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Opioid use disorder, both prescription and illicit, is an epidemic in America. It has profound impacts on individuals, families, children, and communities, and accounts for nearly 50,000 deaths each year. Individuals who misuse opioids are also at increased risk for suicide. Importantly, there are effective treatments for this debilitating illness, including medication with psychosocial support. Learn the warning signs of opioid misuse and suicide risk, and seek an evaluation. You can help save a life.
Opioid Epidemic. The Facts.
What are Opioids?
Opioids are a class of drugs. Common prescription opioids are hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine, and fentanyl (Actiq). Some opioids are naturally found in the opium poppy plant. Other opioids are synthetic or semi-synthetic. Heroin is an opioid made from morphine, a natural substance that comes from the seedpods of opium poppies. Fentanyl is a synthetic opioid similar to morphine. Prescription opioids (including the synthetic drug fentanyl) and heroin are chemically similar.
Doctors use prescription opioids in anesthesia, to treat moderate to severe pain, and to suppress coughing and diarrhea. Prescription opioids used for pain relief are safe when they are taken for a short time and prescribed by a doctor. Higher dosages of opioids have not been shown to reduce pain over the long term.
What is Opioid Misuse?
Opioid misuse is defined as inappropriate use of prescription medicine or any use of heroin or fentanyl. People misuse prescription opioids by taking these medications in a way or dose other than prescribed, taking someone else’s prescription medicine, or taking the medicine to relax or get high.
To be diagnosed with opioid use disorder, you will have experienced at least two symptoms, from a list of eleven symptoms, within the past 12 months. Symptoms include taking more opioids than intended, trying to control opioid use without success, or spending a lot of time obtaining, taking, or recovering from the effects of opioids. They also include tolerance (the need to take increased amounts of opioids to get the same desired effect) and withdrawal symptoms when opioids are discontinued.
HOW COMMON IS OPIOID USE DISORDER?
Approximately 2 million people aged 12 or older had a prescription opioid use disorder in 2018; 526,000 persons aged 12 or older had a heroin use disorder. Prescription opioid use disorder is the second most common substance use disorder, behind cannabis or marijuana use disorder.
OPIOID MISUSE IN THE YOUNG
In 2018, 699,000 American adolescents between the ages of 12 and 17 misused opioids, with the vast majority misusing prescription opioids. Of these, 108,000 had opioid use disorder.
For teens, the attitudes and behaviors of their parents and peers make a difference. Teens are more likely to misuse if they have parents who express favorable attitudes toward substance use, witness a family member overdose, or associate with friends who misuse prescription drugs. In fact, a recent study found that adolescents have a nearly two-fold increased risk of prescription opioid misuse if they have a parent with a history of prescription opioid misuse.
Drug overdose deaths involving heroin tripled between the years 1999 and 2015 in the 15- to 19-year-old age group. The majority of drug overdose deaths during this time period were unintentional overdoses, though female overdose deaths were significantly more likely than male overdose deaths to be suicides.
Risk Factors, Dangers, Addiction, Withdrawal
RISK FACTORS FOR OPIOID MISUSE
Factors that increase the risk of nonmedical use of prescription drugs: History of mental illness (depression, PTSD, anxiety); acute and chronic pain; physical health problems (fatigue, headaches); heightened physiological reactions to certain types of drugs (e.g., euphoria); access to prescription drugs; large dosages or multiple prescriptions; and/or a past history of misuse of other substances.
The most serious danger is that high doses can cause an individual to stop breathing resulting in death. Opioids can also cause confusion, disorientation, and nonfunctional behaviors during use. With long-term use, people build a tolerance to the drug and require higher and more frequent dosing for pain and withdrawal relief. Lives can be saved by having naloxone auto injection or nasal spray on hand if someone at home is using opioids.
Opioids are highly addictive as they block pain and cause a release of large amounts of a neurotransmitter (brain messenger chemical) called dopamine. This release of dopamine stimulates the reward center of the brain, causing the person to crave more.
