Crisis in Health: The Opioid Epidemic

Public health is a multifaceted, constantly changing field that deals with community health. Ranging from pandemics and diseases, to mental health and healthcare disparities, the field is built around supporting communities during times of crisis.¹ Characterized as a drug crisis that has swept the nation since the 1990s (through the increase accessibility of and addiction to Opioids), the Opioid Epidemic is well known throughout public health for its persistence and devastating impact on communities across the United States.

But what exactly are opioids? Classified as synthetic and semisynthetic,² opioids encompass a broad category of drugs that target pain receptors in the brain and spinal cord (the central nervous system) to dull/dampen pain perception. While highly effective, these drugs have extremely addictive properties as they directly affect the brain’s “reward center”, releasing powerful neurotransmitters like endorphins and dopamine. This causes opioid users to experience a sense of elation and euphoria, which, upon the opioids wearing off, causes a “crash” with the decrease in neurotransmitters released.³ Opioids include legal prescription drugs like hydrocodone, oxycodone, fentanyl, and codeine, and illegal drugs like heroin.⁴

The Opioid Epidemic is characterized by 4 main “waves”. The first wave started in the 1990s as a result of increased marketing by pharmaceutical companies on the effectiveness of opioids for pain management. This led to an increased prescription of and subsequent overdependence on opioids, which had devastating effects on thousands of people, families, and communities.⁵ Over the next decade, a rise in opioid addiction led to overuse, misuse, abuse, and overdose deaths. From 1999 to 2010, sales of prescription opioid drugs quadrupled while the rate of overdoses more than doubled from 2.9 to 6.8 deaths per 100,000 people.⁶

The second wave (2002-2013) was characterized by a rapidly expanding illegal drug market, which had a high demand for heroin. As production increased and price decreased, heroin began to be more widely accessible. Those already addicted to opioids were quick to transition to heroin and other highly addictive, illegal drugs. Heroin overdose deaths nearly quadrupled from 0.7 to 2.7 deaths per 100,000 people from 2002 to 2013.⁷

What makes this drug epidemic, in particular, so dangerous is how the waves connect and overlap. Since 2013, the third wave, a result of increased Fentanyl production, has exacerbated opioid effects. Fentanyl’s easy manufacturing and low production costs, in conjunction with its highly addictive, yet fatal nature, make it appealing to the illicit drug market. It is used as a cutting agent within the industry, augmenting other drugs’s quantity and potency.⁸ As a result of boosting the addictive properties of drugs cut with fentanyl, illegal market profits skyrocketed.⁹ From 2019 to 2022, there were approximately 73,000 deaths caused by fentanyl-related drug overdoses, a testament to the dangers of this drug when used in the illicit drug market.¹⁰

The most recent wave of the Opioid Epidemic, the fourth wave (2020-current), is based on the high mortality rate associated with methamphetamines and cocaine combined with opioids.¹¹ This wave is especially dominant in rural communities or those previously untouched by the epidemic, where overdoses have been increasing at an alarming rate akin to that of urban communities.¹² This is due to rural communities often having less access to healthcare because of their geographic distances from medical services, low population densities, and fewer healthcare providers (as seen by the doctor shortage throughout the US).¹³

With each wave characterized by an unprecedented number of deaths, and a rapidly increasing population affected by addiction and opioid abuse, the Opioid Epidemic is considered to be the worst drug epidemic in history and massive failure of US public health regulation. Profit-driven pharmaceutical companies pushed highly addictive drugs (opioids) without proper investigatory measures by US regulatory institutions (i.e. the US Food and Drug Administration). However, while the epidemic rages on, healthcare efforts in the US are focused on spreading awareness about the dangers of opioids and addiction management. Prevention and mitigation efforts, funded through congress legislation, have enabled the development of powerful new tools and strategies to actively save lives. For example, Congress has passed legislation providing over $1 billion dollars annually to the Substance Abuse and Mental Health Services Administration for a new State Opioid Response grant program, with additional funding for the Centers for Disease Control and Prevention and the Health Resources and Services Administration.⁶ Harm reduction programs (such as needle-exchanges) help minimize the spread of harmful, contagious diseases like HIV/AIDS.¹⁴ Additionally, public health approaches work towards making Narcan (an opioid overdose preventing nasal spray) more readily available to help save lives.¹⁵

