Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Opioids can cause side effects such as drowsiness, mental fog, nausea, and constipation. They may also cause slowed breathing, which can lead to overdose deaths. If someone has signs of an overdose, call 911. These signs may include:

• Very small pupils of the eyes
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Vomiting
• Limp body
• Pale, blue, or cold skin
• Faint heartbeat
• Purple lips and fingernails

When using opioids, there is also a risk of opioid use disorder (OUD).

What is opioid use disorder (OUD)?
Opioid use disorder (OUD) means that you have a problematic pattern of using opioids. The pattern causes a lot of distress and impairment (meaning that it causes problems in and interferes with your daily life). Instead of OUD, sometimes people use the terms "opioid dependence" and "opioid addiction." Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm.

The risk of OUD is higher if you misuse the medicines. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

Opioid use disorder and overdoses are serious public health problems in the United States. As more people misuse opioids, more women are misusing opioids during pregnancy. This can lead to health risks for the mother and baby. The baby may be born with neonatal abstinence syndrome (NAS). NAS is a group of withdrawal symptoms that a baby has after being exposed to drugs during pregnancy.

Another problem with increased opioid misuse is that it can also lead to more heroin use. There are some people who switch from prescription opioids to heroin because heroin may be cheaper and easier to get.

How are opioid use disorder (OUD) and opioid overdose treated?
There are effective medicines to treat OUD. Using medicines to treat OUD is called medications for opioid use disorder (MOUD). MOUD can help you stop using the drug, get through withdrawal, and cope with cravings. It is often combined with behavioral therapy and counseling. Having support from family and friends can also help.

There is also a medicine called naloxone which can treat opioid overdoses. It can reverse the effects of the overdose and prevent death if it is given quickly.

How can I prevent problems when taking prescription opioids?
To prevent problems with prescription opioids, be sure to follow your doctor's instructions when taking them. Do not share your medicines with anyone else. Contact your doctor if you have any concerns about taking the medicines.

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Prescription Opioids

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure.

• If you take a medicine in a way that is different from what the doctor prescribed, it is called prescription drug misuse.
• Prescription opioid use, even when used as prescribed by a doctor can lead to a substance use disorder, which takes the form of addiction in severe cases.
• Research Report: Prescription Drug Misuse

Fentanyl

Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. In its prescription form it is prescribed for pain, but fentanyl is also made illegally.

Heroin

Heroin is a highly addictive drug made from morphine, which comes from opium poppy plants. Some prescription opioid pain medicines have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use.

Understanding Drug Misuse, Addiction, and Overdose

When used correctly under a health care provider's direction, prescription pain medicines are helpful. However, misusing prescription opioids risks dependence, addiction, and overdose.

The best ways to prevent opioid overdose deaths are to improve safe opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.

Opioid addiction is a long-lasting (chronic) disease that can cause major health, social, and economic problems. Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief. Some opioids are legally prescribed by healthcare providers to manage severe and chronic pain. Commonly prescribed opioids include oxycodone, fentanyl, buprenorphine, methadone, oxymorphone, hydrocodone, codeine, and morphine. Some other opioids, such as heroin, are illegal drugs of abuse.

Opioid addiction is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. Opioids have a high potential for causing addiction in some people, even when the medications are prescribed appropriately and taken as directed. Many prescription opioids are misused or diverted to others. Individuals who become addicted may prioritize getting and using these drugs over other activities in their lives, often negatively impacting their professional and personal relationships. It is unknown why some people are more likely to become addicted than others.

Opioids change the chemistry of the brain and lead to drug tolerance, which means that over time the dose needs to be increased to achieve the same effect. Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.

Opioid addiction can cause life-threatening health problems, including the risk of overdose. Overdose occurs when high doses of opioids cause breathing to slow or stop, leading to unconsciousness and death if the overdose is not treated immediately. Both legal and illegal opioids carry a risk of overdose if a person takes too much of the drug, or if opioids are combined with other drugs (particularly tranquilizers called benzodiazepines).

