This text has been translated from Norwegian with the assistance of GPT UiO.
Siri Leknes is a professor of social and affective neuroscience at the Department of Psychology, University of Oslo. She has received two prestigious ERC grants, enabling her to delve deeply into the topic of medical use of opioids and how they affect us - both positively and negatively.
What began as basic research for the research group has evolved into public health research due to what is known as the ‘U.S opioid epidemic’. The neuroscience professor points out that over the past 200 years, we have created a multitude of medications that act on the same neurotransmitters in the brain; heroin, morphine, and oxycodone, to name a few. Heroin was first launched as a cough syrup.
– Many opioids have been launched as a ‘non-addictive’ medication. But this has been incorrect every time. So far, we have failed to identify any opioid painkillers that do not lead to addiction, says Leknes.
One in twenty americans reported to have opioid use disorder
The neuroscientist points to statistics from the U.S. revealing that one in twenty adult Americans meets criteria for opioid use disorder.
– This is a problem that could have largely been avoided had the healthcare system been less liberal with prescribing opioids, says Leknes. She emphasizes that Norwegian and European guidelines have been more restrictive, although we also face challenges with opioid addiction.
– Everyone who undergoes surgery at some point in their life in Norway and the western world - and that’s almost all of us - is given opioids. So even if only one percent of us develop a problem, in a population of five million, that means 50,000 could develop problematic opioid use.
Identifying who is at risk
The neuroscience professor stresses that addiction is a problem not only for the individual who becomes dependent but also in the workplace and, crucially, in family life. The big question is in which situations and for whom these medications can be prescribed without risk of problematic opioid use.
– We don’t have a clear answer to that, but we know that genetics play a role. This means, for instance, that some families may be more predisposed to addiction than others, says Leknes. She also notes research suggesting that childhood trauma can be a contributing factor.
Leknes and her research group find that some patients report enjoying opioids received before surgery. – Most will think they need to be careful, even if it feels good, because opioids are considered dangerous. Others will not have those reservations. This could be a risk factor too.
One of the reasons for the opioid epidemic in the U.S. is that many patients are discharged with large quantities of pills after surgery. There are so many spare opioids in people’s medicine cabinets that estate agents have warned that some people appear to attend viewings to access these unused medications.
Ibuprofen and Paracetamol often provide equal benefit
Leknes refers to studies?showing that ibuprofen and paracetamol can, in many cases, replace opioids for pain relief - even for severe pain following surgical procedures or accidents.
– For most people - including many physician - this is surprising. Opioids are referred to as strong painkillers, and many think that strong pain necessitates precisely that. However, a significant reason we call them strong painkillers is due to their dangerous side effects, she emphasizes.
The neuroscientist stresses that she understands the complexity health personnel face daily with a range of complicated issues and various medications. It can thus be easy to revert to opioids out of habit, or because patients expect ‘strong’ painkillers.
– It’s easier for me, who has researched opioids for years, to see the paradox of using opioids when ibuprofen and paracetamol often serve the same purpose.
Siri Leknes still emphasizes that opioids will and should be used in certain cases of pain conditions.
– The advantage of opioids is that there is no ceiling effect. If you take two 500 mg paracetamol, taking another will not help until the original effects have worn off. There is no greater effect with a higher dose. With the so-called strong opioids, however, there is no such limit. Thus, these medications are essential in the clinical toolkit, especially when patients sometimes experience pain that does not respond to, for example, ibuprofen and paracetamol.
Listen to the podcast featuring Siri Leknes (in Norwegian)
Get to know Siri Leknes better in the series "Tett p? en forsker" in the podcast from the University of Oslo. Here, Siri Leknes discusses her journey from backpacker to researcher, the differences between Norway and Spain as well as Norway and the UK, the experience of being a woman in academia, how her twin daughters make her a bit happier in the mornings as a night owl, and about running a laboratory where both opioids are administered and pain is inflicted. She also discusses how opioids have been used by humans for thousands of years for recreational purposes.?