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Opioid use disorder, both prescription and illicit, is an epidemic in America, impacting millions of Americans and accounting for nearly 50,000 deaths annually. Opioid misuse and disorder have profound impacts on families and children. People who abuse opioids are also at increased risk for suicide. But there are effective treatment options. These include medication-assisted treatment with psychosocial support. Learn the warning signs of opioid misuse and suicide risk, and seek an evaluation. YOU can help to save your life or the life of someone you care about.

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 DISORDER

Approximately 2.1 million people aged 12 or older had a prescription opioid use disorder in 2016; 626,000 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 2015, 276,000 American adolescents between the ages of 12 and 17 were current nonmedical users of pain relievers, with 122,000 having an addiction to prescription pain relievers.

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.
DANGERS
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.
ADDICTION
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.
WITHDRAWAL
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 known as Neonatal Abstinence Syndrome (NAS).

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. In 2017, there were 47,600 opioid overdose deaths in the United States, an increase of approximately 5,350 deaths from the previous year. While it is not well documented how many of these deaths were suicides, according to a 2018 article in the New England Journal of Medicine the number of suicides among these deaths are considerable.

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. Geographically, the states with the largest increases in the rates of opioid-related deaths are in the eastern one-third of the United States; this includes Massachusetts. In 2017, there were over 28,000 deaths in the United States involving synthetic opioids. Fentanyl is the main contributor to unintentional opioid deaths, whereas other opioids (e.g., morphine, codeine, hydromorphone, and oxycodone) are predominantly used for suicides.

Opioid Crisis. The Numbers.


2.1 million

people aged 12 or older
have an opioid use disorder

6 in 1,000

babies are born with Neonatal
Abstinence Syndrome (NAS)

Only 8%

of individuals who misuse
prescription opioids seek treatment

80%

of heroin users first misused
prescription opioids

Screening and Treatment Can Make a Difference


1)

Screenings are a simple way to identify individuals who could benefit from a full evaluation from a doctor or mental health professional. On this site, you will find validated screening tools for opioid disorder and suicide risk. Screening followed by evaluation and intervention can save lives.

2)

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.