If you or a loved one is battling opioid addiction, seeking help as soon as possible is critical. Help is available from our opiate abuse hotline, which is open 24/7.

Opioid addiction is a rapidly growing public health crisis in the United States. In 2021, there were over 80,000 deaths involving opioid drugs, including prescription opioids and heroin. More than 70% of these deaths occurred in males. Deaths related to synthetic opioids (mainly fentanyl) increased by 7.5 times between 2015 and 2021. [1]

In addition to overdose deaths, opioid addiction can have other devastating consequences, including serious health complications, getting into trouble with law enforcement, and financial difficulties due to the drug habit and lost productivity at work. Fortunately, opioid addiction can be successfully treated and treatment can help people can get their life back on track.

Substance Overview: Opioids
Some available under prescription; others illegal
Annual deaths
Over 80,000
Side effects
Confusion, drowsiness, nausea, constipation, slowed breathing
Also known as
Heroin, smack, vikes, percs, oxy, happy pills, oxycotton, and hillbilly heroin

What Are Opioids?

Opioids are a group of drugs that are obtained from the opium poppy plant. In addition, some opioids are synthetically manufactured in the laboratory to mimic the effects of opium. Examples of opioids include heroin, which is an illegal drug, and prescription pain medications such as morphine, Vicodin and fentanyl. Opioid narcotic analgesics (painkillers) are legal and are prescribed to people with chronic severe pain. However, these drugs carry a high risk for abuse and addiction, even when taken as directed. [2] [3]

Opioids act directly on the human brain. They are used as pain-relieving medicines because they bind to opioid receptors in the central nervous system and interfere with pain signals between the body and the brain. Opioids can effectively treat moderate to severe pain that cannot be controlled with other non-opioid medications. They are for short-term use only. Long-term use of opioids is linked to a serious risk of abuse, addiction, and fatal overdoses. [4]

Opioid addiction is a rapidly growing problem in the United States and has reached epidemic proportions. The number of deaths related to opioid overdoses rose from approximately 21,000 per year in 2010 to over 47,000 in 2017, over 68,000 in 2020, and over 80,000 In 2021. [5]

Commonly Prescribed Opioid Pain Medications

Opioids are also called narcotic analgesics because of their painkilling properties. Compared to widely available over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil), opioids are powerful pain relievers and are only available by prescription. Some of the commonly used prescription opioid analgesics available in the United States are: [6] [7]

  • Hydrocodone (brand names Vicodin, Lortab, Norco)
  • Oxycodone (brand names OxyContin, Percocet)
  • Hydromorphone (brand names Dilaudid, Exalgo)
  • Oxymorphone (brand name Opana)
  • Methadone (brand names Dolophine, Methadose)
  • Morphine (brand names MS Contin, Avinza, Kadian)
  • Codeine (a common ingredient in many cough and cold medicines)
  • Fentanyl (a synthetic opioid which is up to 100 times more powerful than the naturally occurring morphine) (brand names Duragesic, Fentora, Actiq)
  • Buprenorphine (Suboxone)
  • Meperidine
  • Acetaminophen with codeine phosphate (Acetaminophen-Codeine)
  • Codeine Poli-Chlorphenir Poli

Some people misuse or abuse opioid drugs because they can make you feel relaxed, happy, and “high.” These drugs are sold on the street by slang names such as vikes, percs, oxy, happy pills, oxycotton, and hillbilly heroin.

What Is Prescription Opioid Abuse and Addiction?

Prescription opioids are safe and effective when taken as prescribed by a medical professional for short-term relief of moderate to severe pain. However, these drugs are habit-forming. You can develop a physical and psychological dependence on opioids, even when you take them as prescribed, especially when you use them at high doses or long-term.

Some people misuse or abuse prescription opioids for non-medical reasons (to obtain a high). Using opioids recreationally is linked to a high risk of addiction.

In recent years, with the US in the grips of an opioid epidemic, stricter regulations have been introduced for prescribing opioids, which has made them harder to obtain. Because of this, many people who are addicted to prescription pain pills buy them illegally from street dealers to feed their drug habit.

