If you think someone is overdosing, call 911 immediately. Learn more about the signs of overdose.


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 in a laboratory using the same chemical structure. A few common prescription opioids are:

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

Opioids may be prescribed to reduce acute, severe pain, and the pain that follows surgery. Like all medications, they have side effects. They may cause drowsiness, shallow breathing, and constipation. Because they also can produce temporary changes in mood, including feelings of euphoria, people sometimes misuse them. Opioids are strong, and can be very addictive. Even a single dose may be enough to cause serious health problems, or even death by overdose.

Fentanyl is a synthetic opioid prescribed to treat severe pain. It is 50 times more powerful than heroin. Fentanyl that is illegally made and distributed is on the rise, and is a leading cause of overdose deaths in the United States.

Heroin is an illegal, highly addictive opioid, prepared from morphine. Typically injected, heroin can also be smoked or snorted. Heroin is especially dangerous because it is often mixed with other drugs, including fentanyl, which increases the risk of overdose. In addition, when people inject heroin, they are at risk of serious, long-term viral infections such as HIV, hepatitis C, and hepatitis B, as well as bacterial infections of the skin, bloodstream, and heart. When people overdose on heroin, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain and cause death, coma, or permanent brain damage.

Prescription opioids can be useful in treating acute pain.

If you are prescribed an opioid, the best approach is to try the lowest possible dose in the smallest quantity. Opioids should be used for only as long as necessary. Generally, for acute pain, that means one to three days. Rarely are opioids needed for more than seven days.

Before taking an opioid medication for chronic pain:

  • Discuss with your provider other pain treatment options, including ones that do not involve prescription drugs.
  • Tell your doctor about your medical history and whether you or anyone in your family has a history of substance misuse or addiction to drugs or alcohol.
  • Discuss all of the risks and benefits of taking prescription opioids.

Opioids pose a risk to all patients of unintentional overdose and addiction, although some people might be at higher risk than others (see below). As many as 1 out of 4 people receiving long-term opioid therapy struggles with opioid use disorder. Nationally, there is an overdose death every 20 minutes.

The use of prescription opioids also carries with it possible side effects, even when taken as directed.

  • Tolerance — needing to take more of the medication over time to obtain relief from pain
  • Physical dependence — experiencing symptoms of withdrawal when the medication is stopped
  • Increased sensitivity to pain
  • Constipation
  • Nausea and vomiting
  • Dry mouth
  • Sleepiness and dizziness
  • Confusion
  • Depression
  • Low levels of testosterone that can result in lower sex drive, energy, and strength
  • Itching
  • Sweating

Misuse is when someone takes a prescription drug in higher amounts or for a longer time than recommended; uses someone else’s medication; or uses opioids to get high.

About 25% of people who misuse opioids become dependent.

Anyone who takes prescription opioids can become addicted, though some have a higher risk. You may also develop tolerance — meaning that over time you might need higher doses to relieve your pain, putting you at higher risk for a potentially fatal overdose. You can also develop physical dependence — meaning you have withdrawal symptoms when the medication is stopped.

Teenagers and older adults have higher-than-average risks of becoming addicted. Those who suffered from childhood abuse, survivors of rape, and veterans with post-traumatic stress disorder are particularly susceptible to substance use problems. There is also an increased risk of addiction for individuals with a psychological disorder.

Not everyone who uses prescription painkillers does or will use heroin. However, about 3 out of 4 new heroin users report abusing painkillers prior.

There is evidence that heroin use is increasing as prescription painkillers become less freely available. Nationally, deaths from heroin have tripled in the last five years. More Virginians die every year from overdoses than in automobile accidents, and nationally there is an overdose death every 20 minutes.

Opioids can cause physical dependence — meaning that when someone stops taking them, they might experience withdrawal symptoms. Withdrawal can be physically painful but is usually not life-threatening.

Early opioid withdrawal symptoms include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased lacrimation (eyes tearing up)
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Late withdrawal symptoms include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea
  • Vomiting

There is no guaranteed protection against substance misuse, but there are protective factors, often that start in childhood, including strong family bonds. These factors reduce the chances that someone will develop an addiction from using drugs or alcohol.

Work to build a trusting relationship with this person, so that you are able to regularly discuss the risks of substance use and they know they have support. Be aware of risk factors like a family history of addiction, a mental health condition, an impulsive or risk-taking personality, or a history of trauma.

Do not dispose of prescription medications in the toilet or sink, where they can contaminate waterways and harm fish and other wildlife.

Here’s how you can safely get rid of unused medications:

  • Drug disposal bag: Check online or ask your local drug prevention coalition or police department for information, or request a drug disposal bag from your health department or pharmacy. These bags contain powder to dissolve your unused medication.
  • Home disposal: Follow these steps to safely dispose of medication in your household trash: Remove the medication from its container and mix it with a substance such as dirt, cat litter, or used coffee grounds. Put the mixture in a sealed plastic bag and place it in your trash. To keep others from trying to order refills, scratch out personal information on the bottle and dispose of it in your trash or recycling.
  • Collection and disposal sites: Find authorized sites in Virginia here.

Twelve-step support groups are a form of peer support. They are the most widely available mutual support groups for people trying to break the cycle of addiction and those in recovery.

Although they are not professional treatment, 12-step groups can complement and extend the effects of professional treatment.

