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.

Opioids are a class of drugs, that interacts with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This class of drugs includes the illegal drug heroin; synthetic opioids such as fentanyl, which is often made illegally; and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, and morphine.

Opioid Use Disorder (OUD), a substance use disorder, is 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 use or use resulting in a failure to fulfill obligations at work, school, or home, among other criteria. It can even lead to overdose and death. In 2020, an estimated 2.7 million people ages 12 or older reported having an OUD.

Key Facts

• Millions of people in the U.S. are living with opioid use disorder (OUD).
• Opioid use disorder (OUD) occurs when opioid use causes significant impairment and distress.
• A diagnosis of OUD is based on specific criteria such as unsuccessful efforts to cut down or control use or use resulting in a failure to fulfill obligations at work, school, or home, among other criteria.
• About 2.7 million people in the United States report suffering from OUD.
• Overdoses are a leading injury-related cause of death in the United States and appear to have accelerated during the COVID-19 pandemic.
• OUD is a medical condition that can affect anyone – regardless of race, gender, income level, or social class.
• Common treatment options for OUD include medications for opioid use disorder (MOUD) (including methadone, buprenorphine, naltrexone).

Prescription Opioids

Beginning in the 1990s, there was a dramatic increase in the use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain, despite serious risks and the lack of evidence about their long-term effectiveness.

Naloxone Saves Lives

Naloxone is a life-saving medication that can reverse an overdose from opioids, including heroin, fentanyl, and prescription opioid medications. Naloxone is available in most states without a prescription, easy to use, and light to carry. Keeping naloxone on you and at home can help save lives.

Fentanyl and COVID-19

Fentanyl is a major contributor to fatal opioid overdoses in the U.S. Drug overdose death counts through June 2021 suggested an acceleration of overdose deaths during the COVID-19 pandemic.

Polysubstance Use

The use of more than one drug, also known as polysubstance use, is common. This includes when two or more drugs are taken together or within a short period of time, either intentionally or unintentionally. Whether intentional or not, mixing drugs is never safe because the effects from combining drugs may be stronger and more unpredictable than one drug alone, and even deadly.

Prevention Tips

• Know the signs of an opioid overdose. Recognizing the signs can save a life. 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.
• Know your options. Talk to your doctor about ways to manage your pain that do not involve prescription opioids and create a pain management plan.
• Take and store opioids properly. Never take prescription opioids in greater amounts or more often than prescribed.
• Avoid taking opioids with alcohol, other substances or medications (e.g., sleeping pills, benzodiazepines, or muscle relaxants), or any illicit drugs.
• Treat opioid use disorder by accessing substance use disorder treatment services, including Medications for Opioid Use Disorder (MOUD).

The number of drug overdose deaths increased by nearly 30% from 2019 to 2020 and has quintupled since 1999.  Nearly 75% of the 91,799 drug overdose deaths in 2020 involved an opioid. From 2019 to 2020, there were significant changes in opioid-involved death rates:

• Opioid-involved death rates increased by 38%.
• Prescription opioid-involved death rates increased by 17%.
• Heroin-involved death rates decreased by 7%.
• Synthetic opioid-involved death rates (excluding methadone) increased by 56%.

Three Waves of Opioid Overdose Deaths

From 1999–2020, more than 564,000 people died from an overdose involving any opioid, including prescription and illicit opioids.

This rise in opioid overdose deaths can be outlined in three distinct waves.

1. The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999³.
2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.

Many opioid-involved overdose deaths also include other drugs.

What is it?

Fentanyl is a synthetic opioid that is 80-100 times stronger than morphine. Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin. Because of its powerful opioid properties, Fentanyl is also diverted for abuse. Fentanyl is added to heroin to increase its potency, or be disguised as highly potent heroin. Many users believe that they are purchasing heroin and actually don’t know that they are purchasing fentanyl – which often results in overdose deaths. Clandestinely-produced fentanyl is primarily manufactured in Mexico.

Street Names

Apace, China Girl, China Town, China White, Dance Fever, Goodfellas, Great Bear, He-Man, Poison and Tango & Cash

How is it used?

Clandestine fentanyl is typically injected, or inhaled like heroin.

Paraphernalia

How does it affect the body?

• Intense, short-term high
• Temporary feelings of euphoria
• Slowed respiration and reduced blood pressure
• Nausea
• Fainting
• Seizures
• Death

What is it?

An opiate (narcotic) drug processed from morphine and extracted from certain poppy plants. Heroin comes in a white or brownish powder, or a black sticky substance known as “black tar heroin.” Often “cut” with other drugs or substances such as sugar or powdered milk. User is unaware how much actual heroin is being used, creating likelihood of overdose.

Street Names

Big H, Black Tar, Chiva, Hell Dust, Horse, Negra, Smack, Thunder


How is it used?

