Opioids and Rx Misuse and Abuse

Opioids

What Are Opioids?

  • Opioids, natural or synthetic, also referred to as narcotic analgesics, 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.
  • Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract.  In doing so, they diminish the body's perception of pain. Opioids can also make people feel very relaxed and "high" which is why they are sometimes used for non-medical reasons. Opioids can also have an impact on other systems of the body, such as altering mood, slowing breathing and causing constipation.
  • Opioid pain relievers are generally safe when prescribed by a doctor and taken for a short time, but because they cause euphoria in addition to pain relief, they can be misused.  Opioid misuse results when opioids are taken in larger amounts and more often, taken for longer periods of time than prescribed, and taking opioids that were not prescribed and are someone else's.
  • Regular opioid use - even when prescribed by a doctor - can lead to dependence, and when misused, opioids can lead to addiction, overdose incidents, and deaths.

Opioid Overdose

  • An opioid overdose is when excessive amounts of the drug are taken and injury to the body (poisoning) occurs.  An opioid overdose can be fatal or nonfatal.
  • When people overdose on an opioid medication, their breathing often slows or stops, their body goes limp, their fingernails or lips have a blue or purple color, they may start vomiting or making gurgling noises, and they cannot be awakened or may be unable to speak. If their breathing slows or stops this can decrease the amount of oxygen that reaches the brain, which can result in a coma, permanent brain damage, or death.  
  • Call 911 if you suspect someone has overdosed, so they can receive immediate medical attention.
  • An opioid overdose can be treated by administering the life-saving medication, Naloxone, if done in time.  Naloxone works by rapidly binding to opioid receptors and blocking the effects of opioid drugs, reversing the overdose.  Naloxone is available in an injectable (needle) solution, a hand-held auto injector (EVIZIO), and a nasal spray (Narcan).

Opioid Tolerance vs. Dependence vs. 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 with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug.  Unpleasant physical symptoms occur when the medication is stopped, and may require medical support to stop taking the drug.
  • Opioid addiction or 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 school, work, and home.  Opioid addiction often comes after a person has developed opioid tolerance and dependence, making it physically challenging to stop use and increasing the risk of withdrawal.  

Opioid Use Disorder

  • Opioid misuse, addiction, and overdoses are serious public health problems in the United States.
  • According to the American Medical Association (AMA), an estimated 3 to 19 percent of people who take prescription pain medications develop an addiction to them.  People misusing opioids may try to switch from prescription pain killers to heroin when it is more easily available.  About 45 percent of people who use heroin started with an addiction to prescription opioids, according to the AMA.
  • Opioid use disorder is defined as a problematic pattern of opioid use leading to clinically significant impairment or distress.  Opioid misuse and abuse includes: opioids taken often in larger amounts over a longer period of time than was prescribed, a desire or unsuccessful efforts to cut down or control opioid use, a great deal of time is spent to obtain opioids, use opioids, or recover from its effects, craving or exhibiting a strong desire or urge to use opioids, recurrent opioid use resulting in a failure to fulfill major role obligation in work, school or home, continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids, giving up or reducing social, occupational or recreational activities because of opioid use, recurrent opioid use in which it is physically hazardous, continued opioid use despite having persistent or recurrent physical or psychological problems that were caused or exacerbated from opioid use, exhibiting tolerance and exhibiting withdrawal. 
  • In the past decade there has been a rise in the proportion of infants who have been exposed to opioid drugs, such as prescription pain relievers or heroin.  The increase has been seen in the incidence of neonatal abstinence syndrome (NAS) among newborns - primarily caused by maternal opioid use.
  • The incident of NAS in newborns born to opioid-dependent women is between 70-95 percent.  Research suggests that newborns with NAS are more likely than all other hospital births to have low birth-weight or respiratory complications.

Preventing Opioid Use Disorder

  • Prescription drug monitoring programs.
  • State prescription drug laws.
  • Formulary management strategies in insurance programs, such as prior authorization, quantity limits, and drug utilization review.
  • Academic detailing to educate providers about opioid prescribing guidelines and facilitating conversations with patients about the risks and benefits of pain treatment options.
  • Quality improvement programs in health care systems to increase implementation of recommended prescribing practices.
  • Patient education on safe storage and disposal of prescription opioids.
  • Improve awareness and share resources about the risks of prescription opioids, and the cost of overdose on patients and families.
All information on this page comes from the Centers for Disease Control and Prevention (CDC), National Institute on Drug Abuse and U.S. Department of Health and Human Services