Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant, and others are made from chemicals in a laboratory, using the same chemical structure as the opium found in poppies. These are some common prescription opioids:
Morphine (Kadian®, Avinza®)
Oxycodone (OxyContin®, Percocet®)
Opioids may be prescribed to reduce acute, severe pain and the pain that sometimes follows surgery. Like all medications, they have side effects. They may cause drowsiness, shallow breathing, and constipation. Because they can also produce temporary changes in mood, including feelings of euphoria, people sometimes misuse them. Opioids are strong and can be very addictive. If taken incorrectly, 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. The illegal manufacture and distribution of fentanyl is on the rise, and illegal fentanyl 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 risk contracting 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 decreases the amount of oxygen that reaches the brain and can cause coma, death, 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. Opioids should be used 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 other pain treatment options with your health care provider, including options that do not involve prescription drugs.
Tell your doctor about your medical history, including whether you or anyone in your family has a history of substance misuse or addiction to drugs or alcohol.
Discuss all the risks and benefits of taking prescription opioids with your doctor.
Opioids pose a risk of unintentional overdose and addiction for all patients, although some people may be at higher risk than others. As many as 1 in 4 people receiving long-term opioid therapy develop opioid use disorder. Nationally, there is an overdose death every 5 minutes.
Prescription opioids can also have side effects, even when they are 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
Nausea and vomiting
Sleepiness and dizziness
Low levels of testosterone, which can result in lower sex drive, energy, and strength
Opioid misuse occurs when someone takes a prescription opioid in higher amounts or for a longer time than prescribed, uses someone else’s medication, or uses opioids to get high.
About 25% of people who misuse opioids become physically dependent on them.
Anyone who takes prescription opioids can become addicted, although some people have a higher risk. You may also develop tolerance to the drug — meaning that over time you might need higher doses to relieve your pain, putting you at higher risk for a potentially fatal overdose. You may also develop physical dependence, which means you will have withdrawal symptoms when the medication is stopped.
Teenagers and older adults have a higher-than-average risk of becoming addicted. The presence of mental illness or a psychological disorder also increases an individual’s risk of addiction. Those who have experienced child abuse, rape, or post-traumatic stress disorder are particularly susceptible to substance use disorder.
Not everyone who misuses prescription pain medication goes on to use heroin. However, about 3 in 4 new heroin users report prior misuse of pain medication.
There is evidence that heroin use is increasing as prescription pain medication becomes less freely available. Heroin is often laced with synthetic opioids like fentanyl. Overdose deaths involving fentanyl increased from 57,834 in 2020 to 71,238 in 2021.
Withdrawal is the process people go through when they stop using a drug they have become dependent on. Withdrawal can be physically painful but is usually not life-threatening.
Early opioid withdrawal symptoms include:
Increased tearing (secretion or shedding of tears)
Later withdrawal symptoms include:
There is no guaranteed protection against substance misuse, but there are things you can do to reduce the chances that someone you care about will develop an addiction to drugs or alcohol. One of the most protective factors is having strong bonds with family and friends.
If you think someone you know is at risk, work to build a trusting relationship with them. This will make it easier for you to discuss the risks of substance misuse with them. Let them know they have your 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, because they can contaminate waterways and harm fish and other wildlife.
Here’s how you can safely get rid of unused medications:
Drug disposal bags: These bags contain powder to dissolve your unused medication before you put it in the trash. You can request a drug disposal bag from your health department or pharmacy. You can also check online or ask your local drug prevention coalition or police department for information.
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 label and dispose of the container in your trash or recycling.
Collection and disposal sites: Find an authorized site near you.
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 for people in recovery.
Although they do not provide professional treatment, 12-step groups can complement and extend the effects of professional treatment.
Professional treatment is offered through structured programs that include credentialed counseling for substance abuse. They often provide closely supervised use of prescribed medication as well. These programs are offered in treatment facilities for inpatient or outpatient clients.
Treating withdrawal is not the same as treating addiction.
Detox is the process of managing the acute physical symptoms of withdrawal. This can take place in an inpatient facility or hospital, or on an outpatient basis. Detox is a short-term process, usually lasting less than a week.
Addiction treatment addresses the biological, psychological, and social aspects of addiction and lasts much 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 addiction treatment.
Used properly, these medications do not create addiction; furthermore, they are just one part of the process.
