# data[].attributes.body
- In 2019, nearly 50,000 people in the United States died from opioid overdose.
- In the late 1990's prescribed opioid painkillers gained popularity in the United States.
- 21-29% of people prescribed opioids misuse them.
- 80% of heroin users first misused prescription opioids.

# data[].attributes.attachment_link.readable_text
The U.S. government does not track death rates for every drug. However, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving many of the more commonly used drugs available through 2020 at a searchable database, called CDC Wonder. The NCHS also has 12 month-ending provisional data available by state and drug category. See Provisional Drug Overdose Death Counts.

The CDC also provides timely data related to unintentional and undetermined intent drug overdose deaths by participating jurisdiction through the State Unintentional Drug Overdose Reporting System (SUDORS). Similar data related to nonfatal drug overdoses are reported through CDC's Drug Overdose Surveillance and Epidemiology (DOSE) system.

Figure 1. National Drug-Involved Overdose Deaths-Number Among All Ages, by Gender, 1999-2020. Nearly 92,000 persons in the U.S. died from drug-involved overdose in 2020, including illicit drugs and prescription opioids. The figure above is a bar and line graph showing the total number of U.S. drug overdose deaths involving any illicit or prescription opioid drug from 1999 to 2020. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2020 (Source: CDC WONDER).

Figure 2. National Drug-Involved Overdose Deaths by Specific Category-Number Among All Ages, 1999-2020. Overall, drug overdose deaths rose from 2019 to 2020 with 91,799 drug overdose deaths reported in 2020. Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 56,516 overdose deaths reported in 2020. Those involving psychostimulants with abuse potential (primarily methamphetamine) also continued to increase to 23,837 (Source: CDC WONDER).

Figure 3. National Overdose Deaths Involving Any Opioid-Number Among All Ages, by Gender, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving any opioid from 1999 to 2020. Any opioid includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin and synthetic opioids other than methadone (primarily fentanyl). Opioid-involved overdose deaths rose from 21,088 in 2010 to 47,600 in 2017 and remained steady in 2018 with 46,802 deaths. This was followed by a significant increase through 2020 to 68,630 overdose deaths. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2020 (Source: CDC WONDER).

Figure 4. National Overdose Deaths Involving Prescription Opioids, by other Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving prescriptions opioids (including natural and semi-synthetic opioids and methadone) from 1999 to 2020. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139, followed by an increase to 16,416 in 2020. The bars are overlaid by lines showing the number of deaths involving prescription opioids in combination with synthetic opioids other than methadone (primarily fentanyl) or without any other opioid from 1999 to 2020 (Source: CDC WONDER).

Figure 5. National Overdose Deaths Involving Heroin, by Other Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving heroin from 1999 to 2020. Drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,469 in 2016. Since 2016, the number of deaths has trended down with 13,165 deaths reported in 2020. The bars are overlaid by lines showing the number of deaths involving heroin in combination with synthetic opioids other than methadone (primarily fentanyl) or without any other opioid from 1999 to 2020 (Source: CDC WONDER).

Figure 6. National Overdose Deaths Involving Psychostimulants With Abuse Potential (Including Methamphetamine), by Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving psychostimulants with abuse potential from 1999 to 2020. Drug overdose deaths rose from 547 in 1999 to 23,837 in 2020. The bars are overlaid by lines showing the number of deaths involving psychostimulants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths involving psychostimulants has increased steadily since 2014 regardless of opioid involvement (Source: CDC WONDER).

Figure 7. National Drug Overdose Deaths Involving Cocaine, by Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving cocaine from 1999 to 2020. Drug overdose deaths involving cocaine rose steadily from 5,419 in 2014 to 19,447 in 2020. The bars are overlaid by lines showing the number of deaths involving cocaine in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths in combination with synthetic opioids other than methadone has been increasing steadily since 2014 and is the main driver of cocaine-involved overdose deaths (Source: CDC WONDER).