Though the Opioid Epidemic continues to claim lives, decimating families and communities, public health initiatives have made significant strides in reducing overdose deaths, with reports indicating a 14.5% decrease in opioid-related deaths since 2023.¹⁶ As the US works towards implementing new and innovative opioid-safety measures, we may just be on the cusp of turning the tide for this drug crisis.

References

1. What is public health? American Public Health Association - For science. For action. For health. Accessed February 27, 2025. https://www.apha.org/what-is-public-health

2. Opioids. National Institutes of Health. December 3, 2024. Accessed February 27, 2025. https://nida.nih.gov/research-topics/opioids

3. Am I at risk of opioid addiction? Mayo Clinic. July 20, 2024. Accessed February 27, 2025. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

4. Opioids. Johns Hopkins Medicine. May 11, 2023. Accessed February 27, 2025. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids

5. Writer B, By, Writer S. What led to the opioid crisis-and how to fix it. Harvard T.H. Chan School of Public Health. November 22, 2024. Accessed February 27, 2025. https://hsph.harvard.edu/news/what-led-to-the-opioid-crisis-and-how-to-fix-it/

6. The Opioid Crisis in the United States: A Brief History. Accessed February 27, 2025. https://crsreports.congress.gov/product/pdf/IF/IF12260

7. Vital signs: Demographic and substance use trends among heroin users - United States, 2002–2013. Centers for Disease Control and Prevention. Accessed February 27, 2025. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a3.htm

8. Drugs and Fentanyl Awareness | Fremont Police Department, CA. Accessed February 27, 2025. https://www.fremontpolice.gov/crime-prevention/drugs-and-fentanyl-awareness

9. Understanding heroin cutting agents - the recovery village Palm Beach at Baptist. The Recovery Village Palm Beach at Baptist Health. February 7, 2025. Accessed February 27, 2025. https://www.floridarehab.com/drugs/heroin/heroin-cutting-agents/

10. Drug overdose deaths: Facts and figures. National Institutes of Health. September 30, 2024. Accessed February 27, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#Fig8

11. Ciccarone D. The Rise of Illicit Fentanyl, Stimulants and the Fourth Wave of the Opioid Overdose Crisis. Current opinion in psychiatry. July 1, 2021. Accessed February 27, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC8154745/#:~:text=A%20’fourth%20wave’%20of%20high,with%20the%20ongoing%20opioid%20epidemic

12. Coming wave of opioid overdoses “will be worse than ever been before.” News Center. August 29, 2022. Accessed February 27, 2025. https://news.feinberg.northwestern.edu/2022/08/25/coming-wave-of-opioid-overdoses-will-be-worse-than-ever-been-before/

13. Jenkins R, Ciccarone D, McMahan VM, et al. The fourth wave of the US opioid epidemic and its implications for the rural us: A federal perspective. Preventive Medicine. August 28, 2021. Accessed February 27, 2025. https://www.sciencedirect.com/science/article/pii/S0091743521001250

14. Syringe Services Programs: A Naco opioid solutions strategy brief. National Association of Counties. Accessed February 27, 2025. https://www.naco.org/resource/syringe-services-programs-naco-opioid-solutions-strategy-brief

15. Opioid overdose reversal medications - OORM. SAMHSA. Accessed February 27, 2025. https://www.samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose-reversal

16. Overdose Deaths Decline, Fentanyl Threat Looms. DEA. Accessed February 27, 2025. https://www.dea.gov/press-releases/2024/12/16/overdose-deaths-decline-fentanyl-threat-looms

Ultra-Processed Foods and Health: What Happens When You Cut Them Out?

