What Are Opioids?

Opioids, previously referred to as Opiates, are a type of drug that are chemically equivalent and have similar effects on the body. These drugs bind to Opioid receptors in the brain, block pain signals, and cause the release of large amounts of dopamine (a “feel good” chemical) into the body. In addition to pain relief, Opioids produce feelings of euphoria. Because Opioids carry a significantly increased risk of addiction – even when used as prescribed by a doctor – regular use can quickly become misuse or abuse.

Other possible effects of Opioids on the body include:

  • Slowed breathing
  • Drowsiness
  • Confusion
  • Nausea
  • Vomiting
  • Constipation

Most Opioids are made from the Opium poppy plant, though others are manufactured in pharmaceutical labs, using the same chemical makeup. Opioid analgesics (or pain relievers) are typically prescribed in pill form but are also used in IV’s during and after surgery. Opioids generally fall into one of three categories: natural, semi-synthetic, and synthetic.

Class Composition Examples
Natural Opioids Derived from the Opium poppy plant. Morphine, Codeine
Semi-Synthetic Opioids A combination of chemicals derived from the poppy plant and lab-made compounds. Oxycodone, Hydromorphone, Hydrocodone, Heroin
Synthetic Opioids Man-made chemicals with molecular structures similar to Opium. Methadone, Buprenorphine, Fentanyl, Carfentanil

According to Centers for Disease Control and Prevention research, 1 in 4 Opioid prescription-holders take painkillers regularly for at least a year. In fact, Opioids are so addictive that regular use as prescribed by a doctor can quickly turn into a chronic addiction. Even a 1-day prescription carries a 6% risk of developing a dependency. Statistically, a prescription for 8 days carries a 13.5% chance of dependency lasting at least a year. Of patients who received a 30-day prescription, 30% were still taking them a year later.

Even at relatively low doses and low duration of Opioid use, the risk of long-term use and dependency begins to escalate very early on.

Richard Deyo
Professor of Public Health and Preventative Medicine at Oregon Health and Sciences University, 2017

Info on Common Opioids

Type Also Known As Points to Remember
Codeine Codeine sulfate, also known under street names lean, syrup, and purple drank. Liquid Codeine cough syrup became a popular soda mixer in pop music/rap in the 2000s.

Though less powerful than other Opioids, a tolerance and dependence can develop rapidly.

Seizures are among possible withdrawal symptoms.

Oxycodone & Hydrocodone Oxycodone brand names include OxyContin® and Percocet®. Hydrocodone includes Vicodin® and Lortab®. Oxycodone and Hydrocodone are powerful narcotics prescribed to treat pain.

They are the two most commonly prescribed analgesics.

Previously, Oxycodone and Hydrocodone were classified in different drug schedules by the DEA and FDA. Today, they are both Class II substances.

Heroin Also known by street names dope, smack, or black tar Heroin (when clouded with impurities). 4 to 6% of prescription Opioid users will go on to use Heroin.

80% of people using Heroin reported they started by abusing prescription Opioids.

Injection Heroin use is one of the leading causes of Hepatitis and HIV transmission in the US.

Fentanyl Also known by street names China White, Murder 8, and TNT. As a synthetic Opioid, it is presently manufactured by pharmaceutics labs and illegal drug trafficking organizations.

Fentanyl has become a common “cutting agent” in Heroin and counterfeit pills to boost potency.

Over 20,000 deaths in 2016 involved Fentanyl or one of its analogs.

The Opioid Epidemic

Starting in the 1990s, pharmaceutics companies assured doctors that Opioid painkillers were the best answer to treat patients’ pain. Many were led to believe that Opioids were not addictive. By 2012, doctors wrote 259 million painkiller prescriptions annually. That’s more than enough for every adult in America to have their own bottle of pills. What followed was an addiction and overdose epidemic that has killed more Americans than the HIV/AIDS Epidemic, guns, car accidents, or the entirety of US casualties caused by the Vietnam War. More than 115 people die every day from an Opioid-related overdose in the US.

However, the Opioid Epidemic of today looks very different than it did in the 1990s and early 2000s. The First Wave of the epidemic was characterized by sky-rocketing numbers of prescription Opioids on the market and in medicine cabinets. The Second Wave (beginning in 2010) included high rates of overdose deaths and increasing numbers of Heroin users. Because Heroin is chemically-similar to prescription Opioids, it produces similar effects. Additionally, it is cheaper and generally easier to find than an illegal prescription.

These factors contributed to the rise of the Third Wave of the epidemic. Highly potent synthetic Opioids (like Fentanyl and Carfentanil) began to appear as cutting agents in Heroin as well as counterfeit Oxycodone and Hydrocodone pills. Many people were not accustomed to the sheer strength of these drugs (Carfentanil is 10,000 times more potent than Morphine and 100 times stronger than Fentanyl) and overdosed as a result. Fentanyl-related overdose deaths doubled between 2015 and 2016, killing 19,400 people.

Opioid Abuse Statistics

400%
Overdose deaths increased

Overdose deaths increased four-fold between 1999 and 2008, as did the sales of prescription painkillers between 1999 and 2010 and substance use disorder treatment admissions between 1999 and 2009.

591,000
people

In 2015, 591,000 Americans over the age of 12 suffered from a Heroin addiction.

42,000
deaths

In 2016, over 42,000 people died of an Opioid-related overdose (nearly 40% were caused by prescription Opioids).