Figure 8. National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving benzodiazepines from 1999 to 2020. Drug overdose deaths involving benzodiazepines has steadily increased from 1,135 in 1999 to 11,537 in 2017. Between 2017 and 2020, deaths declined and rose again to 12,290. The bars are overlaid by lines showing the number of deaths involving benzodiazepines in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid (Source: CDC WONDER).

Figure 9. National Drug Overdose Deaths Involving Antidepressants, by Opioid Involvement-Number Among All Ages, 1999-2020. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving antidepressants from 1999 to 2020. Drug overdose deaths involving antidepressants has risen steadily from 1,749 in 1999 to 5,269 in 2017. Since then, deaths have remained steady with 5,597 in 2020. The bars are overlaid by lines showing the number of deaths involving antidepressants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid involvement (Source: CDC WONDER).

Link

Description of Figures

The figures above are bar charts showing the number of U.S. overdose deaths involving select prescription and illicit drugs from 1999 through 2020. The bars are overlaid by lines representing gender or concurrent opioid involvement. There were 91,799 drug-involved overdose deaths reported in the U.S. in 2020 (Figure 1); 69% of cases occurred among males (yellow line). Synthetic opioids other than methadone (primarily fentanyl) were the main driver of drug overdose deaths with a 6-fold increase from 2015 to 2020 (Figure 2).

Drug overdose deaths involving any opioid―prescription opioids (including natural and semi-synthetic opioids and methadone), other synthetic opioids other than methadone (primarily fentanyl), and heroin―continued to rise through 2020 with 68,630 deaths. More than 70% of deaths occurred among males (Figure 3). From 2019 to 2020, the number of deaths involving prescription opioids rose, after remaining steady for two years, to 16,416 (Figure 4).

Overdose deaths involving heroin has trended down since 2016 with 13,165 deaths reported in 2020 (Figure 5). More than 68% of overdose deaths involving heroin also involved synthetic opioids other than methadone (primarily fentanyl).

Since 2014, the number of deaths involving psychostimulants (primarily methamphetamine, Figure 6) have risen significantly each year, with 23,837 deaths in 2020. Cocaine too, has increased steadily since 2014 with 19,447 deaths reported in 2020 (Figure 7).

The final two charts show the number of overdose deaths involving benzodiazepines (Figure 8) or antidepressants (Figure 9). Benzodiazepines were involved in 12,290 deaths in 2020-a steady decline from the 11,537 deaths in 2017. Deaths involving antidepressants have remained steady since 2014, with 5,597 fatalities reported in 2020. Deaths involving benzodiazepines or antidepressants are mainly driven by those also involving opioids.

# data[].attributes.attachment_link.title
Overdose Death Rates | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
The U.S. government does not track death rates for every drug. However, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving many of the more commonly used drugs available through 2020 at a searchable database, called CDC Wonder.

# data[].attributes.body
- Opioids can be classified as Heroin, Synthetic opioids, or commonly prescribed opioids.
- First wave began in the 1990's with an increase in overdoses due to prescribed opioids.
- Second wave began in 2010 with rapid increases in overdoses involving heroin.
- Third wave began in 2013 with the rise of overdoses due to synthetic opioids such as fentanyl.

# data[].attributes.attachment_link.readable_text
The number of people who died from a drug overdose in 2021 was over six times the number in 1999. The number of drug overdose deaths increased more than 16% from 2020 to 2021. Over 75% of the nearly 107,000 drug overdose deaths in 2021 involved an opioid. From 2020 to 2021:

Three Waves of Opioid Overdose Deaths

From 1999-2021, nearly 645,000 people died from an overdose involving any opioid, including prescription and illicit opioids ¹.

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 ⁴.

3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl 5,6,7. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.⁸

Many opioid-involved overdose deaths also include other drugs 9.10.