Properly administered medications allow a person undergoing addiction treatment to regain a normal state of mind, free of drug-induced highs and lows. They free the person from constantly thinking about the drug they want to stop using, and they reduce cravings and the symptoms of withdrawal. This helps the person focus on the lifestyle changes that can lead back to healthy living.
But medication alone is not sufficient to recover from opioid addiction. Most people need some form of professional counseling and support from friends, family, and 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 decreases as the body heals, lasting less than three months.
Benzodiazepines – Sedatives that are often used to treat anxiety, insomnia, and other conditions. Combining benzodiazepines with opioids increases a person’s risk of overdose and death. Sometimes called “benzos.”
Chronic pain – Pain that lasts three months or more. Chronic pain can be caused by disease, injury, medical treatment, or inflammation. Sometimes the cause is unknown.
Drug abuse – A pattern of compulsive substance use marked by recurrent adverse consequences, such as repeated absences from work or school, arrests, and marital difficulties.
Drug addiction – A chronic yet treatable medical disease characterized by the repeated, uncontrollable use of substances. A person who has an addiction continues using the substance regardless of the consequences.
Drug dependence – Physical and/or psychological need to continue taking drugs or alcohol despite the negative consequences. Signs of dependence include the need for increased amounts to achieve the desired effect and the presence of withdrawal symptoms when the drug is decreased or stopped.
Drug misuse – The use of drugs without a prescription or in a manner other than as directed. This includes taking higher doses or taking the drug more frequently or for a longer period of time than advised.
Extended-release/long-acting opioids – Slower-acting medication with a longer duration of pain-relieving action.
Fentanyl – A synthetic opioid approved for treating severe pain — typically, pain caused by advanced cancer. It is 50 to 100 times more potent than morphine. In its prescription form, fentanyl is sold under brand names that include Actiq, Duragesic, and Sublimaze. Illegally made fentanyl is sold through illegal drug markets for its heroin-like effect, and it is often mixed with heroin, cocaine, or both. Common names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, Tango & Cash, and TNT.
Heroin – An illegal opioid 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 and on cells that control heart rate, sleeping, and breathing. Common names for heroin include Big H, Horse, Hell Dust, and Smack.
Illicit drugs – Drugs that are prohibited by law. These include some amphetamine-type stimulants, marijuana and other forms of cannabis (although these are now legal in some states), cocaine, heroin and some other opioids, some synthetic drugs, and MDMA (also known as 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 medication (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
Naloxone – A drug available for purchase over the counter that can reverse the effects of opioid overdose and save a life if administered in time. The drug is sold over the counter under the brand name Narcan. Other forms of naloxone are available from pharmacies under Virginia’s statewide standing order, which authorizes pharmacists to dispense naloxone without a prescription to interested individuals.
Nonmedicaluse – The use of drugs for reasons or in ways other than prescribed or directed. 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 the use of non-opioid medications such as acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil), and medications for depression or seizures; cognitive behavioral therapy; physical therapy and exercise; and interventional therapies such as injections of analgesics, nerve blocks, ablation, and stem cell therapy.
Nonpharmacologic therapy – Treatment that does not involve medication, including physical treatments (e.g., exercise therapy, weight loss) and behavioral treatments (e.g., cognitive behavioral therapy).
Opioid – Class of drugs made from natural or synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain. Opioids reduce the intensity of pain signals and feelings of pain. Common opioids include the illegal drug heroin; synthetic drugs such as fentanyl; and pain medications available legally by prescription such as codeine, hydrocodone, morphine, and oxycodone. 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 – Opioid medications that are used to treat moderate to severe pain; often referred to as prescription opioids. Opioid analgesics fall into three categories: natural (e.g., codeine, morphine); semisynthetic (e.g., hydrocodone, hydromorphone, oxycodone, oxymorphone); and synthetic (e.g., methadone, tramadol, 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, opioid dependence, or opioid addiction.
Overdose – Injury to the body caused by taking too much of a drug. An overdose can be fatal or nonfatal.
Physical dependence – Condition caused by overuse of a tolerance-forming drug and that produces symptoms of withdrawal when the drug is no longer taken.
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 or overdose as a result of overlapping prescriptions, high dosages, or co-prescription of opioids with benzodiazepines.
Tolerance – Reduced response to a drug because of repeated use.