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.

Substance use disorders (SUDs) impact the lives of millions of Americans. More than 100,000 people died from drug overdoses from April 2020 to 2021, an increase of 28.5% from the prior year, according to a report by the Centers for Disease Control and Prevention (CDC).

An opioid overdose can occur for a variety of reasons, including:

• When a person overdoses on an illicit opioid drug such as heroin or morphine
• A person an overdose a methadone. This can occur when someone accidentally takes an extra dose, deliberately misuses a prescription opioid, or mixes opioids with other medications, alcohol, or over-the-counter medications. An overdose can be fatal when mixing an opioid and anxiety treatment medications, including derivatives of Benzodiazepine, such as Xanax or valium.
• When a person misuses an opioid-based pain medication, using not as prescribed by their physician or one prescribed for someone else. Children are particularly vulnerable to accidental overdoses if they take medication not intended for them.

Opioid overdose can occur even with prescription opioid pain relievers and medications used in treating SUD such as methadone and buprenorphine. In addition, individuals using naltrexone for MAT have a reduced tolerance to opioids, and therefore, using the same, or even lower doses of opioids used in the past, can cause life-threating consequences.

Always follow the instructions you receive with your medication. Ask your practitioner or pharmacist if you have questions or are unsure of how to take your medication.

The following tips can help you or a loved one avoid opioid overdose:

• Take medicine as prescribed by your practitioner
• Do not take more medication or take it more often than instructed
• Never mix pain medicines with alcohol, sleeping pills, or illicit substances
• Never take anyone else's medication
• Prevent children and pets from accidental ingestion by storing your medication out or reach.
• Dispose of unused medication safely. Talk to your MAT practitioner for guidance.

Opioid overdose is life-threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.

Call 911 immediately if a person exhibits ANY of the following symptoms:

• Their face is extremely pale and/or feels clammy to the touch
• Their body goes limp
• Their fingernails or lips have a purple or blue color
• They start vomiting or making gurgling noises
• They cannot be awakened or are unable to speak
• Their breathing or heartbeat slows or stops

If you suspect someone is experiencing an opioid overdose immediately consider the following actions to save their life:

• Call 911
• If the person has stopped breathing or if breathing is very weak, begin CPR (best performed by someone who has training)
• If available, treat the person with naloxone to reverse opioid overdose

Family members, caregivers, or the people who spend time with individuals using opioids need to know how to recognize the signs of an overdose and how to administer life-saving services until emergency medical help arrives. Individuals experiencing an opioid overdose will not be able to treat themselves. Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent opioid overdose. Check with your healthcare provider on how to obtain naloxone in your state.

Anyone can save a life during an opioid overdose with naloxone, a front-line defense in the nation’s overdose crisis. Naloxone is a life-saving drug that, when sprayed into the nose or injected, quickly reverses the powerful effects of opioids during an overdose.

Everyone who overdoses with opioids, whether with a prescribed medicine or an illicit drug, can use naloxone, including nasal sprays and injections. Examples of opioids include heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine.

Naloxone products approved by the U.S. Food and Drug Administration are an important tool to reverse overdose in health care and community settings. That’s one of many reasons the FDA is working to help increase access to naloxone.

“Without the administration of naloxone, there is a high risk of fatality from an opioid overdose,” said Marta Sokolowska, Ph.D., deputy center director for substance use and behavioral health at the FDA. “This is the reason it is very important that anyone witnessing an opioid overdose has access to naloxone and feels confident using it during an emergency.”

How to Recognize an Opioid Overdose and Use Naloxone

Opioids are medications that can be used to treat certain kinds of pain or opioid use disorder. Some illicit or nonprescribed substances such as heroin are also opioids. Signs of an opioid overdose may include:

• unconsciousness or unresponsiveness (doesn’t wake up when shaken or called)
• shallow breathing
• limpness
• blue lips, gums, or fingertips
• slow or irregular heartbeat or pulse

“Anyone – including family members, caregivers, or other people who may have to use naloxone in an opioid overdose – should be taught to recognize the signs of an opioid overdose and to administer naloxone,” Sokolowska said.

Naloxone is very powerful and works quickly. When administered soon after someone starts experiencing an overdose, the person will usually wake up within one to three minutes. Repeat administration of naloxone may be necessary.

But naloxone is a temporary treatment, and its effects do not last long, thus it is extremely important to still call 911. After giving someone naloxone and calling 911, stay with the person, even if they are conscious, until emergency medical help arrives. The person could lapse back into unconsciousness and might need another dose of naloxone. Keep trying to wake them up and keep them breathing. Also, lay the person on their side to prevent them from choking if they are unconscious.

Discuss Naloxone When Getting a Prescription for Opioids

Some naloxone products are safe and effective for nonprescription (over-the-counter, or OTC) use, while some other products may require a prescription.

Many states allow “standing orders” – that means consumers can get naloxone directly from a pharmacist, without a prescription. This allows access to naloxone to anyone who thinks they might need it, either for themselves or for someone else who might be at risk for an overdose.

“Naloxone should be available to anyone taking opioids and to anyone who may be around people who are taking opioids,” Sokolowska said. “This medicine is safe and very effective. It is also important to know that naloxone is not addictive.”

To reduce the risk of death from opioid overdose, the FDA recommends that these people carry naloxone:

• People who are prescribed opioid pain relievers.
• People who are prescribed medicines to treat opioid use disorder.
• People who are at increased risk of opioid overdose, such as people who also use alcohol or other drugs such as benzodiazepines.
• Caregivers of people who are at risk of an opioid overdose.