Combatting the Opioid Overdose Epidemic

CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, respond to overdoses, and provide care to those in their communities. Overdose Data to Action (OD2A) is a 4-year cooperative agreement through which CDC funds health departments in 47 states, Washington DC, two territories, and 16 cities and counties for surveillance and prevention efforts. These efforts include timelier tracking of nonfatal and fatal drug overdoses, improving toxicology to better track polysubstance-involved deaths, enhancing linkage to care for people with opioid use disorder and risk for opioid overdose, improving prescription drug monitoring programs, implementing health systems interventions, partnering with public safety, and implementing other innovative surveillance and prevention activities.

CDC's work focuses on:

Monitoring trends to better understand and respond to the epidemic.

Advancing research by collecting and analyzing data on opioid-related overdoses and improving data quality to better identify areas that need assistance and to evaluate prevention efforts.

Building state, local and tribal capacity by equipping states with resources, improving data collection, and supporting use of evidence-based strategies. Overdose Data to Action (OD2A) is a cooperative agreement that aims to increase the timeliness and comprehensives of data and to use those data to inform public health response and prevention activities.

Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.

Partnering with public safety officials and community organizations, including law enforcement, to address the growing illicit opioid problem.

Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids.

Collaboration is essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better coordinate efforts to prevent opioid overdoses and deaths.

Read more about CDC's role in the opioid overdose epidemic.

1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.

2. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths - United States, 2013-2019. MMWR Morb Mortal Wkly Rep 2021;70:202-207. DOI: http://dx.doi.org/10.15585/mmwr.mm7006a4external icon.

3. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers-United States, 1999-2008.MMWR MorbMortal Wkly Rep. 2011 Nov 4; 60(43):1487-1492.

4. Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A. Increases in heroin overdose deaths-28 states, 2010 to 2012.MMWR MorbMortal Wkly Rep. 2014 Oct 3; 63(39):849.

5. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths-27 states, 2013-2014.MMWR MorbMortal Wkly Rep. 2016; 65:837-43.

6. O'Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region-United States, 2006-2015.MMWR MorbMortal Wkly Rep. 2017; 66:897-903.

7. O'Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700-10 states, July-December 2016.MMWR Morb Mortal Wkly Rep. 2017; 66:1197-202.

8. Drug Enforcement Administration. 2019 National Drug Threat Assessment. Drug Enforcement Administration Strategic Intelligence Section, U.S. Department of Justice. Published December 2019. Accessed March 17, 2020 from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf [PDF]

9. Gladden M, O'Donnell J, Mattson C, Seth P. Changes in Opioid-Involved Overdose Deaths by Opioid Type and Presence of Benzodiazepines, Cocaine, and Methamphetamine - 25 States, July-December 2017 to January-June 2018. MMWR Morb Mortal Wkly Rep 2019:68(34);737-744.

10. Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths involving Cocaine and Psychostimulants with Abuse Potential - United States, 2003-2017. MMWR Morb Mortal Wkly Rep 2019:68(17);41-43.

11. Hedegaard H, Miniño AM, Spencer MR, Warner M. Drug Overdose Deaths in the United States, 1999-2020 [PDF] . National Center for Health Statistics, December 2021.

12. Spencer MR, Miniño AM, Warner M. Drug overdose deaths in the United States, 2001-2021. NCHS Data Brief, no 457. Hyattsville, MD: National Center for Health Statistics. 2022. DOI: https://dx.doi.org/10.15620/cdc:122556

# data[].attributes.attachment_link.title
Understanding the Opioid Overdose Epidemic

# data[].attributes.attachment_link.description
The rise in opioid overdose deaths can be described in three distinct waves. There was an increase prescribing opioids in the 1990s; rapid increases in overdose deaths involving heroin beginning in 2010; and in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.

# data[].attributes.body
- 1.6 million people had an opioid use disorder in 2019.
- 745,000 people used heroin in 2019.
- 10.1 million people misused prescription opioids in 2019.
- 1.6 million people misused prescription opioids for the first time in 2019.

