be where the majority of your awareness is going to be.

But it's also going to send a signal to a structure that's deeper down in here

that we can't see called the amygdala.

The amygdala is responsible for processing negative emotions, so this is what makes you not very happy about the fact that you just jammed your finger.

So that's what we call the ascending pain pathway, but the brain or the body I should say also has a descending pain pathway.

Because think about it, after you've jammed your finger, you don't need to have that same pain level as long as the stimulus is gone.

The painful, that noxious stimulus is gone.

So what will happen is your body wants to start numbing the pain with those endogenous opioids.

So again, grab the brain here.

The thalamus will send a signal and it'll go down into this area here.

This is called the midbrain of the brainstem and in the midbrain is what is called gray matter.

Gray matter is just a location where cells are synapsing with each other but this gray matter is called the periaqueductal gray.

You're not really gonna be able to see that all

that much in this section here but from there a signal is going to be sent down the brainstem, down the spinal cord, and and go to

that location in the substantia gelatinosa where those two neurons were communicating with one another.

And it's at this site that the endogenous opioids will be secreted.

And it does this to modulate the pain.

And I say modulate on purpose, it's not like it's getting rid of the pain.

Right?

Just, you jam your finger and then wait two minutes, it's not as though the pain is just completely gone, there's still going to be pain there, and depending on how bad you jammed your finger,

the pain could be much worse.

So this is where the opioids will bind to receptors that we're about to discuss and changes your perception of the pain, which is absolutely fascinating.

Now without getting too far into the weeds when it comes to how this synapse and signal modulation works,

what's being communicated between the pre and the post synaptic neuron are neurotransmitters.

Now there's a lot of different types of neurotransmitters out there, but the ones that are going to be interesting or important to us are going to be glutamate and GABA.

GABA, more so GABA than glutamate.

Just think about it like this, a signal when it's being sent between neurons can either be excitatory or inhibitory.

If it's excitatory, it's just saying let's keep this signal going.

If it's inhibitory, it's saying let's stop this signal.

So if glutamate is released at the synapse, that's an excitatory signal.

But if GABA is released, that's an inhibitory signal.

So I want you to think about this for a second.

If you were able to prevent glutamate from being released,

that would also inhibit the signal or if you were to prevent GABA from being released,

that would also excite the signal and continue the signal on.

This is where opioids are going to do their thing.

Now the way the opioids are able to have an effect

or modulate the signal at the synapse is through those opioid receptors.

Now depending on where you look, you may see as many as five different types of opioid receptors

and each of those have their own subtypes

but for our purposes today we're going to focus on three of them and that's going to be the mu receptor, the delta receptor, and the kappa receptor.

Although we're primarily going to be focusing on the mu receptor

because that is the most well studied and it also happens to be the receptor that fentanyl prefers.

Although fentanyl will definitely choose all three of them but again it prefers that mu receptor.

Now you're going to find the mu receptor

and these other receptors throughout the entire body but they're going to be in different densities.

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So with the mu receptor you're going to find a lot of them in the digestive system

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which actually makes a ton of sense if you understand

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that opioid usage comes with some pretty intense constipation and peristalsis type of issues.

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But when it comes to the nervous system you're also going to find mu receptors in the substantia gelatinosa, right?

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That spinal cord where those two neurons are communicating.

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Again makes a ton of sense.

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When it comes to the brain, I'm going to grab this hemisphere again.

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You're going to find mu receptors in the brainstem

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which is one reason that you're going to have issues with breathing

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and we're going to see that when we get to overdosing here in a moment.

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But you're also going to find mu receptors in the thalamus as well as the cerebral cortex.

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But the mu receptors

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that are in the cerebral cortex are primarily going to be associated with pain processing

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which makes perfect sense because one of the reasons or actually the main reason you take an opioid is for analgesia.

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But you're also going to find mu receptors in another pathway and that is going to be what's called the mesolimbic pathway.

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The mesolimbic pathway is right here actually.

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So there's an area here in the midbrain of the brainstem called the ventral tegmental area

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and the ventral tegmental area is actually going to be communicating

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with another area right about here again it's going to be deep called the nucleus accumbens.

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And what will happen is it will actually be secreting GABA to the nucleus accumbens among other areas.

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And if you recall me saying GABA is inhibitory, so when GABA is being secreted it's telling the other neuron to not secrete what it's going to secrete.

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Well in this case, the nucleus accumbens secretes dopamine.

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So right now, unless you're doing something very pleasureful and joyful, you're probably not secreting dopamine.

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But let's say you enjoy some chocolate.

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We all know chocolate is amazing.

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So if you were to consume some chocolate, what's going to happen is the ventral tegmental area will say, we can enjoy this moment and it's going to stop secreting GABA

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which will then allow the neurons here to start secreting dopamine.

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Well opioids are going to do the same thing.

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What's going to happen is they are going to bind to new receptors in the ventral tegmental area

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which will then stop GABA secretion which will then cause dopamine release and flooding into the nervous system.

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And this is the basis of addiction because it feels amazing

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and this is what you'll see pretty much anyone who consumes opioids

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and when they're beginning to consume opioids is that it feels fantastic.

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The problem is that you're going to have to start taking more and more of the substance, whatever it is.

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And again, it's not just opioids that do this, right?

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There's a vast array of substances that will affect this mesolimbic or this reward pathway,

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but when you start getting tons and tons of dopamine surges, you're going to have to start taking more and more to get the same dopamine surges.