Injected, smoked, or sniffed/snorted. High purity heroin is usually snorted or smoked.

Paraphernalia

How does it affect the body?

• Highly addictive.
• Initial surge of euphoria or “rush,” followed by a twilight state of sleep and wakefulness
• Physical symptoms of use include: drowsiness, respiratory depression, constricted pupils, nausea, a warm flushing of the skin, dry mouth, and heavy extremities.
• Overdose symptoms: slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and possible death.

What is it?

Prescribed at Dilaudid®, it is used as a pain reliever. Hydromorphone is 2-8x more potent than morphine but shorter duration and greater sedation. Available in tablets, rectal suppositories, oral solutions, and injectable formulations.

Street Names

D, Dillies, Dust, Footballs, Juice, Smack

How is it used?

Orally or by injecting tablets dissolved in solution.

Paraphernalia

How does it affect the body?

• Euphoria, relaxation, sedation, and reduced anxiety. It may also cause mental clouding, changes in mood, nervousness, and restlessness
• Constipation, nausea, vomiting, impaired coordination, loss of appetite, rash, slow or rapid heartbeat, and changes in blood pressure.
• Overdose symptoms: severe respiratory depression, stupor or coma, lack of skeletal muscle tone, cold and clammy skin, constricted pupils, and reduced blood pressure and heart rate.

What is it?

Synthetic opiod prescribed as Methadose® and Dolphine®. Tablet, capsule, and liquid, used for detoxification and maintenance of opioid addiction and as a pain reliever for moderate to severe pain.

Street Names

Amidone, Chocolate Chip Cookies, Fizzies, Maria, Pastora, Salvia, Street Methadone, Water

Paraphernalia

How is it used?

Swallowed as pill or liquid or injected.

How does it affect the body?

• Sweating, itchy skin, or sleepiness
• Addictive
• Overdose effects include shallow breathing, stomach spasms, clammy skin, convulsions, weak pulse, coma, and death

What is it?

Non-synthetic narcotic (opioid) made from opium, prescribed as Kadian®,MS-Contin®, Oramorph SR®, MSIR®, RMS®, Roxanol®. Very effective for pain relief, high potential for abuse.

Street Names

Dreamer, Emsel, First Line, God’s Drug, Hows, MS, Mister Blue, Morpho, Unkie

Paraphernalia

How is it used?

• Injected
• Oral solutions
• Tablets, capsules, suppositories

How does it affect the body?

• Euphoria and relief of pain
• Addictive
• Overdose signs: cold and clammy skin, sleepiness, lowered blood pressure and slow pulse rate, coma and possible death

What is it?

Non-synthetic narcotic extracted from the poppy plant, made into a liquid, powder or solid. Opium poppy is a key source for many narcotics.

Street Names

Aunti, Aunti Emma, Big O, Black pill, Chandu, Chinese Molasses, Dopium, Dream Gun, Fi-do-nie, Gee, Guma, Midnight Oil, Zero

How is it used?

• Can be smoked or injected intravenously
• Taken in pill form
• Used in combination with other drugs, such as marijuana and/or methamphetamine

Paraphernalia

How does it affect the body?

• Euphoric rush, relaxation and relief of physical pain
• Slow breathing, seizures, loss of consciousness
• Addictive
• Coma or death

What is it?

U-47700, nicknamed “U4,” “pink,” or “pinky,” is a highly potent synthetic opioid that looks like a white or light pink powder. A lot of times, it is often either sold in baggies or pressed into pills to look like legal painkillers. Abuse of this drug is similar to heroin, and prescription and designer opioids.

Street Names

Pinky , Pink or U4

How is it used?

This drug is usually snorted, swallowed or injected.

Paraphernalia

How does it affect the body?

This drug poses the same risks as heroin and many other designer opioids. The drug’s effects include:

• Numbness
• Sedation
• Cold and clammy skin
• Coma
• Respiratory failure leading to death

This drug is 7 - 8 times more potent than morphine, according to the National Institute of Drug Abuse (NIDA). Not to mention, buyers can’t be certain exactly what they are getting when they purchase the drug online.