Illegally purchased prescription opioids are significantly more risky to use because it is impossible to verify their authenticity or purity. Illegal opioids can range widely in purity. It is common for opioids to be cut with other adulterants to increase profits. Drug dealers also sometimes mix the powerful synthetic opioid, fentanyl, in other drugs to make them stronger, putting users at a very high risk of overdose.

What is Opioid Tolerance and Opioid Withdrawal?

People who become addicted to opioids develop a tolerance to these drugs. This means they need to take more and more of the drug over time to get the same effects. This accelerated use increases the risk of addiction. Repeated use of opioids can also lead to drug dependence. This occurs because with repeated opioid use, neurons (nerve cells) in the brain get used to the drug and are unable to function without it.

Once a person is dependent on opioids, they typically experience uncomfortable and potentially dangerous withdrawal symptoms when they try to cut down on drug use or suddenly stop taking opioid drugs. In some cases, people can develop such a high tolerance that they no longer get “high” from opioids but continue to use them just to feel “normal” or avoid withdrawals.

What is Opioid Addiction?

Opioid addiction, also called opioid use disorder (OUD), is a chronic mental health condition characterized by uncontrolled and compulsive drug-seeking behavior despite the negative consequences of drug use. OUD occurs due to the formation of “reward” or “addiction pathways” in the brain which motivate repeated use of the drug to obtain pleasure. This drives compulsive drug use. These pathways make it very difficult for an opioid drug user to quit using opioids. [8]

Various factors, both environmental and genetic, influence whether a person who experiments with opioids will continue taking them long enough to become dependent or addicted. For example, the risk of opioid dependence and addiction is higher in people who misuse prescription pain pills. Prescription opioids are misused in different ways, such as:

  • Taking the medications at a higher dose or more frequently than prescribed.
  • Taking the medication in a way other than prescribed.
  • Taking someone else’s prescription pain pills.
  • Taking opioid pain relievers for non-medical reasons, for example, to get high.
  • Crushing, snorting, or injecting the pills instead of taking them as directed.
  • Taking other drugs with prescription opioids or drinking alcohol to intensify the effects.

Why Are Opioid Medications Dangerous?

Prescription opioids are powerful drugs that carry significant risks for serious adverse effects. One of the most immediate risks of opioid use is the risk of becoming psychologically and physically dependent on them. The illegal opioid drug heroin is a Schedule I controlled substance with the highest potential for abuse and addiction. Prescription opioid painkillers such as morphine, oxycodone, and fentanyl are Schedule II controlled substances and also carry a high risk of physical and psychological dependence. When a person becomes addicted to these drugs, they often take higher doses or turn to illegal sources to feed their drug habit, which puts them at significant risk of an accidental overdose.

A drug overdose is the most serious risk associated with opioids. Opioids are responsible for almost 75% of overdose deaths each year, more than any other kind of drug. This high rate of opioid overdose deaths is because of the effect of these drugs on the respiratory system (breathing). Opioids act on the central nervous system and cause respiratory depression (slowed breathing). High doses of opioids can cause stopped breathing and death. 

Opioid abuse has become an increasingly dangerous problem in recent years because of the increased availability of synthetic opioids such as fentanyl. Fentanyl is 80–100 times stronger than the naturally occurring opioid morphine, and therefore carries an extremely high risk of fatal overdose. Because fentanyl is widely produced in illegal factories, it is cheaper to manufacture than heroin. In addition, fentanyl is commonly “cut” or added to drugs being sold as heroin or other opioids to increase their potency.

pills in cabinet

Opioid Prescriptions and Addiction: Facts and Figures

Here are some facts and figures on the opioid pain pill crisis in the US: [9] [10]

  • In 2021, over 5% of the US population over 12 years of age (more than 14 million Americans) reported misusing prescription drugs (opioids, stimulants, benzodiazepines, and others).
  • Misuse of prescription pain relievers (opioids) was reported by 3.1% of people over age 12 (8.7 million Americans) in 2021.
  • In 2022, 0.7% of 8th graders, 0.9% of 10th graders, and 1.9% of 12th graders reported misusing OxyContin in the past 12 months.
  • Also in 2022, 0.7% of 8th graders, 1% of 10th graders, and 1.3% of 12th graders reported misusing Vicodin in the past 12 months.
  • In 2021, approximately 5 million Americans (1.8% of the population over age 12) had a prescription opioid use disorder in the past year.
  • More than 16,000 people died from an overdose of prescription opioids in 2021.
  • With increased awareness of the dangers of prescription opioid misuse, the number of opioid prescriptions dispensed in the US has been falling in recent years. An estimated 46.8 opioid prescriptions were dispensed per 100 people in 2019. In 2022, this number had dropped to 39.5 per 100 persons.