People who are addicted to an opioid medication or heroin and then stop using the drug can have severe withdrawal symptoms. Withdrawal symptoms include muscle and bone pain, sleep problems, diarrhea and vomiting, cold flashes with goose bumps, uncontrollable leg movements, and severe cravings for the drug.
What are the short and long term effects of opioids?
Most deaths due to opioids result from overdoses. Opioid overdose can cause slowed breathing, which can lead to hypoxia (too little oxygen reaching the brain). Hypoxia, in turn, can lead to coma, permanent brain damage, or death.
Opioids can cause drowsiness, confusion, nausea, and constipation.
Long-term use of prescription opioids can cause some people to develop a tolerance, which means higher and/or more frequent doses are need to achieve the same effect. This leads to a greater risk of overdose and death, including suicide.
Older adults are more at risk for health effects from opioid medications. They have slower metabolisms, which affects the breakdown of drugs in their systems. Prescription opioids have also been associated with an increased risk of falls and fractures.
Using opioids during pregnancy can lead to miscarriages and low birth weight. The baby can develop dependence on opioids before birth and have withdrawal symptoms after delivery. This is referred to as Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS).
Those who misuse prescription opioids are also at increased risk of turning to heroin or other injectable drugs. Sharing drug injection equipment and having impaired judgment from drug use increases the risk of contracting infectious diseases (e.g., hepatitis C, HIV) and leads to legal difficulties.
A deadly epidemic
Opioid dependence is associated with a death rate that is 13 times greater than that of the general population. Forty percent of the deaths in opioid-dependent persons were from drug overdoses and related complications.
The Centers for Disease Control and Prevention (CDC) documented a six-fold increase in opioid-related overdose deaths between 1999 and 2017. There are now more deaths due to prescription opioid addiction and overdose in the United States than deaths due to motor vehicle accidents and HIV. Rapid increases in overdose deaths involving heroin began in 2010. Although treatment for heroin-related opioid use disorder increased from 37.5 percent in 2016 to 54.9 percent in 2017, heroin-related deaths continue to rise, likely due to the higher potency of heroin now available on the market.
The significant increase in overdose deaths since 2013 has been driven mostly by synthetic opioids, specifically fentanyl, which can deliver up to 50 times the strength of heroin. In 2018, there were 46,802 opioid overdose deaths in the United States. While this is slightly lower than the number of deaths in 2017, overdose death rates involving synthetic opioids (e.g., fentanyl, fentanyl analogs, and tramadol) increased 10% from 2017 to 2018. Fentanyl is the main contributor to unintentional opioid deaths, whereas other opioids (e.g., morphine, codeine, hydromorphone, and oxycodone) are predominantly used for suicides.
Although the total number of drug overdose deaths decreased 4.1% from 2017 to 2018, recent provisional data released by the CDC show a 4.6% increase in drug overdose deaths from 2018 and 2019, reaching a record high of 70,980 drug overdose deaths. Data regarding opioid overdose deaths in particular are not yet available.
Moreover, since the beginning of the COVID-19 pandemic, a surge in the number of opioid overdose deaths has been reported, though it could take several months before the definitive numbers for 2020 are available from the government. The American Medical Association recently issued a warning that opioid overdose deaths have increased in more than 35 states since the pandemic began. This surge is thought to be fueled by a number of factors, including isolation, economic issues, and disruptions to the drug trade. To learn more, click here.
Every day, 5 people in Massachusetts die of opioid overdoses.
Even though Massachusetts has one of the lowest opioid prescribing rates in the country, opioids were still involved in about 88% of drug overdose deaths in the Commonwealth. Synthetic opioids other than methadone accounted for 90% of the 1,991 opioid-involved deaths in 2018.
Opioid Crisis. The Numbers.
people in the United States
have opioid use disorder
13.7 in 1,000
babies in Massachusetts are
born with Neonatal
Abstinence Syndrome (NAS)
of individuals who misuse
prescription opioids seek treatment
of heroin users first misused
Screening and Treatment Can Make a Difference
Effective treatment for opioid misuse and addiction exists. On this site, you will find resources for individuals, families, and healthcare providers to help access this treatment. Connecting at-risk individuals to effective treatment is key.