Professional treatment involves a structured program over time that includes credentialed counseling for substance abuse and is often accompanied by the closely supervised use of prescribed medication. This can occur in a treatment facility for inpatient or outpatient clients.

Treating withdrawal is not the same as treating addiction.

Detox is a process of managing the acute physical symptoms of withdrawal and can be medically managed in an inpatient facility or hospital. It may also occur on an outpatient basis. Detox is a short-term process, usually lasting less than a week.

Treatment addresses the biological, psychological, and social aspects of addiction. It lasts longer than detox: Research shows that most people who are addicted to drugs need at least three months in treatment to reduce or stop their drug use.

Depending on the type of treatment, detox may be the first step. But detox alone with no follow-up is not treatment.

Used properly, medications do not create addiction; furthermore, they are just one part of the process.

Medications allow an addicted person to regain a normal state of mind, free of drug-induced highs and lows. They free the person from constantly thinking about the drug and reduce problems of withdrawal and craving. These changes can give the person the chance to focus on the lifestyle changes that lead back to healthy living.

In addition to medication, to recover from opioid addiction, most people need some form of counseling and support from friends, family, or other members of the recovery community.


  • Acute pain – Pain that usually starts suddenly and has a known cause, such as an injury or surgery. The pain normally gets better as the body heals, and lasts less than three months.
  • Benzodiazepines – Sometimes called “benzos,” these are sedatives often used to treat anxiety, insomnia, and other conditions. Combining benzodiazepines with opioids increases a person’s risk of overdose and death.
  • Chronic pain – Pain that lasts three months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or even an unknown reason.
  • Drug abuse or addiction – Dependence on a legal or illegal drug or medication. See opioid use disorder.
  • Drug misuse – The use of prescription drugs without a prescription or in a manner other than as directed by the prescriber or healthcare provider, including use in greater amounts, more often, or longer than advised.
  • Extended-release/long-acting opioids – Slower-acting medication with a longer duration of pain-relieving action.
  • Fentanyl – A synthetic opioid pain medication, approved for treating severe pain (typically, pain caused by advanced cancer). It is 50 to 100 times more potent than morphine. Illegally made fentanyl is sold through illegal drug markets for its heroin-like effect, and it is often mixed with heroin, cocaine, or both as a combination product. In its prescription form, fentanyl brands include Actiq®, Duragesic®, and Sublimaze®. Common names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, Tango and Cash, and TNT.
  • Heroin – An illegal opioid drug made from morphine, a natural substance taken from the seedpod of various opium poppy plants. Heroin enters the brain rapidly and binds to opioid receptors on cells that control feelings of pain and pleasure as well as cells that control heart rate, sleeping, and breathing. Common names for heroin include Big H, Horse, Hell Dust, and smack.
  • Illicit drugs – A variety of drugs that are prohibited by law. These drugs, which are used for nonmedical purposes, include amphetamine-type stimulants, marijuana/cannabis, cocaine, heroin and other opioids, synthetic drugs, and MDMA (ecstasy).
  • Immediate-release opioids – Faster-acting medication with a shorter duration of pain-relieving action.
  • Medication-assisted treatment – Treatment to overcome opioid use disorder that combines the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
  • Morphine milligram equivalents (MME) – The amount of milligrams of morphine an opioid dose is equal to when prescribed. MME is used to calculate the total daily dose of opioids, accounting for differences in opioid drug type and strength.
  • Naloxone – A prescription drug that can reverse the effects of opioid overdose and can be lifesaving if administered in time. The drug is sold under the brand names Narcan and Evzio.
  • Nonmedical use – Taking drugs — whether obtained by prescription or otherwise — not in the way, for the reasons, or during the time period prescribed. Also, the use of prescription drugs by a person for whom the drug was not prescribed.
  • Non-opioid therapy – Methods of managing chronic pain that do not involve opioids. These methods include acetaminophen (Tylenol) or ibuprofen (Advil), cognitive behavioral therapy, physical therapy and exercise, medications for depression or for seizures, or interventional therapies (injections of an analgesic).
  • Nonpharmacologic therapy – Treatments that do not involve medications, including physical treatments (e.g., exercise therapy, weight loss) and behavioral treatments (e.g., cognitive behavioral therapy).
  • Opioid – Natural or synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This class of drugs includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription such as oxycodone, hydrocodone, codeine, morphine, and many others. Opioid pain medications are generally safe when taken for a short time and as prescribed, but because they produce euphoria in addition to pain relief, they can be misused.
  • Opioid analgesics – Commonly referred to as prescription opioids, medications that have been used to treat moderate to severe pain. Categories include natural opioid analgesics, including morphine and codeine; semi-synthetic opioid analgesics, including oxycodone, hydrocodone, hydromorphone, and oxymorphone; and synthetic opioid analgesics, including methadone and drugs such as tramadol and fentanyl.
  • Opioid use disorder – A pattern of opioid use that causes significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, or use resulting in social problems and failure to fulfill obligations at work, school, or home. Also referred to as opioid abuse or dependence, or opioid addiction.
  • Overdose – Injury to the body caused by poisoning that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.
  • Physical dependence – Adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.
  • Prescription drug monitoring programs (PDMPs) – State-run electronic databases that track prescriptions of controlled substances. PDMPs help providers identify patients at risk of opioid misuse, abuse, or overdose due to overlapping prescriptions, high dosages, or co-prescribing of opioids with benzodiazepines.
  • Tolerance – Reduced response to a drug because of repeated use.