Post by Rebecca Chevrel, undergraduate in Social Science and Psychology pursuing an Interdisciplinary Neuroscience minor at Portland State University.
My name is Rebecca Chevrel. I’m in my senior year of undergrad at Portland State University, pursuing a double major in Psychology and Social Science, and a minor in Interdisciplinary Neuroscience. I’ll be 44 when I finish my bachelor’s degree. I like to mention this to remind folks that it’s never too late to pursue something that is meaningful to you.
Outreach
Over the past three terms I have joined Northwest Noggin in bringing brains and art on a number of outreach visits to elementary, middle, and high schools.
I am always so inspired by the curiosity and enthusiasm of the kids we meet.
We are so excited to explore brain knowledge with them, and they are so eager to share their own ideas and learn. As a parent I have discovered tremendous benefits to teaching kids how their own noggins work. If you understand a tool or a machine really well, you can use it more effectively.
Our brains are incredible tools!!
LEARN MORE: The Case for Neuroscience Research in the Classroom
LEARN MORE: The Neuroscience of Self-Control
LEARN MORE: The Whole Brain Child
LEARN MORE: Neuroscience for Kids
With Noggin, we have explored a lot of important topics from a neuroscience perspective; things like sleep, multilingualism, attention, memory, and emotions. A deeper biological understanding of these topics can impact how kids navigate learning, socialization, and, well, life!
LEARN MORE: Noggins In Nod: The Science of Sleep
LEARN MORE: Multilingual Brains!
Noggin at p:ear
But we bring brains to older kids too, and not just to public schools.
This term I joined Noggin at p:ear in downtown Portland, a nonprofit organization that mentors houseless youth ages 15-24 through art, education and community, and offers them cool practical and vocational skills.
This is an organization that speaks to my heart because I too experienced prolonged houselessness in the San Francisco Bay Area as a teenager on my own. I know how valuable mentorship can be, as well as skill-building, and most especially ART to move those overwhelming feelings through.
LEARN MORE (and support them): P:ear: Creatively Mentoring Houseless Youth
LEARN MORE: Homelessness and Public Health: A Focus on Strategies and Solutions
LEARN MORE: Poetry of Witness – Documentary verse by five homeless poets
LEARN MORE: Noggin @ p:ear
Some of the young people here are profoundly disadvantaged, not just in terms of houselessness, but all that comes with it. This includes exposure to drugs, theft, violence, avoidance and rejection and sometimes fellow houseless people who may have severe untreated mental illness, or who may be responding to the stress of their circumstances in ways that are scary and dangerous.
Several people were in wheelchairs and some of them described chronic health conditions that put them in and out of the hospital on a regular basis.
Nevertheless I witnessed many young people facing the world with creativity and hope. They are building strong friendships, singing, joking, and making cool art and music at p:ear.
Fentanyl
At Northwest Noggin we love hearing what young people are curious about. At p:ear there were several questions and concerns about the drug fentanyl.
In downtown Portland there is currently an epidemic of fentanyl, a synthetic opioid 100 times as strong as morphine, which is widely used and responsible for overdoses, many resulting in death, including for children as young as one year old exposed to very tiny amounts.
IMAGE SOURCE: DEA Washington Warns of Deadly Counterfeit Drugs on Social Media
The toll on the streets of downtown Portland is severe.
LEARN MORE: Fentanyl
LEARN MORE: What is Fentanyl?
LEARN MORE: Facts About Fentanyl
LEARN MORE: Portland’s Fentanyl Crisis
LEARN MORE: “It wasn’t here, and now it is. It’s everywhere”: fentanyl’s rising presence in Oregon’s drug supply
LEARN MORE: ‘It’s crazy out there’: The reasons behind Oregon’s deepening drug crisis
The first time I visited p:ear earlier this fall, the young people there were unusually silent and withdrawn, and few of them interacted with the brains and art.
People were low energy, quiet, heads in hands. We were told it was because eight of them had overdosed the previous day They stopped breathing after fentanyl use. They had been resuscitated with Naloxone (often referred to by one of its brand names, Narcan).
