Opioid FAQs

What are opioids?

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioid drugs 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. 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.

How do opioids affect the brain and body?

Opioids act by attaching to and activating opioid receptor proteins, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they inhibit the transmission of pain signals. Opioids can also produce drowsiness, mental confusion, nausea, constipation, and respiratory depression, and since these drugs also act on brain regions involved in reward, they can induce euphoria, particularly when they are taken at a higher-than-prescribed dose or administered in other ways than intended. For example, OxyContin is an oral medication used to treat moderate to severe pain through a slow, steady release of the opioid. Some people who misuse OxyContin intensify their experience by snorting or injecting it. This is a very dangerous practice, greatly increasing the person’s risk for serious medical complications, including overdose.

What are the possible consequences of prescription opioid misuse?

When taken as prescribed, patients can often use opioids to manage pain safely and effectively. However, it is possible to develop a substance use disorder when taking opioid medications as prescribed. This risk and the risk for overdose increase when these medications are misused. Even a single large dose of an opioid can cause severe respiratory depression (slowing or stopping of breathing), which can be fatal; taking opioids with alcohol or sedatives increases this risk.

When properly managed, short-term medical use of opioid pain relievers—taken for a few days following oral surgery, for instance—rarely leads to an opioid use disorder or addiction. But regular (e.g., several times a day, for several weeks or more) or longer-term use of opioids can lead to dependence (physical discomfort when not taking the drug), tolerance (diminished effect from the original dose, leading to increasing the amount taken), and, in some cases, addiction (compulsive drug seeking and use). See Understanding Dependence, Addiction, and Tolerance to learn how these differ.

Can someone overdose from misusing a prescription opioid?

A person can overdose on any opioid, whether they are prescribed or illegal.

What happens after someone recovers from an overdose?

The person may not realize what has happened. They may be agitated or upset because they come out of the overdose feeling sick. Always stay with someone who has come out of an overdose. Depending on how much of a substance the person used, they could re-overdose after the administration of naloxone. Do your best to stay calm and keep the person company while waiting for emergency medical personnel. Encourage the individual to seek treatment and give them hope for recovery. Treatment works and recovery is possible!

What are the symptoms of opioid withdrawal?

With both dependence and addiction, withdrawal symptoms may occur if drug use is suddenly reduced or stopped. These symptoms may include:

Restlessness
Muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goose bumps
Involuntary leg movements

How is prescription opioid misuse related to chronic pain?

Health care providers have long wrestled with how best to treat the more than 100 million Americans who suffer from chronic pain. Opioids have been the most common treatment for chronic pain since the late 1990s, but recent research has cast doubt both on their safety and their efficacy in the treatment of chronic pain when it is not related to cancer or palliative care. The potential risks involved with long-term opioid treatment, such as the development of drug tolerance, hyperalgesia, and addiction, present doctors with a dilemma, as there is limited research on alternative treatments for chronic pain.

Patients themselves may even be reluctant to take an opioid medication prescribed to them for fear of becoming addicted. In Connecticut, patients who do not wish to receive a prescription for opioids can fill out a Voluntary Non-Opioid Directive (VNOD) form to be added to their medical record. The VNOD serves to inform doctors that you do not want to be given or prescribed opioids.

To mitigate addiction risk, physicians should adhere to the CDC Guideline for Prescribing Opioids for Chronic Pain. Before prescribing, physicians should assess pain and functioning, consider if non-opioid treatment options are appropriate, discuss a treatment plan with the patient, evaluate the patient’s risk of harm or misuse, and co-prescribe naloxone to mitigate the risk for overdose. When first prescribing opioids, physicians should give the lowest effective dose for the shortest therapeutic duration. As treatment continues, the patient should be monitored at regular intervals, and opioid treatment should be continued only if meaningful clinical improvements in pain and functioning are seen without harm.

What are common prescription opioids?

Hydrocodone (Vicodin®)
Oxycodone (OxyContin®, Percocet®)
Oxymorphone (Opana®)
Morphine (Kadian®, Avinza®)
Codeine
Fentanyl

Popular slang terms for opioids include Oxy, Percs, and Vikes.

What’s the relationship between prescription opioids, heroin, and fentanyl?

Heroin and prescription opioids are chemically similar and can produce a similar high. Heroin is often cheaper and easier to obtain than prescription opioids, so some people switch to heroin instead. The majority of Americans using heroin (including those in treatment) reported misusing prescription opioids prior to using heroin. While prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse pain relievers switch to heroin, suggesting that prescription opioid misuse is just one factor leading to heroin use.

Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It’s typically used to treat patients with severe pain and patients with chronic pain who are physically tolerant to other opioids. When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenges. However, the fentanyl and fentanyl analogs associated with recent overdoses are produced in clandestine laboratories. This non-medical fentanyl is often mixed with or substituted for heroin or sold as tablets that mimic other opioids. The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl.

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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