Opioid Overdose Deaths

  • There were more than 106,000 drug overdose deaths reported in the US in the year 2021. Of these, over 80,000 deaths were related to opioid drugs. Among opioid drugs, more than 70,000 overdose deaths were attributed to synthetic opioids, mainly fentanyl.
  • Drug overdose deaths involving prescription opioids have more than quadrupled from approximately 3,500 per year in 1999 to more than 16,500 per year in 2021. [11]

Transition to Heroin Abuse

An overwhelming majority (94%) of people receiving opioid addiction treatment say they chose heroin because it was less expensive and easier to obtain than prescription opioids. [12]

Heroin is an illegal opioid and it is both cheaper and more accessible than prescription opioids in many parts of the country. This makes it more likely that people who become addicted to prescription opioids make a switch to heroin. Approximately 80% of people who use heroin report that they first misused  or abused a prescribed pain medication.

Economic Impact

The cost of prescription opioid abuse is estimated to be nearly $80 billion per year in the United States. This includes healthcare costs, criminal justice involvement, lost productivity at work, and addiction treatment costs.

Cost of Opioids

Prescription opioids are expensive, which encourages people with an opioid addiction to switch to the illegal drug heroin that has similar chemical properties and produces similar effects at a more affordable price. Street prices of heroin have been falling lately. [13]

The Opioid Crisis in the United States

In the late 1990s, prescription opioid pain relievers were heralded as lifesavers for people with chronic (long-lasting) moderate to severe pain. Pharmaceutical companies assured the medical community that opioid pain pills were not addictive. Based on this reassurance, healthcare providers began prescribing opioid analgesics at increased rates. However, over the next decade or so, diversion and misuse of prescription opioids became widespread. It soon became apparent that opioid painkillers are in fact highly addictive. The death rate from opioid drug overdoses began to climb. In 2021, over 75% of all drug-related deaths involved opioids. In addition, there was a rising incidence of newborn babies with opioid withdrawal syndrome (neonatal abstinence syndrome) due to increasing opioid abuse among pregnant women. [14]

The devastating consequences of prescription opioid abuse led the U.S. Department of Health and Human Services (HHS) to declare it a public health emergency in 2017. A 5-point strategy was outlined to combat the opioid crisis in the United States:

  • Improving access to opioid addiction treatment.
  • Promoting the use of naloxone, an opioid-overdose-reversing drug.
  • Strengthening knowledge about the opioid epidemic.
  • Supporting research on pain pill addiction.
  • Advancing best practices and non-addictive therapies for pain management.

High-Risk Groups for Opioid Addiction

Opioid addiction can affect people of any age, gender, ethnicity, and socioeconomic status. However, certain social, economic, genetic, and psychological factors put some people at higher risk for addiction. For example, having a family history of addiction, growing up in a crime-ridden neighborhood, childhood trauma, or early exposure and experimentation with drugs all increase the likelihood of addiction.

Older people receiving prescription opioid pain pills are at risk of accidental misuse or abuse because of treatment with multiple medications for various chronic ailments. They are also at risk of drug–drug and drug–disease interactions, which can lead to serious health complications. People who struggle with chronic medical or mental health conditions are also more likely to become addicted by overusing opioids to reduce or cope with pain.

There is a gender-based difference in opioid addiction as well. Women are more likely to suffer from chronic pain and receive treatment with prescriptions pain relievers. Additionally, women tend to receive higher doses of opioid pain pills and also to use them for longer, compared to men. Moreover, research has shown that women develop addiction to opioids more quickly than men.