Learn More: How Does Narcan Save A Life?
Learn More: What Is It Like To Be Brought Back To Life?
Learn More: Narcan Side Effects
In contrast, on my next visit to p:ear with Noggin I got many more direct questions.
“What do drugs do in your brain? Why do opioids slow you down so much? What happens to your brain when you take fentanyl? How much fentanyl can kill you?”
LEARN MORE: What is Fentanyl? (NIDA)
As I mentioned, I’ve had my own journey with addiction and recovery (it’s never too late!) and I wanted to give them real answers.
Compared to morphine, fentanyl is small and lipid-soluble, so it can more easily cross the blood brain barrier and interact with our brain cells. This means the effects of fentanyl happen VERY fast.
LEARN MORE: The Blood Brain Barrier
LEARN MORE: Video: What is the blood-brain barrier?
Our brain cells communicate with each other mainly through the release of chemicals called NEUROTRANSMITTERS, at small gaps between neurons called SYNAPSES. The way neurotransmitters work is by binding (like a key into a lock) to specific protein RECEPTORS embedded in the cell membrane.
Some receptors open tiny gates and let charged ions through, changing the electrical activity of neurons, either inhibiting (stopping an electrical message, or action potential) or exciting them (starting an action potential that travels down the axonal wire). Other receptors have additional “G-proteins” attached to them on their intracellular side (inside the cell), which get released inside the cell to perform other biochemical tasks after a neurotransmitter binds to parts of the receptor sticking outside the cell (the extracellular side).
LEARN MORE: Communication Networks In The Brain
LEARN MORE: Video: 2 Minute Neuroscience – Action Potentials
LEARN MORE: How Neurons Communicate
LEARN MORE: The structure and function of G-protein-coupled receptors
Opioids inhibit neuron activity
Opioids bind to G-protein coupled opioid receptors and inhibit activity, making both the sending (pre-synaptic) and receiving (post-synaptic) cells less likely to fire. These receptors are intended for our body’s own opioid neurotransmitters and hormones (known as “endogenous” opioids), which play a key role in pain relief.
Opioids inhibit BOTH pre-synaptic and post-synaptic neurons
In the pre-synaptic neuron, G-proteins are released and block calcium channels, which stops the cell from continuing its release of vesicles (small, membrane bound sacs) full of neurotransmitter into the synapse. In the post-synaptic neuron, the released G-proteins actually open potassium channels, which causes an ion leak that prevents the cell from firing off additional messages.
LEARN MORE: What Are Endogenous Opioids?
LEARN MORE: Basic opioid pharmacology: an update
LEARN MORE: Mechanisms of actions of opioids and non-steroidal anti-inflammatory drugs
LEARN MORE: Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior
LEARN MORE: Synaptic Inhibition: An Overview
Opioids inhibit GABA, and increase release of dopamine
Opioids inhibit GABA, itself an inhibitory neurotransmitter that regulates dopamine release. Without the GABA to keep a strict eye on things, dopaminergic neurons in the ventral tegmental area (VTA) flood a deep brain structure called the nucleus accumbens with dopamine, the neurotransmitter that usually rewards us with motivation and anticipation for doing things that sustain life, like eating, having sex and caring for our children.
LEARN MORE: How opioids inhibit GABA-mediated neurotransmission
LEARN MORE: Brain mechanisms of drug reward and euphoria
LEARN MORE: Video: Opioid Drugs: Mechanisms of Action
LEARN MORE: Dopaminergic reward system: a short integrative review
Fentanyl is POTENT, and tolerance develops fast
The potency of fentanyl causes users to develop tolerance quickly.
Our brains seek balance, or homeostasis, so as opioids slow us down, more regulatory chemicals are produced to speed things up. More and more opioids are required to induce the pleasurable inhibited state, and when no opioids are present, our nervous system is still in compensatory overdrive, causing increased heart rate, upset stomach, pain, a reduction in motivating neurotransmitters, and the jitters. This is withdrawal.