# data[].attributes.body
- Opioids bind to and activate the opiate receptors in the brain, spinal cord and various organs.
- When the opioids bind to these receptors they block pain signals from the brain to the body.
- While opioids block pain signals to the body large amounts of dopamine are released throughout the body giving the opioid user a euphoric feeling.
- This euphoric feeling causes the opioid user to want to continue using opioids therefore creating the habit.
-Unfortunately the user will have to increase dosage to chase that same feeling.
-Ultimately this leads to dangerously high dosages of opioids and eventually accidental overdose.

# data[].attributes.attachment_link.readable_text
What are 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. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and "high" - which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin is one of the world's most dangerous opioids, and is never used as a medicine in the United States.

What are common prescription opioids?

How do people misuse prescription opioids?

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by a doctor, but they can be misused. People misuse prescription opioids by:

taking the medicine in a way or dose other than prescribed

taking someone else's prescription medicine

taking the medicine for the effect it causes-to get high

When misusing a prescription opioid, a person can swallow the medicine in its normal form. Sometimes people crush pills or open capsules, dissolve the powder in water, and inject the liquid into a vein. Some also snort the powder.

How do prescription opioids affect the brain?

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.

What are some possible effects of prescription opioids on the brain and body?

In the short term, opioids can relieve pain and make people feel relaxed and happy. However, opioids can also have harmful effects, including:

Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

What are the other health effects of opioid medications?

Older adults are at higher risk of accidental misuse or abuse because they typically have multiple prescriptions and chronic diseases, increasing the risk of drug-drug and drug-disease interactions, as well as a slowed metabolism that affects the breakdown of drugs. Sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV and from unprotected sex.

Prescription Opioids and Heroin

Prescription opioids and heroin are chemically similar and can produce a similar high. In some places, heroin is cheaper and easier to get than prescription opioids, so some people switch to using heroin instead. Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin and about 80 percent of people who used heroin first misused prescription opioids. More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.

This suggests that prescription opioid misuse is just one factor leading to heroin use. Read more about this intertwined problem in our Prescription Opioids and Heroin Research Report.

Can I take prescription opioids if I'm pregnant?

If a woman uses prescription opioids when she's pregnant, the baby could develop dependence and have withdrawal symptoms after birth. This is called neonatal abstinence syndrome, which can be treated with medicines. Use during pregnancy can also lead to miscarriage and low birth weight. Read more in the Substance Use in Women Research Report.

It can be difficult for a person with an opioid addiction to quit, but pregnant women who seek treatment have better outcomes than those who quit abruptly. Methadone and buprenorphine are the standard of care to treat opioid-dependent pregnant women. Methadone or buprenorphine maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the adverse outcomes associated with untreated opioid addiction. If a woman is unable to quit before becoming pregnant, treatment with methadone or buprenorphine during pregnancy improves the chances of having a healthier baby at birth.

In general, it is important to closely monitor women who are trying to quit drug use during pregnancy and to provide treatment as needed.

Tolerance vs. Dependence vs. Addiction

Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.

Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.

Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.

Can a person overdose on prescription opioids?

Yes, a person can overdose on prescription opioids. An opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death. When people overdose on an opioid medication, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage, or death.

How can an opioid overdose be treated?

If you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone. Naloxone is a medicine that can treat an opioid overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. Naloxone is available as an injectable (needle) solution and nasal sprays (NARCAN ® Nasal Spray and KLOXXADO ®).

Some states have passed laws that allow pharmacists to dispense naloxone without a personal prescription. Friends, family, and others in the community can use the nasal spray versions of naloxone to save someone who is overdosing.

Read more in our Naloxone DrugFacts.

Can use of prescription opioids lead to addiction?

Yes, repeated misuse of prescription opioids can lead to a substance use disorder (SUD), a medical illness which ranges from mild to severe and from temporary to chronic. Addiction is the most severe form of an SUD. An SUD develops when continued misuse of the drug changes the brain and causes health problems and failure to meet responsibilities at work, school, or home.

