Opioid addiction is a rapidly growing problem in the United States. In 2017 there were 49,068 deaths from opioid overdose. From 2002 to 2017 the number of deaths from opioid overdose quadrupled. If you or a loved one is suffering from opioid addiction, seek help as soon as possible. Help is available from our opiate abuse hotline, which is open 24/7.

Opioid addiction can have devastating consequences with high rates of disease and death as well as substantial costs related to healthcare, law enforcement, and lost productivity at work. The good news is that opioid addiction can be successfully treated and people can get their life back on track.

Substance Overview: Opioids

Legality

Some available under prescription; others illegal

Cost

varies

Annual deaths

47,000

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 class of drugs obtained from the opium poppy plant or synthetically made drugs that mimic the effects of opium. Heroin falls within this drug class, as well as prescribed painkillers like morphine, Vicodin and fentanyl. While certain opioids may be prescribed to people struggling with chronic pain, they also carry a high risk for abuse and addiction, even when taken as directed. 1 2

Opioid addiction is a rapidly growing problem in the United States and is increasingly being called an epidemic. In 2017 there were 49,068 deaths from opioid overdose. From 2002 to 2017 the number of deaths from opioid overdose quadrupled. 3

Opioids have a range of effects on the human brain. They are used as pain-relieving medicines because they contain chemicals that reduce pain and make people feel relaxed, happy, and “high.” Opioids can be effective treatments for moderate to severe pain when used short-term or for serious conditions. However, long-term use of opioids often leads to abuse, addiction, and even fatal overdoses. 4 5 6

Commonly Prescribed Opioid Pain Medications

Opioids are sometimes called narcotic analgesics because of their painkilling properties. Unlike over-the-counter medications like Tylenol or Advil, opioids are powerful pain relievers that are only available by prescription. Some of the commonly used prescription opioid analgesics in the United States are: 7 8

  • 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, 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

People who abuse opioids sometimes refer to them by slang names like vikes, percs, oxy, happy pills, oxycotton, and hillbilly heroin.

What is Prescription Opioid Abuse and Addiction?

Prescription opioids can be safe when taken as prescribed by a medical professional for short-term relief of moderate to severe pain. However, some people misuse or abuse opioids for non-medical reasons to obtain a high. It is possible to become addicted to prescribed opioids even when taking them as directed, especially when they are used regularly for a long period of time.

In recent years, increased prescribing regulations on opioids has made them harder to obtain. Because of this, many people who become addicted to prescribed pain pills end up buying opioids illegally to maintain their habit.

Illegally purchased opioids are more risky to use because people are usually unable to verify their authenticity or purity. Illegal opioids can vary in purity and many are cut with the powerful synthetic opioid fentanyl, which has a very high risk of overdose.

People who become addicted to opioids develop a tolerance to opioids, meaning they need to take more to get the same effects. This accelerates the risk for addiction. Once addicted to opioids, a person will experience painful withdrawals if they miss doses, cut down, or suddenly stop taking the medication. In some cases, a person may have developed such a high tolerance that they no longer get “high” from opioids and use just to feel “normal” or avoid withdrawals.

Repeated use of opioids can lead to tolerance and drug dependence. Tolerance means a person needs higher or more frequent doses of opioids to obtain the desired effects. Drug dependence occurs when repeated use makes neurons (nerve cells) in the brain unable to function without the drug. A person who is dependent on opioids experiences withdrawal symptoms without opioids. Opioid addiction, also called opioid use disorder, is a chronic brain disease characterized by uncontrolled and compulsive drug-seeking behavior despite the negative consequences of drug use.

Opioid addiction, also called opioid use disorder, is a chronic brain disease characterized by the formation of “reward” or “addiction pathways” in the brain which lead to compulsive drug-seeking behavior despite the negative consequences of drug use. These pathways do not make it impossible for an addict to stop using but does make it much more difficult. 9

The risk of opioid dependence and opioid addiction is higher in people who misuse prescription pain pills. Prescription opioids can be misused in different ways, such as:

  • Taking the medications at a higher dose 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 or drinking alcohol to intensify the effects

Why Are Opioid Medications Dangerous?

Prescription opioids are powerful drugs that carry high risks for adverse effects. One of the most immediate risks of opioids is the risk of becoming physically addicted to them, as they have more addictive qualities than other drugs of abuse. When a person becomes addicted, they often take higher doses or turn to illegal sources for their drugs, which makes it more likely that they will accidentally overdose.

Overdose is the most serious risk associated with opioids. Consistently, opioids are responsible for more overdose deaths each year than any other kind of drug. 70% of overdoses are related to an opioid. The high rate of opioid overdose is caused by respiratory depression. Opioids slow a person’s breathing and can even cause people to stop breathing altogether, leading to death. 

Opioid use has only become more dangerous over time because of the increased availability of synthetic opioids like fentanyl, which is 80-100 times stronger than morphine, and carries an extremely high risk for fatal overdose. Because fentanyl is widely produced in illegal factories, it is cheaper to obtain than heroin or opium and is commonly substituted or “cut” into drugs being sold as heroin or other opioids.