When we first think of bacteria, we may usually think about the harmful strands and the infections they cause. However, what if I said that some bacteria are actually helpful? In fact, we have over a thousand different species of bacteria in our gut which serve a vital role in ensuring our well being¹. For instance, Lactobacillus reuteri (L. reuteri) is a common bacteria that protects our gut from harmful pathogenic microorganisms, aids in lactose digestion, produces vitamins, and contains several anti-inflammatory properties². If L. reuteri alone plays these roles in maintaining our wellbeing, just imagine the effect of a thousand different bacterial species acting in our gut! However, to see these health benefits, we have to sustain our gut microbiota – something that is becoming increasingly difficult in a society where ultra-processed foods (UPFs) are consumed daily. But what exactly are UPFs and how do they hinder our gut microbiota?

Ultra-processed foods (UPFs) are foods that have been heavily refined, infused with various additives, and contain high amounts of fats, sugars, and salts³. As delicious as these foods may be, they are lacking in essential nutrients and fiber, and constant consumption has negative effects on our well being tied to disruptions to gut microbiota³. Our gut bacteria are highly dependent on the diet we sustain. A healthy diet means our gut bacteria are supplied with essential nutrients to keep them thriving; however, UPFs lack the necessary nutrients to help our microbiota grow⁴. As mentioned before, these foods are high in additives and fat, which means our gut bacteria are not being properly nourished. As a result, there is a reduction in microbiota diversity.

With a decrease in essential gut bacteria, our intestines are more susceptible to harmful pathogens and inflammation⁵. Studies have shown that excess consumption of UPFs have led to several health disorders, among which includes Inflammatory Bowel Disease (IBD), anxiety and depression³. Additionally, excess consumption of UPFs and their high fat content have been linked to a number of brain disorders³. This is because the hippocampus, a region of the brain responsible for memory and learning, is vulnerable to excess saturated fat, and damage to the hippocampus can result in decreased cognitive function and neuroinflammation⁶. On the other hand, the high added sugar content in UPFs can accumulate as fat in our tissues and lead to disorders such as obesity and non-alcoholic fatty liver disease⁶.

Ultra-processed foods, gut microbiota, and overall human wellbeing are all linked together. Our gut bacteria is essential in protecting our body from harmful pathogens and supplies our body with essential nutrients, but the overconsumption of UPFs kills these bacteria and leads to health complications. In order to ensure we take care of our bodies, it is important to be kind to our gut and cognizant of the food we consume.

References

1. Zhang YJ, Li S, Gan RY, Zhou T, Xu DP, Li HB. Impacts of Gut Bacteria on Human Health and Diseases. Int J Mol Sci. 2015;16(4):7493-7519. doi:10.3390/ijms16047493

2. Mu Q, Tavella VJ, Luo XM. Role of Lactobacillus reuteri in Human Health and Diseases. Front Microbiol. 2018;9:757. doi:10.3389/fmicb.2018.00757

3. Song Z, Song R, Liu Y, Wu Z, Zhang X. Effects of ultra-processed foods on the microbiota-gut-brain axis: The bread-and-butter issue.

4. Shi Z. Gut Microbiota: An Important Link between Western Diet and Chronic Diseases. Nutrients. 2019;11(10):2287. doi:10.3390/nu11102287

5. Cuevas-Sierra A, Milagro FI, Aranaz P, Martínez JA, Riezu-Boj JI. Gut Microbiota Differences According to Ultra-Processed Food Consumption in a Spanish Population. Nutrients. 2021;13(8):2710. doi:10.3390/nu13082710

6. Martínez Leo EE, Segura Campos MR. Effect of ultra-processed diet on gut microbiota and thus its role in neurodegenerative diseases. Nutrition. 2020;71:110609. doi:10.1016/j.nut.2019.110609