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include:

muscle and bone pain

sleep problems

diarrhea and vomiting

cold flashes with goose bumps

uncontrollable leg movements

severe cravings

These symptoms can be extremely uncomfortable and are the reason many people find it so difficult to stop using opioids. There are medicines being developed to help with the withdrawal process, including lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms that was approved by the U.S. Food and Drug Administration (FDA) in 2018. The FDA has also approved sale of a device, NSS-2 Bridge, that can help ease withdrawal symptoms. The NSS-2 Bridge is a small electrical nerve stimulator placed behind the person's ear, that can be used for up to five days during the acute withdrawal phase.

What type of treatment can people get for addiction to prescription opioids?

A range of treatments including medicines and behavioral therapies are effective in helping people with opioid addiction.

Two medicines, buprenorphine and methadone, work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms. Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from having an effect.

Behavioral therapies for addiction to prescription opioids help people modify their attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication. Some examples include, cognitive behavioral therapy which helps modify the patient's drug use expectations and behaviors, and also effectively manage triggers and stress. Multidimensional family therapy, developed for adolescents with drug use problems, addresses a range of personal and family influences on one's drug use patterns and is designed to improve overall functioning. These behavioral treatment approaches have proven effective, especially when used along with medicines. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.

Points to Remember

Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea.

People misuse prescription opioids by taking the medicine in a way other than prescribed, taking someone else's prescription, or taking the medicine to get high. When misusing a prescription opioid, a person may swallow, inject, or snort the drug.

Opioids bind to and activate opioid receptors on cells located in the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure, and can strongly reinforce the act of taking the drug, making the user want to repeat the experience.

People who use prescription opioids can feel relaxed and happy, but also experience drowsiness, confusion, nausea, constipation, and slowed breathing.

Prescription opioids have effects similar to heroin. While prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse opioid pain relievers switch to heroin.

A person can overdose on prescription opioids. Naloxone is a medicine that can treat an opioid overdose when given right away.

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. Withdrawal symptoms include muscle and bone pain, sleep problems, diarrhea and vomiting, and severe cravings.

A range of treatments including medicines and behavioral therapies are effective in helping people with an opioid use disorder.

Learn More

For more information about opioid medications, see our:

References

1. Muhuri PK, Gfroerer JC, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm. Accessed May 13, 2016.

2. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7):821-826. doi:10.1001/jamapsychiatry.2014.366.

3. Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-134. doi:10.1016/j.drugalcdep.2015.12.026.

4. Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017 Nov;74:63-66. doi: 10.1016/j.addbeh.2017.05.030. Epub 2017 May 23. PubMed PMID: 28582659. https://www.ncbi.nlm.nih.gov/pubmed/28582659

# data[].attributes.attachment_link.title
Prescription Opioids DrugFacts | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
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. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain.

# data[].attributes.body
- Pin point pupils.
- Respirations less than 12 a minute
- Slowed heart rate.
- Cannot be woken up or is unable to speak.
-Drowsiness.
- Pale, cool and clammy skin signs.

# data[].attributes.attachment_link.readable_text
What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, people who take opioids are at risk for opioid dependence and addiction, as well as an overdose. These risks increase when opioids are misused. Misuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids.

What is an opioid overdose?

Opioids affect the part of the brain that regulates breathing. When people take high doses of opioids, it can lead to an overdose, with the slowing or stopping of breathing and sometimes death.

What causes an opioid overdose?

An opioid overdose can happen for a variety of reasons, including if you

Take an opioid to get high

Take an extra dose of a prescription opioid or take it too often (either accidentally or on purpose)

Mix an opioid with other medicines, illegal drugs, or alcohol. An overdose can be fatal when mixing an opioid and certain anxiety treatment medicines, such as Xanax or Valium.

Take an opioid medicine that was prescribed for someone else. Children are especially at risk of an accidental overdose if they take medicine not intended for them.

There is also a risk of overdose if you are getting medication-assisted treatment (MAT). MAT is a treatment for opioid abuse and addiction. Many of the medicines used for MAT are controlled substances that can be misused.

Who is at risk for an opioid overdose?