Opioid Addiction Facts and Figures

Here are some stats on the opioid pain pill crisis in the US: 10 11 12 13 14 15 16

  • More than 10 million Americans misused prescription opioids in 2018.
  • Of the approximately 20 million Americans with substance use disorders, 2 million are addicted to prescription pain relievers (opioid use disorder).
  • Sales of prescription pain relievers, addiction treatment admissions, and overdose death rates increased four- to six-fold in the two decades between the late 1990s and 2010.
  • In 2012, there were 259 million opioid prescriptions written, enough for each American to get their own bottle of pain pills.
  • Roughly 2.3% of high school seniors reported OxyContin misuse in the past year in 2019.
  • 21–29% of patients prescribed opioid medication for chronic pain will misuse the drugs.
  • Opioid use disorder develops in around 8–12%
  • 4 to 6 percent who misuse prescription opioids switch to illegal heroin.
  • Misusing prescription opioids is the gateway to heroin, accounting for more 80% of cases
  • 17 states had declining prescription opioid overdose deaths between 2017-2018 among the 38 states providing data; it did not increase by a large amount in any state

Opioid Overdose Deaths

  • Of the 52,000 drug overdose deaths in the US in 2015, more than 20,000 were related to prescription pain pills. 17
  • Based on 2018 data, 47,000 people die every year from opioid overdoses (this includes prescription pain pills, heroin, and synthetic drugs like fentanyl).18

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. 19

Heroin is both cheaper and more accessible than prescription opioids in parts of the country, making it more likely that people who become addicted will switch to heroin. 80% or people who use heroin first used 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 accounts for healthcare costs, criminal justice involvement, lost productivity at work, and addiction treatment costs. The estimated “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year.

Cost of Opioids

Prescription opioids can be expensive, which has encouraged users to switch to heroin to achieve a similar effect at a more affordable price. Street prices of heroin have been falling of late. 20

The Opioid Crisis in the United States

In the late 1990s, prescription opioid pain relievers were often prescribed for patients with 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 them at increased rates. However, over the next decade or so, diversion and misuse became widespread. It soon became obvious that opioid painkillers can be highly addictive. The death rate due to opioid overdoses began to climb. In 2018, 70% of all drug-related deaths involved an opioid. There was a rising incidence of newborns with opioid withdrawal syndrome (neonatal abstinence syndrome) due to opioid abuse among pregnant women. 21 22

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 of the opioid epidemic.
  • Supporting research on pain pill addiction.
  • Advancing best practices and non-addictive therapies for pain management.

In light of these efforts, in 2017-2018, among the 38 U.S. states that reported data on prescription opioid overdose deaths, 17 reported a decline. There were no states with a significant increase in opioid overdose deaths. 23

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 place some people at higher risk for addiction. For example, having a family history of addiction, growing up in a crime-ridden neighborhood, childhood trauma, early exposure and experimentation with drugs all increase the likelihood of addiction.

Older individuals receiving prescription opioid pain pills are at risk of accidental misuse or abuse because they are on multiple medications for various chronic ailments. This increases the risk of drug-drug and drug-disease interactions, which can lead to various health complications. People who struggle with chronic medical or mental health conditions are also more likely to become addicted, and may overuse opioids to reduce or cope with their pain.

There is a gender-based difference in opioid addiction. Women are more likely to suffer from chronic pain and receive treatment with prescriptions pain relievers. Women tend to receive higher doses of opioid pain pills and also to use them for longer compared to men. Women can develop addiction to opioids more quickly than men.

Children and adolescents are not immune to opioid addiction. They can access opioid painkillers in the medicine cabinets of their homes. In 2015, an estimated 275,000 adolescents reported non-medical use of pain pills. More than 120,000 adolescents had opioid addiction, and the pain pills were often obtained from friends and relatives.24

Signs and Symptoms of Opioid Abuse

People who are struggling with an opioid use disorder may not show any obvious signs of a problem in the beginning. However, friends and family members should remain vigilant for symptoms of opioid addiction.

Like many addictions, symptoms of opioid abuse and addiction often start with lifestyle changes, such as lack of hygiene, stealing from friends and family, financial difficulties, and isolation from loved ones. If opioid abuse continues, it can lead to 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 someone has been prescribed opioid pain relievers to manage pain, they should take them as directed by the prescribing physician. The following behaviors and symptoms can indicate that such a person could 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.25
  • 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)

Effects & Risks of Opioid Use

Addiction is a progressive disease that worsens and becomes more severe over time. In the early stages, people who become addicted will experience mild problems or consequences related to their use. If they escalate their use, these problems and consequences will become more severe, and can include things like:

  • Legal problems or consequences
  • Impairments at work or job loss
  • Financial debts or instability
  • Loss of important relationships
  • Inability to function independently
  • Worsened physical health
  • Symptoms of mental illness including depression or anxiety

A person who has developed an addiction to an opioid drug will almost certainly experience physical symptoms of withdrawal if they cut back or suddenly stop using. These symptoms can last a few days to a week or more and can include:

  • Muscle and bone pain
  • Nausea and vomiting
  • Diarrhea and loose stools
  • Insomnia and restless leg syndrome
  • Hot and cold flashes
  • Sweating
  • Severe drug cravings
  • Anxiety
  • Depression
  • Irritability

By far the most serious risk associated with opioid use is the risk of fatal overdose. People who consume too much of an opioid can experience respiratory depression that can lead to death. 26

These symptoms can be reversed with immediate administering of the medication Naloxone, which is carried by most first responders. Private citizens can also obtain naloxone to give an emergency dose as needed to a loved one they know struggles with opioid addiction.