From Lizards to Mammals: Unraveling the Science Behind Cell Regeneration

Have you ever seen a lizard regrow its tail? What if people had this ability to regrow a lost limb or organ? In the animal kingdom, anamniotes—fish and amphibians that lay eggs in aquatic environments—such as salamanders and zebrafish, have extensive regenerative properties. The axolotl is the first model for regenerative studies and has been studied since the 1860s for its ability to restore limbs, tails, eyes, and hearts [1]. Zebrafish are even capable of regenerating their brains. Lizards, on the other hand, are part of a vertebrate group known as amniotes. Amniotes include reptiles, birds, and mammals that reproduce on dryland. Surprisingly, lizards are the only amniotes capable of cell regeneration and are the closest relatives of humans that can regrow tissue [5]. They regrow their tails through autonomy, an anti-predation strategy that utilizes cell regeneration to restore damaged and lost tissue [2]. Understanding this regenerative process could be essential for regenerative medicine and treating neurological disorders.

How is regeneration possible? Neurogenesis is a process integral to tail regeneration. Neurons are generated from neural stem cells in the adult brain to add to or replace neurons in pre-existing circuits [3]. It occurs in the telencephalon, the part of the brain responsible for higher-level functions such as thinking, memory, and processing sensory information. Adult neurogenesis occurs in all vertebrate groups, including humans, but has more extensive effects in non-mammalian groups [3]. For example, neurogenesis in lizards produces more neurons and impacts more parts of the brain. In mammals, it is restricted to olfactory bulbs and the hippocampal dentate gyrus, the regions of the brain responsible for sense of smell and processing sensory information. This limitation means that while neurons are replaced in these areas, other parts of the brain are still susceptible to damage and deterioration.

Current hypotheses suggest that regeneration is a trait that occurred early in evolution, as it is most commonly found in lower-level organisms. Higher-level organisms, like humans and other mammals, evolved to have more robust immune systems with defensive macrophages— white blood cells responsible for detecting and breaking down viruses and bacteria—at the expense of regenerative capabilities [1]. These strong immune systems dispose of viral and bacterial tissue, whereas lizards and anamniotes rely on non-immune mechanisms to avoid infection [5]. Baffling to researchers, although macrophages regulate the regeneration process, macrophage depletion in salamanders and zebrafish leads to delayed or altogether halted regeneration [5].

Harnessing this ability in humans would revolutionize research and healthcare. Researchers are working to leverage the unique regenerative capabilities of lizards as a model to transform the field of regenerative medicine. They use the lizard model to reprogram somatic cells—cells found in mammals that repair or replace damaged or aging tissue—toward a multipotent state, in which they become specialized for various tissues and functions [1]. This would mean that, on a small scale, humans could restore damaged or lost tissue. Advancements in studying neurogenesis could significantly impact regenerative medicine, neuroscience, and the treatment of neurological disorders. This progress would revolutionize the future of medicine, changing the landscape for disease and disorder treatment.

References

Daponte, V., Tylzanowski, P., & Forlino, A. (2021). Appendage Regeneration in Vertebrates: What Makes This Possible? Cells, 10(2), 242. https://doi.org/10.3390/cells10020242. Most helpful connection to biomedicine.

Donato, S. V., & Vickaryous, M. K. (2022). Radial Glia and Neuronal-like Ependymal Cells Are Present within the Spinal Cord of the Trunk (Body) in the Leopard Gecko (Eublepharis macularius). Journal of Developmental Biology, 10(2), 21. https://doi.org/10.3390/jdb10020021

González-Granero, S., Font, E., Desfilis, E., Herranz-Pérez, V., & José Manuel García‐Verdugo. (2023). Adult neurogenesis in the telencephalon of the lizard Podarcis liolepis. Frontiers in Neuroscience, 17. https://doi.org/10.3389/fnins.2023.1125999

