Opioids: The Drug

Prescription opioids are commonly used to treat moderate-to-severe pain. Pain can be acute, such as for an injury or after surgery, or it can be chronic, such as with cancer. Less commonly, they can be used to treat coughing and diarrhea. Some types of prescription opioids include:

Oxycodone (OxyContin^®)
Hydrocodone (Vicodin^®)
Codeine
Morphine

Opioids work by attaching to opioid receptors in the nervous system. Once attached, they can block pain messages from being sent to the brain. They are very effective at relieving pain and can also induce a sense of euphoria. They are highly addictive, especially when used to manage chronic pain over a long period of time. Other side effects include sleepiness, constipation, and nausea.

Fentanyl is a synthetic opioid, commonly used to treat severe pain, such as with advanced cancers. It is 50 to 100 times stronger than morphine and has been associated with a surge in opioid overdoses. While available by prescription, illegally produced fentanyl has become increasingly common and appears to drive the majority of overdoses.

Opioids also include illegal drugs, such as heroin. Often, people who become addicted to prescription opioids begin using these illegal drugs due to their availability.

Sources:

CDC: Prescription Behavior Surveillance System

ASAHQ: What are Opioids?

Opioid Addiction

Anyone who take a prescription opioid can become addicted. Often, opioid addiction starts through misuse of the drug. According to Medline Plus, misuse can be defined as:

Taking a drug the was prescribed for someone else
Taker a larger dose than directed
Taking the drug in a different way than directed. For example, crushing tablets to snort or inject them is a form of misuse
Using the medicine for another purpose, such as getting high

Source: MedlinePlus: Prescription Drug Misuse

When people misuse prescription opioids, they become more at risk of addiction. According to the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), opioid use disorder (OUD) can be characterized by the following:

Opioids are often taken in larger amounts or over a longer period of time than intended
There is a persistent desire or unsuccessful efforts to cut down or control opioid use
A great deal of time is spent in activities necessary to obtain the drug, use the drug, or recover from its effects
Cravings, or a strong desire to use opioids
Recurrent use resulting in failure to fulfill major role obligations at work, school, or home
Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids
Important social, occupational or recreational activities are given up or reduced because of use
Recurrent use in situation in which it is physically hazardous
Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids
Tolerance, as defined by:
- A need for markedly increased amounts of opioids to achieve intoxication or desired effect
- A markedly diminished effect with continue use of the same amount of the opioid
Withdrawal, as defined by:
- Opioid withdrawal syndrome (see symptoms below)
- The same or similar substance taken to avoid withdrawal symptoms.

Source: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5^th edition). American Psychiatric Association.

Opioid withdrawal occurs when a person dependent on opioids stops taking the drug and experiences a variety of unpleasant symptoms:

Runny nose, water eyes and yawning
Restlessness or anxiety
Irritability or mood disturbances
Increased pain
Goose bumps on the skin, chills or sweating
Stomach cramps
Nausea, vomiting or diarrhea
Muscle cramping or aches and joint pain
Tremors or muscle twitching
Rapid heart rate
Blood pressure changes
Trouble sleeping
Thoughts of suicide

Source: Mayo Clinic: Tapering off Opioids: When and How

Consequences

Individual Consequences

Overdose

People who misuse opioids or experience opioid addiction are especially vulnerable to overdose. A person overdosing from opioids may display the following symptoms:

Sleepiness or unresponsiveness
Slow or absent breathing
Slow heartbeat or pulse
Cold, clammy skin
“Pinpoint” pupils
Blue nails or lips

An opioid overdose is a medical emergency that may be reversed with the drug naloxone (Narcan^®). If you think someone is overdosing, call 911 immediately.

In Wyoming, the death rate due to opioid overdoses is 8.1 per 100,000 people, almost 60% higher than it had been a decade prior. However, these rates have begun to stabilize in the past several years.

Other Effects

Aside from the risk of overdose, people who misuse opioids are more likely to suffer from a variety of effects, including addiction. Addiction is often linked with other problems, such as impaired decision-making, social problems, financial difficulties, and mental illness.

Health effects related to long-term use of opioids include constipation, sleep apnea, depression, anxiety, dry mouth, and impotence. People who misuse opioids are also at a higher risk of contracting communicable diseases, such as HIV and Hepatitis C.

Community Consequences

The consequences of opioid addiction affect more than the individual. Its impacts affect family members, workplaces, and the community as a whole. Some of these indirect effects include higher health care costs, spread of infectious diseases, drug-related crime, increased family stress, and decreased productivity.

Sources:

Baldini, A., Von Korff, M., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. The primary care companion for CNS disorders, 14(3), PCC.11m01326. https://doi.org/10.4088/PCC.11m01326

APA: What is Addiction?

Surgeon General: The Many Consequences of Alcohol and Drug Misuse

Prevention

There are many diverse, evidence-based strategies to prevent misuse and abuse of opioids and other prescription drugs. This includes improved monitoring of prescription drugs, restrictions on access to opioids, and improving access to alternative treatment options. Go to the best practices section of this site to find more about what works. It is important to remember that not every strategy will work in every community.

Knowing your community and engaging stakeholders is an essential step in efforts to curb prescription drug abuse. See the capacity section on this website to learn more about engaging stakeholders.

Treatment

While not always thought of in the context of prevention, proper treatment is essential to address the harms of opioid addiction and dependency, both for the individual and community. In particular, it plays an important role in preventing overdose deaths and further progression of addiction.

Medication-assisted treatment (MAT) is the recommended treatment for opioid use disorder. It is an evidence-based practice that combines medication with counseling and behavioral therapies to provide a comprehensive approach in treating individuals affected by opioid use disorders. Drugs used for MAT include methadone, buprenorphine, and naltrexone.

For more information about MAT: SAMHSA: Medication-Assisted Treatment, MAT as a Best Practice

To find treatment options in your community: findtreatment.samhsa.gov