Signs of overdose that require immediate medical attention 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 and/or heartbeat

Opioid addiction is the result of a complex combination of lifestyle, environmental, and genetic factors.27 Some of the factors that can increase the risk of opioid addiction include:

  • Easy access to prescription opioids, legally or illegally.
  • Previous history of substance use disorders.
  • Anxiety, depression, or other psychiatric illnesses.
  • Abuse or neglect during childhood.
  • Personality traits, such as sensation-seeking behavior, poor decision-making, disinhibition, and impulsivity.
  • Socioeconomic conditions (living in a poverty-stricken area and associating with others who have opioid addiction increases a person’s risk of developing opioid use disorder).

Also, a family history of opioid abuse increases a person’s risk of developing an opioid addiction. The Harvard Twin Study of Substance Abuse by Tsuang et al found genetics has a moderate contribution to opioid abuse and dependence. 28

Short- and Long-Term Effects of Opioid Addiction

Prescription opioid medications reduce pain and produce feelings of relaxation and happiness. They are extremely useful in managing pain but can have many unwanted, even dangerous effects. Some of the side effects of opioid pain pills include:

  • Confusion or mental fog
  • Drowsiness
  • Nausea
  • Constipation
  • Slowed breathing

Long-term use of opioids can lead to a variety of health problems involving the respiratory, cardiovascular, gastrointestinal, musculoskeletal, immune, endocrine (hormonal), and central nervous systems.29 The most dangerous effect of opioids is slowed breathing, which can lead to hypoxia (lack of oxygen supply) in the brain. This can result in short- and long-term neurological and psychological effects, including permanent brain damage, coma, and death.

Other adverse effects of opioid abuse and addiction include:

  • Various health problems.
  • Failure to meet work/school and family responsibilities.
  • Impaired judgment from drug use can lead to risky behaviors, such as unprotected sex.
  • Shared drug injection equipment increases the risk of contracting infections like HIV.
  • Prescription opioids are similar in chemical structure to the illegal drug heroin. Some people who misuse opioid medicines switch to heroin because it is cheaper and easier to obtain. An estimated 80% of heroin users say they first misused prescription opioids and later transitioned to heroin. 30

Prescription Opioids and Pregnancy

Expectant mothers who abuse opioids are at risk of miscarriage and giving birth to low birth weight babies. If a pregnant woman misuses a prescription opioid, her baby can develop a dependence on the drug. Such babies also often experience withdrawal symptoms after birth because they are no longer getting 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 death or life-threatening effects. Opioid medications can slow down or stop breathing, which can result in coma or permanent brain damage if the person survives. 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 and/or heartbeat

An opioid overdose is a medical emergency and requires immediate attention (call 911 or your local emergency number). A drug called naloxone can treat opioid overdose and get the person breathing again. Naloxone binds to opioid receptors in the brain, thereby blocking the effect of the opioid drug. Family members and friends of opioid addicts may be 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).

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 may have severe withdrawal symptoms within only several hours of the last dose. Symptoms of opioid withdrawal can include:

  • Extreme 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 opioid 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 after a major injury or surgery. These medications are also sometimes prescribed to reduce pain related to health conditions like 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 for opioid pain pill use.
  • Do not crush, chew, or dissolve the opioid pain pills.
  • Do not drive or operate heavy machinery (opioids can cause drowsiness and lead to accidents).
  • 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. The computer system will alert the pharmacist if any of your other medications can interact with opioid pain pills.

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 in a child. Also, to lower 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 in checked baggage during air travel).
  • Dispose of unused opioid medication properly by taking it to your pharmacy or flushing down the toilet (the FDA website lists the correct way 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, or saliva. Opioid screening helps ensure that an individual is taking the right amount of medicine. 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/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 one of your loved ones is suffering from opioid addiction seek help as soon as possible. If you are intervening for a loved one, it is essential to be compassionate, supportive, and to understand that opioid addiction is usually compounded with other health problems and stressful life conditions. Fortunately, there is hope for either you or your loved one.

Research has shown the most effective treatment for opioid addiction to be medications such as buprenorphine, methadone, and naltrexone. Rapid detoxification in 2 to 3 days can also be achieved with naltrexone. When used properly, these medicines do not result in euphoria or addiction.

Often opioid addiction accompanies other health problems including chronic pain and depression. Full recovery requires treatment and consideration of all conditions. Our opiate hotline can connect you to treatment centers that can offer help for addiction as well as associated mental health problems.

Our opiate addiction hotline can help you start your treatment journey. We are available to help 24/7/365.

Last updated: October 1, 2020

About the author

Hailey Shafir
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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