Misuse of prescription opioids and heroin affects more than 2 million Americans and an estimated 15 million people worldwide each year. The prevalence of opioid misuse and addiction is rapidly increasing.

In 2016, more than 20,000 deaths in the United States were caused by an overdose of prescription opioids, and another 13,000 deaths resulted from heroin overdose. Drug overdoses are now the leading cause of death in U.S. adults under age 50, and opioids account for more than half of all drug overdose deaths.

Prescription opioids such as oxycodone, hydrocodone, morphine, and fentanyl, among others, are powerful medications that have pain-reducing benefits but also may lead to misuse, addiction, overdose, and even death. Various factors will increase an individual's risk of misuse, addiction or overdose while taking opioids. These risk factors include:

Opioid Dose, Duration, and Formulations

• High Dose. The higher the opioid dose the higher the risk for misuse and overdose death. Higher doses, >100 morphine milligram equivalents (MME), have over two times the risk relative to lower doses. Even low doses (such as 20-50 MME) can present a risk.
• Prolonged Duration. Prolonged use is associated with significant risk of addiction. Physical dependence and addiction to opioids may occur in as little as a few days. As many as one in four people receiving prescription opioids long term in a primary care setting struggles with opioid addiction.
• Extended Release and Long Acting Formulations. There are greater risks of overdose and death associated with extended-release and long-acting opioid formulations versus immediate release formulations.

Healthcare Conditions and Individual Characteristics

Individuals with certain healthcare conditions or characteristics may be more sensitive to opioid effects, which may also lead to overdose. These conditions and characteristics include:

• Older adults (65 years and older)
• Respiratory conditions (Sleep Apnea, Asthma, or Chronic Obstructive Pulmonary Disease)
• Wasting syndrome (Cachexia)
• Impaired energy or strength (Debilitated Patients)

Some individuals with certain healthcare conditions or characteristics are at higher risk of misuse, which may lead to overdose. These include:

• Younger adults (18-25 years old)
• Mental Health Disorders (Depression, Anxiety, Post-traumatic Stress Disorder)
• History of alcohol or substance abuse

As opioids have highly-addictive properties, they pose a substantial risk of addiction and overuse.

Concomitant Use of Other Medications or Other Agents

Unless advised by your health care provider, certain medications should be avoided when taking opioids due to increased risk of severe drowsiness, decreased awareness, breathing problems, coma, or death. These medications include:

• Benzodiazepines (alprazolam, lorazepam, or diazepam)
• Sedative/hypnotic agents (zolpidem or eszopiclone)
• Muscle relaxants (carisoprodol, chlorzoxazone, or methocarbamol)
• Antipsychotics (haloperidol, quetiapine, or risperidone)
• Other central nervous system depressants (alcohol or street drugs)

Opioids may interact with other medications that may increase your risk of overdose, arrhythmias, or seizures. It is best to check with your healthcare provider and pharmacist and read information from the Food and Drug Administration (FDA) before taking other medications in conjunction with opioids.

Need Help? If you or someone you know needs help dealing with opioid abuse please visit FindTreatment.gov or call 1-800-662-HELP (4357)

The causes of opioid addiction are complex. This condition results from a combination of genetic, environmental, and lifestyle factors, some of which have not been identified.

Many of the genes that are thought to play a role in opioid addiction are involved in the endogenous opioid system, which is the body's internal system for regulating pain, reward, and addictive behaviors. It consists of opioid substances produced naturally within the body (called endogenous opioids) and their receptors, into which opioids fit like keys into locks. Opioids introduced from outside the body (called exogenous opioids), including opioid medications and heroin, also exert their effects by acting on these receptors. Variations in the genes that provide instructions for making opioid receptors have been studied extensively as genetic risk factors for opioid addiction. Researchers suspect that differences in the receptors' structure and function influence how the body responds to opioids.