“We want naloxone in the hands of the friends, family members, and caregivers of people taking opioids,” Sokolowska added.

Naloxone Will Not Harm Someone Who Does Not Have Opioids in Their System

If someone is having a medical emergency other than an opioid overdose – such as a diabetic coma or cardiac arrest – giving them naloxone will generally not have any effect or cause them additional harm.

Naloxone can be administered to people of all ages, so it can also be used for suspected overdose in infants, children, and the elderly.

“Don’t hesitate to administer naloxone in an emergency even if you’re not sure if the person is experiencing an opioid overdose,” Sokolowska said. “Giving someone naloxone who does not have opioids in their system shouldn’t hurt them, but it could help them and save their life.”

Xylazine, a non-opioid veterinary tranquilizer not approved for human use, has been linked to an increasing number of overdose deaths nationwide in the evolving drug addiction and overdose crisis. Studies show people exposed to xylazine often knowingly or unknowingly used it in combination with other drugs, particularly illicit fentanyl.

While the full national scope of overdose deaths involving xylazine is unknown, research shows overdose deaths linked to xylazine have spread westward across the United States, with the largest impact in the Northeast. From 2015 to 2020, the percentage of all drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania. Xylazine was involved in 19% of all drug overdose deaths in Maryland in 2021 and 10% in Connecticut in 2020.

Research has shown xylazine is often added to illicit opioids, including fentanyl,and people report using xylazine-containing fentanyl to lengthen its euphoric effects. Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.

Also known as “tranq,” xylazine is a central nervous system depressant that can cause drowsiness and amnesia and slow breathing, heart rate, and blood pressure to dangerously low levels. Taking opioids in combination with xylazine and other central nervous system depressants—like alcohol or benzodiazepines—increases the risk of life-threatening overdose.

In the event of a suspected xylazine overdose, experts recommend giving the opioid overdose reversal medication naloxone because xylazine is frequently combined with opioids. However, because xylazine is not an opioid, naloxone does not address the impact of xylazine on breathing. Because of this, experts are concerned that a growing prevalence of xylazine in the illicit opioid supply may render naloxone less effective for some overdoses. Emergency medical services should always be alerted to a suspected overdose.

Repeated xylazine use is also associated with skin ulcers, abscesses, and related complications. People report using xylazine or xylazine-containing drugs by injecting, snorting, swallowing, or inhaling.

NIDA-supported research is underway to continue to elucidate emerging drug use patterns and changes to the illicit drug supply across the United States, including the use of xylazine, synthetic opioids, and changes in patterns of polydrug use. 

What are opioids?

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.

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 health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, people who take opioids are at risk for opioid dependence and addiction, as well as an overdose. These risks increase when opioids are misused. Misuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids.

What is an opioid overdose?

Opioids affect the part of the brain that regulates breathing. When people take high doses of opioids, it can lead to an overdose, with the slowing or stopping of breathing and sometimes death.

What causes an opioid overdose?

An opioid overdose can happen for a variety of reasons, including if you

• Take an opioid to get high
• Take an extra dose of a prescription opioid or take it too often (either accidentally or on purpose)
• Mix an opioid with other medicines, illegal drugs, or alcohol. An overdose can be fatal when mixing an opioid and certain anxiety treatment medicines, such as Xanax or Valium.
• Take an opioid medicine that was prescribed for someone else. Children are especially at risk of an accidental overdose if they take medicine not intended for them.

There is also a risk of overdose if you are getting medication-assisted treatment (MAT). MAT is a treatment for opioid abuse and addiction. Many of the medicines used for MAT are controlled substances that can be misused.

Who is at risk for an opioid overdose?

Anyone who takes an opioid can be at risk of an overdose, but you are at higher risk if you

• Take illegal opioids
• Take more opioid medicine than you are prescribed
• Combine opioids with other medicines and/or alcohol
• Have certain medical conditions, such as sleep apnea, or reduced kidney or liver function
• Are over 65 years old

What are the signs of an opioid overdose?

The signs of an opioid overdose include

• The person's face is extremely pale and/or feels clammy to the touch
• Their body goes limp
• Their fingernails or lips have a purple or blue color
• They start vomiting or making gurgling noises
• They cannot be awakened or are unable to speak
• Their breathing or heartbeat slows or stops

What should I do if I think that someone is having an opioid overdose?

If you think someone is having an opioid overdose,

• Call 9-1-1 immediately
• Administer naloxone, if it is available. Naloxone is a safe medication that can quickly stop an opioid overdose. It can be injected into the muscle or sprayed into the nose to rapidly block the effects of the opioid on the body.
• Try to keep the person awake and breathing
• Lay the person on their side to prevent choking
• Stay with the person until emergency workers arrive

How can I prevent an opioid overdose?

There are steps you can take to help prevent an overdose:

• Take your medicine exactly as prescribed by your health care provider. Do not take more medicine at once or take medicine more often than you are supposed to.
• Never mix pain medicines with alcohol, sleeping pills, or illegal substances
• Store medicine safely where children or pets can't reach it. Consider using a medicine lockbox. Besides keeping children safe, it also prevents someone who lives with you or visits your house from stealing your medicines.
• Dispose of unused medicine promptly

If you take an opioid, it is also important to teach your family and friends how to respond to an overdose. If you are at high risk for an overdose, ask your health care provider about whether you need a prescription for naloxone.