Types of opioids include prescription painkillers, fentanyl, and heroin. Risk factors for opioid misuse, dependence, and serious harm include past use of other drugs, a history of untreated mental illness, access to the drug, and recent treatment for an overdose.
Opioid withdrawal symptoms include cravings, nausea, and vomiting. Slowed or stopped breathing is a sign of an overdose. Call 911 and administer naloxone, if it’s on hand.
Work with a licensed medical provider to explore approved medications and proven behavioral therapies that treat opioid use disorder.
Opioids are a chemically related class of drugs. Types of opioids include natural derivatives of the opium poppy plant, such as heroin; semisynthetic prescription pain relievers, such as oxycodone or Oxycontin (“oxy”); and synthetic opioids like fentanyl. They can be taken by mouth, injected, smoked, or snorted.
Medical providers prescribe opioids to relieve pain from advanced cancer and other illnesses and injuries. However, many people misuse or become dependent on these potent drugs, whether or not they’re obtained lawfully. Illegally manufactured fentanyl, in particular, is driving an epidemic of opioid overdoses and deaths.
Fortunately, there are effective treatments for opioid misuse or dependence. And the over-the-counter product naloxone can stop an opioid overdose and save a life. If you or a loved one is dependent on any type of opioid, it may be time to seek help.
Recovery is possible.
Opioids enter the brain and cling to cellular proteins called opioid receptors, which are found in the brain and elsewhere in the body. Our brain’s opioid system is involved in behaviors related to mood, pain, reward, and impulsivity.
Opioids stimulate the brain’s reward circuits and cause a surge in dopamine, a chemical messenger that can make us feel a pleasurable “high.” This high can also make us want to take more of the drug, increasing the risk of daily use leading to dependence.
Various risk factors are associated with misusing, becoming dependent on, or overdosing on common types of opioids.
Factors that can make using prescription opioids more dangerous or indicate misuse or dependence include:
Fentanyl is particularly associated with fatal and nonfatal overdoses. Factors that may lead to serious harm and even death include:
Fentanyl test strips may be used to detect the presence of this often-deadly substance in drugs obtained illegally. However, they are not 100% reliable in detecting trace amounts of fentanyl. If you see someone experiencing a fentanyl overdose, call 911 and administer naloxone, if available. Keep the person awake and on their side until first responders arrive. Learn more.
Heroin is a highly addictive opioid. Factors that make dependence on heroin more likely include:
Many opioids are potent. Pharmaceutical fentanyl, for instance, is 50–100 times as strong as morphine. Illicit fentanyl, which other drugs are sometimes laced with, is highly variable and dangerous, with stronger side effects and greater overdose risk than heroin.
Opioids mask pain and induce feelings of euphoria, intense calm, and sleepiness. Other common short-term side effects of opioids include confusion, slowed or stopped breathing, sickness and vomiting, and gastrointestinal issues such as constipation. Long-term use of these substances can cause dependence, heart and lung infections, and muscle pain.
Stopping use of opioids can cause intense, flu-like withdrawal symptoms. Preventing the onset of these ill feelings can lead to continued, long-term opioid use and dependence, a condition sometimes called opioid use disorder.
Use of opioids can lead to serious harm and even death. Consumption of illegally manufactured fentanyl — which may be sold as counterfeit prescription opioids or added to cannabis, cocaine, heroin, or methamphetamine — is driving up rates of opioid overdose and death. Heroin is also a highly addictive drug; 23% of people who use it develop a dependence on it.
These additional factors could increase your risk of misusing, becoming dependent on, or facing serious harm from opioids:
Naloxone can stop an opioid overdose and save a life. If you or someone you know is using opioids, carry naloxone, a medication available over the counter without a prescription that can safely reverse the toxic effects of an overdose. Learn more.
In the case of prescription and other opioids, experts recommended that you slowly taper off and stop use of these drugs under the care of a medical provider, who can help you manage any withdrawal symptoms. Withdrawal can start within eight hours and last as long as 20 days. Slowed or stopped breathing is a sign of an opioid overdose. If you see someone with these symptoms, call 911 and administer naloxone if you have it available. Naloxone used in this way is generally safe, even if it’s mistakenly administered to a person who is not experiencing an overdose.
These drugs are also associated with specific withdrawal symptoms, which can start within a few hours of stopping use of the substance. They may include cold flashes and goose bumps, watery eyes, runny nose, diarrhea and vomiting, bone and muscle pain, uncontrolled leg movements, severe cravings, irritability, yawning, and sleep difficulties.
Faces & Voices of Recovery
Karlee tells her story about prescription drug addiction, its negative effects on her life, and how she recovered.Close
Recovery from opioid misuse and dependence is possible. Behavioral therapies can reduce the potential for relapse, and prescription medications can lessen withdrawal symptoms.
Therapy: A licensed medical provider may recommend medication for addiction treatment (MAT), which combines the use of prescription drugs to alleviate withdrawal symptoms with therapies such as behavioral counseling. Studies have shown that MAT reduces opioid use and related deaths. Types of counseling to treat dependence on fentanyl and other opioids include cognitive behavioral therapy; contingency management, which assigns “points” for negative drug tests; and motivational interviewing, which is a form of patient-focused counseling. The Food and Drug Administration (FDA) has also authorized a mobile cognitive behavioral therapy app called reSET that can be used with MAT and other therapies; the app is available by prescription.
Medications: Specific FDA-approved opioid use treatments include buprenorphine (brand names include Suboxone and Subutex); methadone; and extended-release naltrexone (marketed as Vivitrol). The FDA has also approved the nonopioid treatments clonidine and lofexidine (sold under the brand names Catapres and Lucemyra, respectively) for managing opioid withdrawal. Use these medications with caution, as they can cause low blood pressure. Until you’re fully recovered from opioid use dependence, carry naloxone, an over-the-counter nasal spray that can reverse opioid overdose.
Recovery: Further manage your symptoms and promote your recovery by drinking a lot of water, getting plenty of exercise, and practicing relaxation techniques such as yoga and meditation.
Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic, Centers for Disease Control and Prevention Health Alert Network, December 17, 2020
Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Washington (DC): National Academies Press (US); July 13, 2017