• Acute Pain – Pain that usually starts suddenly and has a known cause, like an injury or surgery. It normally gets better as your body heals and lasts less than three months.
• Analgesics – Pain relieving medications including over-the-counter medications like acetaminophen (Tylenol^®) or ibuprofen (Advil^®) and prescription opioids.
• Analog – Drugs that are similar in chemical structure or pharmacologic effect to another drug, but are not identical.
• Benzodiazepines – Sometimes called “benzos,” these are sedatives often used to treat anxiety, insomnia, and other conditions. Combining benzodiazepines with opioids increases a person’s risk of overdose and death.
• Chronic pain – Pain that lasts 3 months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or an unknown reason.
• Drug misuse – The use of illegal drugs and/or the use of prescription drugs in a manner other than as directed by a doctor, such as use in greater amounts, more often, or longer than told to take a drug or using someone else’s prescription.
• Drug addiction – The preferred term is substance use disorder. When referring to opioids, see the Opioid Use Disorder (OUD) definition below and text box discussing the difference between “tolerance,” “dependence,” and “addiction.”
• Extended-release/long-acting (ER/LA) opioids – Slower-acting medication with a longer duration of pain-relieving action.
• Fentanyl – Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. However, illegally made fentanyl is sold through illicit drug markets for its heroin-like effect, and it is often mixed with heroin or other drugs, such as cocaine, or pressed in to counterfeit prescription pills.
• Heroin – An illegal, highly addictive opioid drug processed from morphine and extracted from certain poppy plants.
• Illicit drugs – The nonmedical use of a variety of drugs that are prohibited by law. These drugs can include: amphetamine- type stimulants, marijuana/cannabis, cocaine, heroin, other opioids, and synthetic drugs, such as illicitly manufactured fentanyl (IMF) and ecstasy (MDMA).
• Immediate-release opioids – Faster-acting medication with a shorter duration of pain-relieving action.
• Medication-assisted treatment (MAT) – Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
• Methamphetamine – A highly addictive central nervous system stimulant that is also categorized as a psychostimulant. Methamphetamine use has been linked to mental disorders, problems with physical health, violent behavior, and overdose deaths. Methamphetamine is commonly referred to as meth, ice, speed, and crystal, among many other terms.
• Morphine milligram equivalents (MME) – The amount of milligrams of morphine an opioid dose is equal to when prescribed. Calculating MME accounts for differences in opioid drug type and strength.
• Naloxone – A drug that can reverse the effects of opioid overdose and can be life-saving if administered in time. The drug is sold under the brand name Narcan or Evzio.
• Narcotic drugs – Originally referred to any substance that dulled the senses and relieved pain. Some people use the term to refer to all illegal drugs but technically, it refers only to opioids. Opioid is now the preferred term to avoid confusion.
• Nonmedical use – Taking prescribed or diverted prescription drugs (drugs not prescribed to the person using them) not in the way, for the reasons, in the amount, or during the time-period prescribed.
• Non-opioid therapy – Methods of managing pain that does not involve opioids. These methods can include, but are not limited to, acetaminophen (Tylenol^®) or ibuprofen (Advil^®), cognitive behavioral therapy, physical therapy, acupuncture, meditation, exercise, medications for depression or for seizures, or interventional therapies (injections).
• Non-pharmacologic therapy – Treatments that do not involve medications, including physical treatments (e.g., exercise therapy, weight loss) and behavioral treatments (e.g., cognitive behavioral therapy).
• Opioid – Natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This class of drugs includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others. Prescription opioids are generally safe when taken for a short time and as directed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused and have addiction potential.
• Opioid analgesics – Commonly referred to as prescription opioids, medications that have been used to treat moderate to severe pain in some patients. Categories of opioids for mortality data include:
  • Natural opioid analgesics, including morphine and codeine;
  • Semi-synthetic opioid analgesics, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone;
  • Methadone, a synthetic opioid that can be prescribed for pain reduction or for use in MAT for opioid use disorder (OUD). For MAT, methadone is used under direct supervision of a healthcare provider;
  • Synthetic opioid analgesics other than methadone, including drugs such as tramadol and fentanyl.
• Opioid use disorder (OUD) – A problematic pattern of opioid use that causes significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, or use resulting in social problems and a failure to fulfill obligations at work, school, or home, among other criteria. Opioid use disorder is preferred over other terms with similar definitions, “opioid abuse or dependence” or “opioid addiction.”
• Overdose – Injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.
• Physical dependence – Adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.
• Prescription drug monitoring programs (PDMPs) – State or territorial-run electronic databases that track controlled substance prescriptions. PDMPs help providers identify patients at risk of opioid misuse, opioid use disorder, and/or overdose due to overlapping prescriptions, high dosages, or co-prescribing of opioids with benzodiazepines.
• Tolerance – Reduced response to a drug with repeated use.

“Opiates” vs. “opioids” Although these terms are often used interchangeably they are different:

Opiates refer to natural opioids such as heroin, morphine and codeine.

Opioids refer to all natural, semisynthetic, and synthetic opioids.

What is the difference between “tolerance,” “dependence,” and “addiction”?

Opioid tolerance occurs when a person using opioids begins to experience a reduced response to medication, requiring more opioids to experience the same effect.

Opioid dependence occurs when the body adjusts its normal functioning around regular opioid use. Unpleasant physical symptoms occur when medication is stopped.