Children and adolescents are not immune to opioid addiction. These age groups access opioid painkillers from the medicine cabinets of their homes. Many teenagers report obtaining pain pills from friends and family members. In 2022, more than 8.4 million people over the age of 12 in the US reported past-year misuse of prescription pain pills, including 400,000 adolescents between the ages of 12 and 17 years. [15]

concerned woman with hot drink

Signs and Symptoms of Opioid Abuse

People who are struggling with an opioid use disorder often do not show any obvious signs of a problem in the beginning. This can make it challenging for friends and family members to detect opioid abuse and addiction in a loved one.

Like many addictions, symptoms of opioid abuse often start with lifestyle and behavioral changes, such as a lack of personal hygiene, stealing from friends and family, financial difficulties, getting into trouble with the law, and isolation from loved ones. In addition, continued opioid abuse can cause various physical symptoms, such as:

  • Slurred speech
  • Dilated or small pupils
  • Difficulty breathing
  • Drowsiness or changes in sleep habits
  • Nausea and vomiting
  • Delirium
  • Agitation
  • Changes in heart rhythm or blood pressure

If you or a loved one has been prescribed opioid pain relievers to manage pain, it’s important to take these medications exactly as directed by your prescribing physician. The following behaviors and symptoms can indicate that such a person may be misusing their opioid pain pills:

  • Running out of pain prescriptions early.
  • Doctor and pharmacy shopping in an attempt to obtain opioid medicines from multiple sources.[16]
  • Showing symptoms of opioid abuse (see above).
  • Needing to take more of the drug to get pain relief (this is called tolerance and is a sign of physical dependence).
  • Feeling ill when they don’t take pain pills (this is called withdrawal and is also a sign of physical dependence on opioids).
  • Using the pain pills in a way other than prescribed (crushing, snorting, or injecting).

Prescription Opioids and Pregnancy

Opioid drugs can be harmful to a pregnant woman and her unborn child. Expectant mothers who abuse opioids are at risk of miscarriage and low birth weight babies. When a pregnant woman misuses a prescription opioid, she exposes her baby to the drug, and the baby can develop a dependence on the opioid. Such babies often experience withdrawal symptoms after birth when they are no longer obtaining the drug from the mother’s circulation. This is called neonatal abstinence syndrome (NAS). NAS can be treated with medications.

Opioid addiction treatment can help pregnant women overcome their dependence on prescription pain pills. Medications like methadone and buprenorphine, combined with other drug treatment modalities, improve the chances of giving birth to a healthy baby. Quitting opioids before becoming pregnant can reduce the risk of many of the adverse outcomes associated with opioid addiction during pregnancy.

Opioid Overdose

An opioid overdose happens if someone takes a large amount of an opioid drug in a short period, enough to produce life-threatening effects. Opioid medications can slow down or stop breathing, which can result in coma or permanent brain damage and even death. Signs of an opioid overdose include:

  • Pale, clammy skin
  • Limp body
  • Blue or purple fingernails or lips
  • Vomiting or gurgling noises
  • Unresponsive or unable to speak
  • Slowed or stopped breathing
  • Slowed heartbeat

An opioid overdose is a medical emergency and requires immediate attention. Call 911 or your local emergency number if you suspect someone has overdosed. A rescue medication called naloxone can be used in emergencies to treat an opioid overdose and start the person’s breathing again. Naloxone binds to opioid receptors in the brain, thereby blocking the effect of the opioid drug. Family members and friends of opioid drug users are permitted to keep naloxone on hand to treat a potential overdose. Naloxone is available as a nasal spray (NARCAN) and hand-held auto-injector (EVZIO). A 4-mg naloxone nasal spray has been approved for OTC (over-the-counter) nonprescription use by the FDA in 2023.

Opiate Withdrawal

Repeated and long-term use of prescription pain medications can lead to opiate addiction, also known as opioid use disorder. If a person who is addicted to an opioid medication stops using the drug, they can develop severe withdrawal symptoms within hours of the last dose. Symptoms of opioid withdrawal may include:

  • Extreme drug cravings
  • Muscle discomfort (including possible uncontrolled twitching)
  • Diarrhea
  • Vomiting
  • Sleep difficulties
  • Cold flashes

These uncomfortable opioid withdrawal symptoms are the reason many people are unable to stop using the drugs without medical support. Drug rehab facilities are staffed by addiction treatment experts who can make the withdrawal process easier and safer.