LEARN MORE: Opioid Withdrawal
We get a huge exaggerated reward for taking opioid drugs, our neural networks adapt quickly and change, and rewards for other activities we once enjoyed begin to pale in comparison. With continued use, our brains keep changing, until there’s little appreciation for the good things in life.
How does fentanyl kill?
There are also opioid receptors on neurons in the brainstem that control our breathing reflex. These too become inhibited when fentanyl binds to receptors. What is so dangerous about fentanyl is that an amount the size of a sesame seed could be enough to completely block this reflex and make us stop breathing.
Fentanyl is also often unknowingly cut into other drugs which people could normally safely take higher doses of, like cocaine or MDMA. In my surrogate family, the San Francisco dance music scene, it is all too common now for people to have an accidental fentanyl overdose when they thought they were taking something else. Before Naloxone was accessible at most raves we lost several members of our community.
LEARN MORE: How Fentanyl Depresses Respiration
LEARN MORE: If fentanyl is so deadly, why do drug dealers use it to lace illicit drugs?
Naloxone saves lives
It’s fortunate that harm reduction organizations like syringe exchanges often can provide fentanyl test strips and free Narcan in case of overdose.
“Do you hear that? All the things
I meant to do are burnt spoons
hanging from the porch like chimes,
Do you have some wind? Just a hit
and was the grass always this vocal?
A hit and the blades start sharpening
in the sun. I wear a belt
because my pants don’t fit.
My pants don’t fit because I wear
the belt. I can tell you how it tastes.
Tannin. Heaven. Is it May already?
As onetime owner of my own
private spring, I can say
it’s overrated. Remember? Someone
found me in a coffee shop bathroom
after I’d overdone it
and carried me like a feed sack
to the curb. As they brought me back,
they said, the poppies on my arms
bruised red petals.
They said, He’s your savior.
But let’s not get carried away.
Let’s stop comparing everything
to wings. Have you ever even felt
like you’re going to not die
forever? It’s terrifying.”
— Naloxone, by William Brewer
Information about harm reduction and where to get Narcan and Fentanyl test strips in Portland, Oregon: Project Red, Multnomah County Overdose Prevention, NextDistro
However, relying on Narcan in order to continue a drug habit is a losing proposition. Lack of oxygen in the blood and brain for even a short time can result in significant neurological damage.
Changing habits
It is never too late to try changing our habits, environment and neural patterns!
Only a few weeks after detoxification, the brain can return to homeostasis and a person can begin to feel normal again. Within a few months the brain can start restoring more effective levels of dopamine. There are a number of medications that can help ease this transition.
LEARN MORE: Blog Post: Feeling Normal After Fentanyl Detox
LEARN MORE: Neuroscience: The Brain in Addiction and Recovery
One thing that was critical for my own recovery was a change of scenery, and getting away from places and people I associated with using drugs. An added benefit is that exploring places and situations that are novel to our brain may increase neuroplasticity – how changeable the brain can be!
LEARN MORE: Novel Experiences & Neuroplasticity
Exercise is also extremely helpful because it can trigger dopamine release. Other things that can make recovery easier are eating a healthy diet and learning to bring the parasympathetic (calming) nervous system online through simple exercises like this vagus nerve reset, or through regularly practicing resonance breathing to increase heart rate variability, which has been shown to improve self-regulation and willpower.
LEARN MORE: Novel Experiences & Neuroplasticity
LEARN MORE: Vagus Nerve Stimulation via The Outer Ear
LEARN MORE: Heart Rate Variability and Self-Regulation
Looking for community support is perhaps the most important thing in maintaining recovery. The fellowship element is a big reason when 12 step programs like Alcoholics Anonymous prove successful. I personally found refuge in the Buddhist principles applied in the Recovery Dharma community, which has plenty of meetings in Portland. If you go, they will tell you what I’m telling you here…
It is never too late to seek true happiness.