Opioid addiction (Opioid use disorder (OUD)) occurs when attempts to cut down or control use are unsuccessful or when use results in social problems and a failure to fulfill obligations at work, school, and home. Opioid addiction often comes after the person has developed opioid tolerance and dependence, making it physically challenging to stop opioid use and increasing the risk of withdrawal.

Do opioids show up on drug tests?

Just like other drugs, opioids can show up on a drug test within hours of being taken. Opioids, including heroin, can show up on a drug test for days, and in some cases weeks, after being taken. How long they stay in your system depends on how long a person has been taking the drug, the amount of drug they use, or the person’s metabolism (how your body handles the drug).

Is it safe to take opioids if you are pregnant?

Opioid use during pregnancy — even if taken as a doctor instructed — can lead to miscarriage or low birth weight. It can also cause neonatal abstinence syndrome, a medical condition where the baby is born dependent on opioids and has withdrawal symptoms after being born. If a pregnant woman tries to stop taking opioids suddenly without medical help, she can put the baby at risk. It is important for the mother to tell her doctor about all drugs she is taking or planning to take so that the baby has a greater chance of being born healthy. There are treatments that can help.

I have heard about something called fentanyl. What is that?

Fentanyl is an opioid drug that is 50 times more powerful than heroin. Medically, it is used to treat extreme pain and for surgeries. But now it’s being made illegally and is sometimes mixed with other drugs, leading to overdose.

Are opioids addictive?

Yes. Over time, opioid use can change the brain, leading to addiction. Addiction means a person continues to use a drug despite negative consequences, and actively tries to get more and more of the drug. Many people get addicted to opioids, leading to deadly overdoses — taking enough to make you stop breathing.

However, many people who take prescription opioids for pain become dependent, not addicted.  Dependence means your body has gotten used to the drug, and it will hurt and feel uncomfortable if you suddenly stop. Patients using prescription opioids should ask their doctors how to safely stop using them.

A person can be dependent on a drug without being addicted. But sometimes dependence can lead to addiction, if you don’t make an effort to stop taking them.

Can opioid addiction be treated?

Quitting opioids can be hard, but it is possible. There are three FDA-approved medicines to treat opioid addiction. Medicines like buprenorphine and methadone bind to the same receptors in the brain as prescription opioids to reduce cravings. Naltrexone is another medication that treats opioid addiction by preventing opioids from having an effect on the brain. Additionally, a medicine named lofexidine was recently approved to help lessen withdrawal symptoms for people who are trying to stop using opioids.

Counseling and therapy are also important to help people stop using opioids, rebuild relationships with friends and family, and build healthy life skills. A combination of behavioral therapy and medication has proven to be very effective in treating opioid addiction.

Doctors develop treatment plans to fit the unique needs of the patient.

Do opioids produce withdrawal symptoms when someone tries to quit using them?

Yes. The brain gets so used to the opioids that when someone stops taking them, they can go into withdrawal. Withdrawal symptoms include sweating, shaking, vomiting, sleep problems, and diarrhea. The symptoms can be so severe that it can be hard for someone to stop using opioids, even if they want to. This is why it can take several tries to stop drug use.

Can you overdose on opioids?

Yes, you can. In fact, overdose deaths have almost tripled in the last 15 years and the majority of these deaths involve opioids. One of the ways opioids work to relax your body is by slowing down your breathing. When misused, opioids can slow your breathing too much. This can cause you to stop breathing entirely and lead to an overdose. For some people, just one dose is enough to make them stop breathing.

Can you stop an opioid overdose?

Yes, if you act quickly. If you think a friend or family member has overdosed on opioids, call 911 so they can receive immediate medical attention. When paramedics arrive, they will likely give the person naloxone. Naloxone works to quickly block the effects of opioids. It is available as an injectable solution, an auto-injector, and a nasal spray.

Some states require a doctor to prescribe naloxone, but other states allow pharmacies to sell naloxone without a personal prescription. This lets friends and family members use it to save someone who is overdosing. But naloxone doesn't take the place of medical care, and after using it, the person who overdosed should immediately get medical help.

What can teenagers do to protect themselves?

Take charge of your own health. The best thing teenagers can do is to turn away from peer pressure to use opioids “for fun” and to only take opioids as prescribed by your doctor. Even then, opioids should be taken for as short a time as possible. If your doctor or dentist prescribes opioids for a painful condition, ask them how quickly you can stop taking them or if there are other medications to use instead.

What is being done to stop the overdose crisis?

Opioid misuse has become a nationwide public health crisis. Luckily, federal, state, and local governments, advocacy organizations, and health professionals are working together to tackle the crisis from every angle. A holistic public health approach is being undertaken to:

• Improve access to treatment and recovery services
• Promote the use of overdose-reversing drugs
• Strengthen our understanding of the crisis through better public health monitoring
• Develop safe, effective medications strategies for pain management
• Improve medications to treat people who are addicted to opioids Advance better pain management practices