Safe Opioid Use

Healthcare providers prescribe opioid pain relievers to manage moderate to severe pain, for example, after a major injury or surgery. These medications are also sometimes used to control severe pain related to health conditions such as cancer. People who use prescription pain pills are at risk of developing an opioid addiction. The risk is higher if opioids are misused (not taken according to the doctor’s instructions). Here are some ways to ensure the safe use of opioids:

  • Take the opioid pain pills exactly as prescribed. Do not take larger doses or extra doses.
  • Make sure you understand the doctor’s instructions on how to take opioid pain pills.
  • Do not crush, chew, or dissolve the opioid pain pills.
  • Opioids can cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how an opioid painkiller affects you.
  • Contact your healthcare provider if you have side effects. Do not attempt to adjust the dose of opioids yourself.
  • Use the same pharmacy to obtain all your prescriptions. Do not obtain opioids from multiple doctors or pharmacies.
  • Never obtain prescription opioids from illegal sources like drug dealers. They may contain adulterants that could put your life at risk.
  • Never use someone else’s prescription opioids or share your prescription with others.
  • Give your doctor and pharmacist a complete list of your other medications. This will help avoid potentially dangerous drug interactions between opioid pain pills and your other medications.
  • Avoid drinking alcohol while taking prescription opioids. Alcohol can make some of the side effects of these medications worse and increase your risk of serious adverse effects.

In addition to the correct intake of prescription opioids, it is important to store and dispose of the medicines properly.

  • Store opioid pain pills safely, in a lockbox if necessary, out of reach of children and pets. This is necessary to prevent a potentially fatal overdose, especially in a child. It also lowers the risk of someone who lives with you or visits you from stealing the medicines to use or sell.
  • Carry the medicines on you when you travel (do not place them in checked baggage during air travel).
  • Dispose of unused opioid medication properly by taking it to your pharmacy or flushing it down the toilet (the FDA website lists the correct ways to dispose of various drugs).
  • Never share or sell your opioid pain pills.
  • If your prescription opioids are stolen, report the theft to the police.

Opioid Testing

Opioids are powerful drugs that reduce pain and produce feelings of pleasure. People who have been prescribed opioid pain pills by a healthcare provider for medically valid reasons can sometimes become addicted to these drugs.

Opioid testing is used to monitor people who are taking prescription opioids. Tests are performed to detect opioids in the urine, blood, and saliva. Opioid screening ensures that a person is taking the medication as prescribed. Sometimes opioid testing is part of a comprehensive drug test to screen for a variety of substances, such as marijuana, cocaine, and opioids. Drug testing may be requested by employers or for legal or forensic purposes (for example, as part of a criminal or motor-vehicle accident investigation). Most of the time, opioid testing is done on a clean-catch urine sample. Sometimes, opioid screening is done on a blood sample obtained from a vein or a saliva swab from inside the cheek.

Call Our Opioid Addiction Hotline

If you or a loved one is battling opioid addiction, it’s vital that you seek help as soon as possible. When seeking intervening for a loved one, remember to be compassionate and supportive. Keep in mind that opioid addiction is usually compounded by other health problems and stressful life conditions. Do not be judgmental or accusatory. Instead, offer support but remain firm in insisting the person seek addiction treatment.

Fortunately, research has shown the it is possible to overcome opioid dependence. Treatment for opioid addiction involves the use of medications such as buprenorphine, methadone, and naltrexone. Rapid detoxification in 2 to 3 days can be achieved with naltrexone. These medications are also opioids, but when used properly, they do not result in euphoria (high) or addiction.

Opioid addiction often accompanies other health problems, including chronic pain and depression. Full recovery requires concurrent treatment for all these conditions. Our opiate hotline can connect you to treatment centers in your area that offer programs for opioid addiction and associated mental health problems.

Call our opiate addiction hotline today and help you start your treatment journey. We are available to help 24/7/365.

Last updated: March 18, 2024

Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS

Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.

Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.


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