Opioid receptors are found in the nervous system, where they are embedded in the outer membrane of nerve cells (neurons). When endogenous or exogenous opioids attach (bind) to the receptors, the interaction triggers a series of chemical changes within and between neurons that leads to feelings of pleasure and pain relief. The mu (μ) opioid receptor, which is produced from the OPRM1 gene, is the primary receptor for most opioid drugs. Common variations in the OPRM1 gene appear to influence how the body responds to opioids, including the amount of an opioid medication needed to achieve pain relief. At least in some populations, these variations have also been associated with the risk of opioid addiction.

Variations in genes involved in other aspects of nervous system function have also been studied as risk factors for opioid addiction. Some of these genes play roles in various neurotransmitter pathways, in which chemicals called neurotransmitters and their receptors relay signals from one neuron to another. Other genes provide instructions for proteins that help control the growth, survival, and specialization (differentiation) of neurons. Although variations in several of these genes have been associated with opioid addiction, it is unclear how these genetic changes influence the way in which the nervous system responds to opioids.

Opioid addiction is a complex disorder, and nongenetic factors also play a critical role. Factors that have been shown to increase the risk of opioid addiction include a history of substance abuse; depression or other psychiatric disorders; childhood abuse or neglect; and certain personality traits, including impulsivity and sensation-seeking. Living in poverty and in a rural area, associating with others who abuse opioids or other substances, and having easy access to prescription or illegal opioids also contribute to a person's risk of opioid addiction. It is likely that a combination of health, social, economic, and lifestyle factors interact with genetic factors to determine an individual's risk.

Opioid addiction does not have a clear pattern of inheritance, although many affected individuals have a family history of addiction to opioids or other substances. People who have family members with addiction appear to have a higher risk of addiction themselves. This increased risk is likely due in part to shared genetic factors, but it may also be related to environment, lifestyle, and other nongenetic influences that are shared by members of a family.

A major warning sign of addiction is if a person keeps using opioids even though taking them has caused problems before—like trouble keeping a job, relationship turmoil, or run-ins with law enforcement. Other signs can include:

• Trying to stop or cut down on drug use, but not being able to.
• Using drugs because of being angry or upset with other people.
• Taking one drug to get over the effects of another.
• Making mistakes at school or on the job because of using drugs.
• Drug use hurting relationships with family and friends.
• Being scared at the thought of running out of drugs.
• Stealing drugs or money to pay for drugs.
• Being arrested or hospitalized for drug use.
• Developing a tolerance, and needing larger amounts of drugs to get the same effect.
• Overdosing on drugs.

Everyone can play a role and take action to help end the opioid overdose epidemic in the United States.

• Reach out, if you think you or someone you know has a problem. Talk to family members, friends, or a health care professional.
• Be supportive (not judgmental) if a loved one has a problem. Recognize that a substance use disorder is a medical condition, not a moral failing.
• Show support towards people in recovery. Acknowledge and celebrate their achievements. Encourage them to maintain their recovery program and supports.

Addiction is a medical condition. Treatment can help. Recovery is possible.

Opioid addiction, also known as opioid use disorder (OUD), is a chronic and relapsing disease that can affect anyone. In fact, millions of Americans suffer from opioid addiction.

As with most other chronic diseases, addiction is treatable. If you or someone you know is struggling, treatment is available. While no single treatment method is right for everyone, recovery is possible, and help is available for opioid addiction.

Recovery is possible.

Preventing overdose death and finding treatment options are the first steps to recovery. Treatment may save a life and can help people struggling with opioid addiction get their lives back on track by allowing them to counteract addiction’s powerful effects on their brain and behavior. The overall goal of treatment is to return people to productive functioning in their family, workplace, and community.

Opioid addiction treatment can vary depending the patient’s individual needs, occur in a variety of settings, take many different forms, and last for varying lengths of time.

Evidence-based approaches to treating opioid addiction include medications and combining medications with behavioral therapy. A recovery plan that includes medication for opioid addiction increases the chance of success.

Medications used in the treatment of opioid addiction support a person’s recovery by helping to normalize brain chemistry, relieving cravings, and in some cases preventing withdrawal symptoms. The choice to include medication as part of recovery is a personal medical decision, but the evidence for medications to support successful recovery is strong.