Hye Ryeong Kim, Choi, H., Soon Yong Park, Song, Y., Kim, J.-H., Shim, S.-I., Jun, W., Kim, K., Han, J., Chi, S., Sun‐Hee Leem, & Jin Woong Chung. (2022). Endoplasmin regulates differentiation of tonsil-derived mesenchymal stem cells into chondrocytes through ERK signaling. Journal of Biochemistry and Molecular Biology, 55(5), 226–231. https://doi.org/10.5483/bmbrep.2022.55.5.173

Londono, R., Tighe, S., Milnes, B., DeMoya, C., Quijano, L. M., Hudnall, M. L., Nguyen, J., Tran, E., Badylak, S., & Lozito, T. P. (2020). Single cell sequencing analysis of lizard phagocytic cell populations and their role in tail regeneration. Journal of Immunology and Regenerative Medicine, 8, 100029. https://doi.org/10.1016/j.regen.2020.100029

Epigenetics: The Hidden Key To Development

Have you ever wondered why your parents have different colored eyes than you, or why you and your sibling don’t look alike? The answer may lie in one simple yet complicated term: epigenetics. Epigenetics is defined as the “study of heritable changes in gene expression that do not involve modification to the underlying DNA sequence” [1]. To put it in simpler terms, it’s how certain molecular modifications alter the way genes, such as those determining eye color, are expressed. There are a multitude of factors that determine how certain genes are expressed, but these epigenetic patterns begin in fetuses during pregnancy. 

To understand the factors that affect a fetus, we need to first understand the mechanism behind epigenetics. Firstly, gene expression is regulated by the modification of nucleosomes. A nucleosome is essentially elongated and uncoiled DNA that is wrapped around a set of proteins called histones [2]. While DNA carries a negative charge, histones generally carry a positive charge; like magnets, the negatively charged DNA molecules are attracted to the positively charged histones, and the degree of attraction regulates gene expressions. Modifications often affect how tight the DNA is wrapped around the histones [2]. One common modification is DNA methylation, in which a special molecule called methyl is added to the histones, which affects how tightly DNA is wrapped around the histones [2]. The increased attraction causes DNA to tightly coil around the histones, creating heterochromatin – tightly packed DNA — which prevents gene expression [2].   

Now, let's take a look at how these molecular processes apply to pregnancy. According to a study by Andrawus and peers, the patterns for DNA methylation in a fetus are established during pregnancy [3]. Furthermore, environmental factors during a pregnancy also play a role in epigenetics [3]. Two notable environmental factors that affect gene expression are pollution and nutrition. Pregnant mothers living in areas with increased air pollution “have been reported to show decreased DNA methylation” in a gene called LINE-1 [4]. Studies have shown that decreased methylation of LINE-1 is a common contributor to cancer and its development [5]. Furthermore, changes to maternal nutrition can lead to physical and mental changes in development [1]. According to Zuccarello and peers, vitamin B12 intake during pregnancy affects the methylation of DNA, and“high levels of vitamin B12 in maternal blood was correlated with the reduction” of DNA methylation of the fetus [1]. Such high levels of vitamin B12, and the corresponding decrease in DNA methylation levels, can result in potential intrauterine growth, which means that the fetus does not grow to a healthy weight as expected [1].

Overall, epigenetic expression during pregnancy plays an important role in our physical traits, as well as our overall well being. Both pollution and nutrition play a role in affecting DNA methylation patterns throughout development, which can affect the health of the child. Ensuring that pregnant women are in clean environments with access to correct nutrition allows them to sustain a healthy pregnancy and birth a healthy child.