Opioid Overdose

Unfortunately, Opioids are one of the easiest substances for an individual to overdose on. As a central nervous system (CNS) depressant, certain processes (such as breathing) slow as more or stronger Opioids are consumed. An Opioid overdose occurs when the brain’s Opioid receptors are overwhelmed, causing breathing to stop entirely. Also called hypoxia, the stoppage of oxygen to the brain can cause short- and long-term psychological and neurological issues (including coma, permanent brain damage, and death).

If you think someone is experiencing an Opioid overdose, the first step is to call 911 immediately. Emergency medical services are equipped with anti-overdose medications like Naloxone and Narcan, which can be administered as an injectable shot or nasal spray. Naloxone works by binding to the brain’s Opioid receptors and blocking Opioids from reaching them. Naloxone and Narcan, by stopping the effects of Opioids, can put people into immediate withdrawal.

Opioid Withdrawal

One way to measure if someone is addicted to Opioids is by their body’s response once they stop taking them. If a person suffers from Opioid addiction or dependence, their body will go into withdrawal when they quit.

Symptoms of Opioid withdrawal include:

  • Body pain
  • Insomnia
  • Diarrhea
  • Vomiting
  • Cold flashes and goose bumps
  • Involuntary leg movement
  • Cravings

Opioid withdrawal (and detox from Opioids) is one of the most difficult for people to overcome because the symptoms of withdrawal are often so severe. Thus, it’s important for people suffering from an Opioid Use Disorder (OUD) to seek medically-supervised help when detoxing. Addiction treatment specialists make detox more comfortable (and increase chances of a successful detox) by prescribing medication-assisted treatment to reduce withdrawal symptoms and cravings. Methadone and Buprenorphine (or Suboxone) are common Opioid treatment medications.

Mixing Opioids With Other Drugs

During the Second Wave of the Opioid Epidemic, mixing Opioids with other substances grew in popularity. According to overdose and coroners’ reports, up to 72% of overdose patients have more than one drug in their system and up to 98% of overdose fatalities involve multiple drugs. At times, people mix substances to experience even more pronounced effects (such as mixing Opioids and alcohol). Others combine Opioids and Benzodiazepines to self-medicate mental health issues like depression, anxiety, and thoughts of suicide. More recently, Opioids are being “cut” with Cocaine (called speedballing) or Methamphetamines to counteract the painkillers’ effects. However, this is a grave misunderstanding of both drugs’ effect on the body and can result in permanent damage, overdose, and death.

Mixing Opioids and Alcohol

According to the American Society of Anesthesiologists, taking even one Oxycodone with a “modest amount of alcohol increases the risk of a potentially life-threatening side effect known as respiratory depression.” Both substances are CNS depressants and the co-abuse of both compounds their negative effects. When taken together, Oxycodone and alcohol can reduce oxygen intake by up to 47%. Under the influence of both, a person will experience moments of stopped breath until they quit breathing altogether. The elderly are at an even greater risk of stopped breathing and overdose because their bodies are unable to recover as quickly.

Mixing Opioids and Benzodiazepines

Benzodiazepines (or Benzos) are prescribed primarily for the treatment of anxiety disorders and psychiatric or neurological illnesses. In the 2000s, Xanax (the most-commonly prescribed Benzo) was a major drug of abuse. Unlike Opioids, Benzos bind to GABA receptors in the brain to calm overactive brain activity – alcohol-like “highs” are also an effect.

During the Opioid Epidemic, prescriptions for painkillers like OxyContin and Percocet outpaced Xanax prescriptions. Rates of overdose including Benzos and Opioids quickly climbed around the country. Taking both together increases a person’s risk of overdose and can aggravate criminal, psychological, and medical problems many addiction sufferers already experience.

Mixing Opioids and Cocaine (Speedballing)

One of the most common combinations among overdose deaths is the co-abuse of Cocaine and Heroin, known as speedballing. Sometimes, people take drugs with wildly different effects simultaneously to counteract each other. This is not how these substances work within the body. Taking an “upper” (such as a stimulant like Cocaine or Meth) with a “downer” (such as a CNS depressant like Opioids, alcohol, or Benzos) does not “balance out” a person’s system. While some states have seen their Opioid overdose rates fall in recent years, overdose deaths involving Cocaine are doubling and tripling in some parts of the country.

When there are no Opioids involved in Cocaine-overdose deaths you see an overall decline in recent years. But when you look at Cocaine and Opioids together, we see a more than doubling in the number of overdoses since 2010, with heroin and synthetic Opioids increasingly involved in these deaths.

Christopher M. Jones
acting associate deputy assistant secretary of the Department of Health and Human Services, 2017

Significant increases in Opioid overdoses involving Cocaine have occurred primarily along the eastern half of the country. Fifteen states (including Maryland, Virginia, and Washington D.C.) saw an increase in the number of synthetic Opioid deaths involving Cocaine since 2015.

Mixing Opioids and Marijuana

While many eastern states are seeing increases in the use of Opioids with Cocaine, western and midwestern states now see significant increases in Opioid and psychostimulant use (like Marijuana). Nevada, New Mexico, and Oklahoma saw the highest expansion in this type of poly-drug use. This is likely due to the legalization of recreational Marijuana in neighboring states like Colorado and California.

Among teens who abuse prescription Opioids, 24% said they “usually or always” combined them with Marijuana. Many believe that Marijuana is not harmful because more and more states are legalizing its use. However, when taken in conjunction with Opioids, the risk of fatal overdose may be ever greater as people could be unaware of negative changes within their body until it’s too late.