Medications for opioid addiction include:

Buprenorphine

• Available as dissolving tablet, cheek film, extended-release injection, or 6-month implant under the skin.
• Can be prescribed by a doctor for use outside of a clinic.

Methadone

• Available as daily liquid.
• Can only be used in a certified opioid treatment program setting.

Naltrexone

• Can be prescribed by any clinician who can legally prescribe medication.
• Only used for people who have not used opioids for at least 7–10 days.

Talk with a doctor to find out what types of treatments are available in your area and what options are best for you and/or your loved one. Addiction is a chronic, relapsing disease; be sure to ask your doctor about the risk of relapse and overdose.

Everyone can play a role.

If you notice that someone may be struggling with opioid addiction:

• Ask if you can help. Everyone can play a role and take action to help their loved ones in recovery. Treatment and the support and help from family, friends, co-workers, and others can make a big difference in the recovery process.
• Be supportive, and reduce stigma. Stigma or the fear of stigma may stop someone from sharing their health condition and prevent them from seeking the health or behavioral health services and support services they need. Recognize that opioid addiction is a medical condition, not a moral failing. Stopping stigma is important to helping loved ones feel safer and healthier.
• Carry naloxone. Naloxone can reverse overdose and prevent death. It is a non-addictive, life-saving drug that can reverse the effects of an opioid overdose when administered in time.

Millions of people in the United States are living with opioid use disorder (OUD); in 2020, an estimated 2.7 million people ages 12 or older reported having an OUD, a problematic pattern of opioid use that causes significant impairment or distress.

OUD is a treatable, chronic disease that can affect anyone – regardless of race, gender, income level, or social class. A diagnosis of OUD is based on specific criteria such as unsuccessful efforts to cut down or control opioid use or opioid use resulting in a failure to fulfill obligations at work, school, or home, among other criteria.

Overdoses are a leading injury-related cause of death in the United States and appear to have accelerated during the COVID-19 pandemic. Overdose deaths are preventable and preventing an opioid overdose death starts with being able to recognize the signs of an overdose. During an overdose, breathing can be dangerously slowed or stopped, causing brain damage or death.

Recognizing the signs of opioid overdose

Recognizing the signs of opioid overdose and acting fast can save a life. Here are some things to look for:

• Small, constricted “pinpoint pupils”
• Falling asleep or losing consciousness
• Slow, weak, or no breathing
• Choking or gurgling sounds
• Limp body
• Cold and/or clammy skin
• Discolored skin (especially in lips and nails)

It may be hard to tell if a person is high or experiencing an overdose. If you aren’t sure, it’s best to treat it like an overdose— you could save a life.

1. Call 911 immediately.
2. Administer naloxone, if available.
3. Try to keep the person awake and breathing.
4. Lay the person on their side to prevent choking.
5. Stay with the person until emergency workers arrive.

Factors that increase risk for an opioid overdose

Anyone who uses opioids can experience an overdose, but certain factors may increase risk including but not limited to:

• Having a history of overdose or a substance use disorder (SUD)
• Having sleep apnea or other sleep-disordered breathing
• Taking higher dosages of opioids (e.g., ≥50 MME/day)
• Returning to a high dose after losing tolerance (e.g., patients undergoing tapering or recently released from prison)
• Taking benzodiazepines with opioids
• Having kidney or liver failure
• Being 65 years and older

Death from an opioid overdose happens when too much of the drug overwhelms the brain and interrupts the body’s natural drive to breathe. Teach your family members and friends how to respond to an overdose. Learn how and when to use naloxone, a life-saving medication that can reverse an opioid overdose.

Take and Store Opioids Properly

• Never take prescription opioids in greater amounts or more often than prescribed.
• Always let your doctor know about any side effects or concerns you may have about using opioids.
• Avoid taking opioids with alcohol and other substances or medications. It is very dangerous to combine opioids with other drugs, especially those that cause drowsiness, such as:
  • Benzodiazepines (such as Xanax® and Valium®)
  • Muscle relaxants (such as Soma® or Flexeril®)
  • Sleep aids (such as Ambien® or Lunesta®)
  • Other prescription opioids
• Do not share or sell your prescription opioids.
• Store prescription opioids in a secure place, out of reach of others (including children, family, friends, and visitors).
• Dispose of unused prescription opioids at the end of your treatment. Find your community drug take-back program or your pharmacy mail-back program, or flush them down the toilet.