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And that is the basis of addiction, at least in terms of pleasure, joy, and eventually just outright need.

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Now you may be wondering why fentanyl is even available given how extremely powerful it is.

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If you recall me saying earlier it's around a hundred times more powerful than morphine, although I have seen some texts suggest that it could be as high as 400 times as powerful,

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although they weren't perfectly clear if that was fentanyl or derivatives of fentanyl because as depressing as this is,

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there are even more powerful synthetic opioids than fentanyl out there and they are on the street just as fentanyl is.

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You have to understand that fentanyl is supposed to be administered under very specific circumstances

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and so like think like extreme pain maybe someone has been taking morphine,

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a lot of morphine for their pain eventually they become tolerant to it, they need something stronger.

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Maybe they have cancer pain right because cancer can be extraordinarily painful.

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Fentanyl has some great usage for that.

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You'll also see fentanyl be administered by anesthesiologists.

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Maybe someone's going under the knife or maybe they're having epidural for some for some reason.

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So there are plenty of use cases for fentanyl

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and they have been used in very good ways right in very controlled

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and proper ways but it's just not meant to be where it is today

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and you can see why that is such a problem because of that right.

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It's so easy to overdose on fentanyl like extremely easy to overdose.

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If you recall me saying opioids can actually have an effect on the respiration centers of the body

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so in the brain stem but also into an area called the hypothalamus.

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So you have to understand that right now as you're breathing, your body is monitoring everything.

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You have respiratory rhythms going from to your diaphragm coming from the brainstem saying breathe in, breathe out, breathe in, breathe out.

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Your brain is monitoring how much carbon dioxide is actually in your bloodstream

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and so then that when carbon dioxide starts to increase, it'll actually reflexively cause you to inhale oxygen or exhale the carbon dioxide and inhale oxygen.

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But if you have, if you're going, if you're overdosing on an opioid, that can get so saturated by the opioids themselves that you can't overcome that.

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And so what will happen is you will actually die from respiratory depression.

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You literally cannot breathe because the opioids have completely saturated those areas, the opioid receptors on those areas.

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The only way out of that is with another opioid called Naloxone.

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Also sometimes people will call it Narcan, that's a brand of it.

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So what they'll do is by administering Narcan or Naloxone, what will happen is those will actually bind to those same receptors and prevent fentanyl,

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morphine, or any of the other opioids from getting there and it will actually, so then what will happen is the person will come out of it.

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They'll be able to breathe again and typically they'll go immediately into withdrawals and that will make them very uncomfortable.

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You have to understand, withdrawals are, from what I hear, unbearable.

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I mean, from any opioid.

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This isn't just fentanyl exclusive because when you're withdrawing from it, you have to understand that the nerves,

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that loss of pain, you get so used to it.

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It's not just the dopamine.

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It's not just the dopamine, the euphoria that you have to overcome, the addiction on that end.

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It becomes excruciatingly painful because your neurons are used to not sending painful signals.

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Now all of a sudden when there's no opioids to tell them not to send signals, any sensitization of those neurons, even if it's not painful.

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Think about this.

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If you're so used to not feeling pain, when that fully comes online,

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your shirt itself can become painful because the neurons are just not used to processing that pain.

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It makes withdrawal symptoms excruciating and so someone who actually will take Naloxone

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or Narcan can actually kick right into one of those withdrawals.

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It is absolutely awful.

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In fact, everything about it is absolutely awful.

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You know, opioids are one of those things that, you know, I am just deathly afraid of When I tell everyone

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that I come into contact with who's going into the hospital, it's like, if you're going to be taking any kind of opioid, you need to be very careful with that, right?

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I remember when I was in the hospital for some of my gut issues, and they were telling me, hey, we're going to be giving you this and that.

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I was very resistant to taking any opioid in any capacity, and it's because I'm afraid of them.

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It's not to say that they can't be beneficial.

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I know they can.

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It's just I literally live in fear

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because I know what it can do to even the best and most well-intentioned of people.

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And that's what's so unfortunate and heartbreaking for me, seeing so many people out there.

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I'm a veteran and I have friends who have actually fallen victim to opioid abuse.

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They have opioid use disorder, they have opioid dependence.

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Living in North America, I don't know how you can drive on the freeway without seeing billboards just saying get help for your opioid addiction.

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It's such a horrifying problem that is happening.

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So, my hope is that we can find a way out of this.

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And I'm not going to pretend as though I have a way out of it.

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I don't want you to think that the anatomy guy who's teaching you on YouTube has the solution to the opioid epidemic.

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I just am hoping that people can educate themselves on it to make better decisions about

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if they have an opioid coming up, maybe they have some kind of procedure or something, or maybe they can just at least better understand someone who has already fallen into this opioid trap

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because it is absolutely horrifying and depressing.

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So, I hope you enjoyed today's video.

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If you did, be sure to like, comment, subscribe, share this video with someone that maybe you think they could benefit from it as well.

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But as As always, I appreciate you watching and hanging out with me for a little bit, and I will see you in the next video.

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تدريب Shadowing: Why Fentanyl Is So Incredibly Dangerous - تعلم التحدث بالإنجليزية مع YouTube

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تدريب Shadowing: Why Fentanyl Is So Incredibly Dangerous - تعلم التحدث بالإنجليزية مع YouTube

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