Anyone who takes an opioid can be at risk of an overdose, but you are at higher risk if you

Take illegal opioids

Take more opioid medicine than you are prescribed

Combine opioids with other medicines and/or alcohol

Have certain medical conditions, such as sleep apnea, or reduced kidney or liver function

Are over 65 years old

What are the signs of an opioid overdose?

The signs of an opioid overdose include

The person's face is extremely pale and/or feels clammy to the touch

Their body goes limp

Their fingernails or lips have a purple or blue color

They start vomiting or making gurgling noises

They cannot be awakened or are unable to speak

Their breathing or heartbeat slows or stops

What should I do if I think that someone is having an opioid overdose?

If you think someone is having an opioid overdose,

Call 9-1-1 immediately

Administer naloxone, if it is available. Naloxone is a safe medication that can quickly stop an opioid overdose. It can be injected into the muscle or sprayed into the nose to rapidly block the effects of the opioid on the body.

Try to keep the person awake and breathing

Lay the person on their side to prevent choking

Stay with the person until emergency workers arrive

Can an opioid overdose be prevented?

There are steps you can take to help prevent an overdose:

Take your medicine exactly as prescribed by your health care provider. Do not take more medicine at once or take medicine more often than you are supposed to.

Never mix pain medicines with alcohol, sleeping pills, or illegal substances

Store medicine safely where children or pets can't reach it. Consider using a medicine lockbox. Besides keeping children safe, it also prevents someone who lives with you or visits your house from stealing your medicines.

Dispose of unused medicine promptly

If you take an opioid, it is also important to teach your family and friends how to respond to an overdose. If you are at high risk for an overdose, ask your health care provider about whether you need a prescription for naloxone.

# data[].attributes.attachment_link.description
Opioids affect the part of the brain that regulates breathing. When people take high doses of opioids, it can lead to an overdose, with the slowing or stopping of breathing and sometimes death. Learn how to prevent and treat opioid overdoses.

# data[].attributes.body
Assistant Secretary of Public Affairs (ASPA). “What Is the U.S. Opioid Epidemic?” HHS.gov, Https://Plus.google.com/+HHS, www.hhs.gov/opioids/about-the-epidemic/index.html.

Davis, Mike, director. TED-Ed: What Causes Opioid Addiction, and Why Is It So Hard to Combat? YouTube, TEDEducation, 7 May 2020, www.youtube.com/watch?v=V0CdS128-q4.

Emergency Medical Services, www.sandiegocounty.gov/content/sdc/ems.html.

Haydon, Ian. “How Opioids Reshape Your Brain, and What Scientists Are Learning about Addiction.” Https://Www.inquirer.com, The Philadelphia Inquirer, 24 July 2018, www.inquirer.com/philly/health/addiction/what-science-knows-about-how-opioids-reshape-your-brain-20180724.html.
HealthVermont, director. How to Administer Naloxone/Narcan. YouTube, SAMHSA, 26 Nov. 2019, www.youtube.com/watch?v=EHMFjo25F2U.

National Institute on Drug Abuse. “Opioid Overdose Crisis.” National Institute on Drug Abuse, 1 July 2021, www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis.

National Institute on Drug Abuse. “Prescription Opioids DrugFacts.” National Institute on Drug Abuse, 1 July 2021, www.drugabuse.gov/publications/drugfacts/prescription-opioids.

“Opioid Overdose.” MedlinePlus, U.S. National Library of Medicine, 3 June 2021, https://medlineplus.gov/opioidoverdose.html.

SAMHSA, director. What Is Naloxone? YouTube, SAMHSA, 25 Sept. 2018, www.youtube.com/watch?v=RcAaZQQqd50.

Thehealthcaretriage, director. Opioid Addiction and Treatment. YouTube, Healthcare Triage, 23 May 2016, www.youtube.com/watch?v=Ptokjgt2j3Y.

“Understanding the Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Mar. 2021, www.cdc.gov/opioids/basics/epidemic.html.