Addiction can happen to anyone

One in 7 Americans reports experiencing a substance use disorder. There is not one single driving factor that leads to addiction. Some people may use drugs to help cope with stress, trauma, or to help with mental health issues. Some may even develop opioid use disorder after misusing opioids they are prescribed by doctors. In any case, using drugs over time makes it easier to become addicted.

Drug use and effects on the brain

When people take drugs, the brain is flooded with chemicals that take over the brain’s reward system and cause them to repeat behaviors that feel good but aren’t healthy.

The brain adapts to continued drug use by developing a tolerance, which means it takes more of a drug to feel the same result.

Not only does this lessen the brain’s ability to resist temptation, but it can also affect the amount of pleasure a person receives from normal, healthy activities like enjoying food or the company of others.

Addiction is a treatable disease

Addiction is a disease, not a character flaw. People suffering from SUDs have trouble controlling their drug use even though they know drugs are harmful.

Overcoming a SUD is not as simple as resisting the temptation to take drugs through willpower alone. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may even require checking into a rehabilitation facility. Recovery can be challenging, but it is possible.

Recovery options

There are safe and effective ways to recover from SUDs. Finding the right treatment option can be the key to a successful recovery journey.

Medications for opioid use disorder (MOUD)

Opioid use disorder may require medication as the first course of treatment. Medications for opioid use disorder (MOUD) can help with cravings and withdrawal symptoms. MOUD is effective in helping people overcome addiction, stay in recovery longer, and prevent reoccurrence of use.

MOUD medications approved by the Food and Drug Administration (FDA):

• Methadone
• Buprenorphine
• Naltrexone

Taking these medications during treatment doesn’t mean taking the easy way out; it means finding something that works best for that individual.

Medication-assisted treatment (MAT)

Treatment that combines medicine with counseling or other behavioral therapy is called medication-assisted treatment (MAT). MAT can be an effective way to overcome addiction to opioids. Behavioral therapy can be equally important as it helps people change their attitudes and behaviors related to drug use, helps prevent relapse, and keeps people in recovery longer.

Additional Treatment Options

• Twelve-step facilitation therapy is an individual active engagement strategy designed to encourage people to accept drug addiction as a chronic, progressive disease and prepare them to begin a 12-step mutual support program.
• Outpatient counseling can help people understand addiction, their triggers, and their reasons for using drugs. This form of treatment can be done at a doctor’s office or via telehealth appointment.
• Inpatient rehabilitation at a full-time facility provides a supportive environment to help people recover without distractions or temptations.

Relapsing is not a sign of failure

Reoccurrence of use may happen to people who use drugs and can happen even years after not taking the substance. More than anything, reoccurrence of use may be a sign that more treatment or a different method is needed. A routine review of one’s treatment plan may be necessary to determine if another method could be more effective.

Signs of overdose

Recognizing the signs of opioid overdose can save a life. Here are some things to look for:

• Small, constricted “pinpoint pupils”
• Falling asleep or losing consciousness
• Slow, weak, or no breathing
• Choking or gurgling sounds
• Limp body
• Cold and/or clammy skin
• Discolored skin (especially in lips and nails)

What to do if you think someone is overdosing

It may be hard to tell whether a person is high or experiencing an overdose. If you aren’t sure, treat it like an overdose—you could save a life.

• Call 911 Immediately.*

• Administer naloxone, if available. **

• Try to keep the person awake and breathing.

• Lay the person on their side to prevent choking.

• Stay with the person until emergency assistance arrives.

*Most states have laws that may protect a person who is overdosing or the person who called for help from legal trouble.

**Naloxone is a life-saving medication that can reverse the effects of opioid overdose and save lives. It is available in all 50 states and can be purchased from a local pharmacy without a prescription in most states.