References:

Zuccarello, D., Sorrentino, U., Brasson, V., Marin, L., Piccolo, C., Capalbo, A., Andrisani, A., & Cassina, M. (2022). Epigenetics of pregnancy: Looking beyond the DNA code. Journal of Assisted Reproduction and Genetics, 39(4), 801–816. https://doi.org/10.1007/s10815-022-02451-x

Al Aboud, N. M., Tupper, C., & Jialal, I. (2023). Genetics, Epigenetic Mechanism. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532999/

Andrawus, M., Sharvit, L., & Atzmon, G. (2022). Epigenetics and Pregnancy: Conditional Snapshot or Rolling Event. International Journal of Molecular Sciences, 23(20), 12698. https://doi.org/10.3390/ijms232012698

Li, S., Chen, M., Li, Y., & Tollefsbol, T. O. (2019). Prenatal epigenetics diets play protective roles against environmental pollution. Clinical Epigenetics, 11(1), 82. https://doi.org/10.1186/s13148-019-0659-4

Phokaew, C., Kowudtitham, S., Subbalekha, K., Shuangshoti, S., & Mutirangura, A. (2008). LINE-1 methylation patterns of different loci in normal and cancerous cells. Nucleic Acids Research, 36(17), 5704–5712. https://doi.org/10.1093/nar/gkn571

GUM GUM: Recent Research Produces Rubbery Material to Replace Human Tissue

“GUM GUM BAZOOKA!” (Eiichiro, 1999) the protagonist of hit anime One Piece, Monkey D. Luffy, howls to deliver the finishing blow on his enemy.

As watchers of the acclaimed series know, Luffy’s power is that of the gum-gum fruit, which makes his body act as rubber. This seems like something only to happen in an anime, and while it is likely best that rubber bones stay relegated to that fictional, animated world, recent nanostructures and materials research could provide humans with a multipurpose, synthetic, rubbery substance that works in accordance with the human body. At Chalmers University of Technology in Sweden, researchers in the chemistry, chemical engineering, and applied physics departments have discovered a rubbery substance that has the potential to replace human tissue (Rajasekhara et al., 2019). 

In order to create an synthetic elastomer (material of a solid state but with relatively high amounts of elasticity) that could agree with the human body, scientists rethought the process of making elastomers. Previously, researchers made elastomers by randomly linking polymers - materials created by the linking of macromolecules - together. To create elastomers that are compatible with the human body, they sought a more organized approach. This new elastomer would be used as synthetic tissue, so its creators used a technique called ordered structuring to connect polymers with collagen and elastin, two fibrous proteins prominent in human skin (Rajasekhara et al., 2019).

With the help of state-of-the-art nanostructuring technologies, ordered structuring now makes the creation of elastomeric substances possible. This allows the surface to be lined by a material (namely what would be in contact with organs) with antibacterial peptides, making the elastomer resistant to bacteria so that it will not be damaged by the natural bacteria present in humans. One of the current applications for this elastomer involves catheter tubes. The material is able to carry medicine or blood while remaining decontaminated and also not killing the bacteria. This is helpful because there is an increasing trend of bacteria becoming antibiotic resistant , so it is becoming harder to eliminate them (“Nanostructured rubber-like material…”, 2020). This synthetic elastomer tube does not result in bacteria death, rather bacteria removal.

Beyond bacterial resistance, the elastomer has a variety of unique properties. Its soft and elastic nature means that it can be injected into the body by a cannula or 3D printed into a specific shape, and its nanopores can be filled with medicine to allow the synthetic tissue to cater to patients’ specific needs (“Nanostructured rubber-like material…”, 2020).

In theory, these biological elastomeric tissues could be used to create a being with rubbery bones. But, let's leave the gum-gum fruit abilities to Luffy and appreciate the material for its potential to revolutionize medicine.

References:

Eiichiro, O. (Oda), & Konosuke, U. (Uda). One Piece. Toei Animation.

Nanostructured rubber-like material with optimal properties could replace human tissue. (n.d.). ScienceDaily. https://www.sciencedaily.com/releases/2020/03/200316090334.html 
Rajasekharan, A. K., Gyllensten, C., Blomstrand, E., Liebi, M., & Andersson, M. (2019). Tough Ordered Mesoporous Elastomeric Biomaterials Formed at Ambient Conditions. ACS Nano, 14(1), 241–254. https://doi.org/10.1021/acsnano.9b01924