# data[].attributes.body
- Ensure patent airway
- O2 saturation PRN
- O2 and/or ventilate PRN
- Carboxyhemoglobin monitor PRN, if available
Ingestions:
- Identify substance
- Transport pill bottles and containers with patient, PRN
Symptomatic suspected opioid OD with RR <12. Use caution in opioid-dependent, pain management patients.
- Naloxone 4mg via nasal spray preloaded single-dose device. Administer full dose in one nostril OR
- Naloxone 2mg via atomizer and syringe. Administer 1mg into each nostril.
- EMT's may assist family or friend to medicate with patients prescribed naloxone in symptomatic opioid OD.

# data[].attributes.attachment_link.readable_text
County EMS Grantville offices have officially moved!

All County EMS Staff are working remotely. There are NO in-person services available. Please call or email with any questions.

Here is our new mailing address:

San Diego County EMS Office (MS O-202)
5510 Overland Avenue, Suite 250
San Diego, CA 92123-1239

The Fire Captain Ryan Mitchell behavioral health support program is a free, confidential 24/7 peer-supported referral hotline.

This program aims to increase awareness about local mental health resources and decrease the stigma and barriers associated with First Responders seeking behavioral health support services.

# data[].attributes.attachment_link.description
All County EMS Staff are working remotely. There are NO in-person services available. Please call or email with any questions. Here is our new mailing address: San Diego County EMS Office (MS O-202) 5510 Overland Avenue, Suite 250 San Diego, CA 92123-1239 The Fire Captain Ryan Mitchell behavioral health support program is a free, confidential 24/7 peer-supported referral hotline.

# data[].attributes.body
- After prolonged use of Opioids the brain can be damaged, Opioid abuse can affect someones ability to make decisions and plan for the future.
- Prolonged use of Opioids builds "cravings" in the brain and even affects the user's ability to resist opioid use.

https://www.inquirer.com/philly/health/addiction/what-science-knows-about-how-opioids-reshape-your-brain-20180724.html

# data[].attributes.headline
TED-Ed: What Causes Opioid Addiction, and Why Is It So Hard to Combat?

# data[].attributes.subject
TED-Ed: What Causes Opioid Addiction, and Why Is It So Hard to Combat?

# data[].attributes.body
(A comprehensive overview of opioid addiction)
- "Morphine, codeine, and other substances made directly from the poppy plant are called opiates." (0:49)
- In the 19th century, these compounds were isolated for use in medicine and pain control. (0:40)
- Later, in the 20th century, these drugs were manufactured (synthetic) into other more dangerous drugs such as heroin, hydrocodone, oxycodone, and fentanyl. (1:01) These drugs are extremely addictive and what has lead us to the epidemic today.

# data[].attributes.attachment_link.title
What causes opioid addiction, and why is it so tough to combat? - Mike Davis

# data[].attributes.body
- "Dependence is the tolerance one develops over time and the withdrawal one suffers after stopping the drug." (0:09)
- "Addiction is a behavioral disorder that refers to the desire a person feels for the effects of a drug." (0:09)
- One of the most common treatments for addiction is the use of methadone. (3:06)

# data[].attributes.headline
How to use Naloxone in Suspected Opioid Overdose:

# data[].attributes.subject
How to use Naloxone in Suspected Opioid Overdose:

# data[].attributes.body
- Check pulse and breathing rate.
- Check pupil size, if pupils are pinpoint and respirations are less than 12 a minute prepare to administer naloxone.
- As EMT, ensure patent airway and insert OPA or NPA.
- As an EMT, Connect Bag Valve Mask to oxygen bottle and begin breathing for patient with high flow oxygen.
- Administer naloxone and continue breathing for patient until patient wakes up.

# data[].attributes.body
- Naloxone is a safe medication that reverses the affects of opioids. (0:23)
- Naloxone attaches to opioid receptors without activating the receptors. (0:45)
- Naloxone replaces the opioids in the receptors and allows the body to breathe normally again. (1:50)