Opioid Abuse

Medically reviewed by Dr. Bonnie Milas, MD, September 5, 2024.

Opioids are highly addictive, and opioid abuse has become a national crisis in the United States. Statistics highlight the severity of the epidemic, with the Centers for Disease Control and Prevention reporting that in 2023, 108,000 people died from a drug overdose, and 75% of those deaths were due to opioids.

Why do people become addicted to opioids?

Opioids can make your brain and body believe the drug is necessary for survival. As your body develops a tolerance for the dose you’ve been prescribed, you may find that you need even more medication to relieve the pain or achieve well-being, which can lead to dependency. Addiction takes hold of the brain in several ways—and is far more complex and less forgiving than many people realize.

How can you avoid addiction to opioids?

If you or a loved one is considering taking opioids to manage pain, it is vital to talk to an anesthesiologist or other pain medicine specialist about using them safely and, if needed, about exploring alternative pain management options that might work for you.

What are the signs of an addiction?

People addicted to drugs may change their behavior. Possible signs include:

Mixing with different groups of people or changing friends
Spending time alone and avoiding time with family and friends
Losing interest in activities
Not bathing, changing clothes, or brushing their teeth
Acting very tired and sad
Eating more or less than usual
Exhibiting excessive energy, talking fast, and saying things that don’t make sense
Acting nervous or cranky
Changing moods quickly
Sleeping at odd hours
Falling asleep standing up or during activities
Missing important appointments
Getting into trouble with the law
Attending work or school on an erratic schedule
Mismanaging their money to the point of financial hardship
Scratching their skin
Incurring new injuries, like bruising over veins (particularly with IV drug use)

What should you do if you or someone you know has an addiction?

If you or a loved one is ready to seek help for an addiction, the first step is to find a health professional who specializes in addiction medicine. You can ask your physician for a referral or search the American Society of Addiction Medicine’s website for addiction specialists in your area. The American Academy of Addiction Psychiatry also has a Patient Referral Program.

Another resource is the Substance Abuse and Mental Health Services Administration (SAMHSA). Call their toll-free help line at 800-662-HELP (4357) to find drug treatment near you, or use SAMHSA’s treatment facility locator. There’s also a State Agencies webpage that helps you find the Single State Agency that oversees substance use treatment programs in your state.

If you or a loved one is ready to seek help for an addiction, the first step is to find a health professional who specializes in addiction medicine.

If you are supporting a friend or loved one in overcoming addiction, the National Institute on Drug Abuse offers the following advice: Assure your friend or loved one that addiction can be managed successfully, but acknowledge that it may take several attempts at treatment to find the best approach. If your friend or loved one refuses to seek help, a confrontational intervention is not recommended. These encounters can escalate into violence or backfire in other ways. Try to convince the person to consult with a physician.

What are opioid withdrawal symptoms and how can you alleviate them?

Opioid withdrawal symptoms can but won’t necessarily include some of the following:

Drug cravings
Anxiety/irritability
Insomnia
Abdominal pain
Vomiting
Diarrhea
Tremors (shaking)
Feeling cold
Dilated pupils
Racing heart or palpitations
Sweating
Runny nose

Opioid withdrawal symptoms generally last between three and five days, although they can last up to 10 days, according to the American Society of Addiction Medicine (ASAM).

Withdrawal from opioids can be difficult and even dangerous. Trying to quit cold turkey is not recommended by ASAM because it can lead to stronger cravings and continued use. The safest way to alleviate opioid withdrawal symptoms is through medically supervised treatment, which generally includes medicines, counseling, and support. Two medications used to relieve withdrawal symptoms are methadone and buprenorphine (Subutex). These can also be used as long-term maintenance medicine for opioid dependence. In addition, a medication called clonidine can be used during withdrawal to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings. An addiction medicine physician may also prescribe medication to treat vomiting and diarrhea and help with insomnia.

What are the symptoms of an opioid overdose?

Signs of an overdose include:

Slow, shallow breathing
Unconsciousness or extreme sleepiness
Inability to talk
Blue skin and dark-colored lips
Snoring or gurgling sounds

How should you respond to an opioid overdose?

If you think someone may be experiencing an opioid overdose, take the following actions immediately:

Lightly tap, shake, and shout at the person to get a response. If you do not get a response, rub your knuckles on the person’s breastbone.
If the individual responds, keep them awake.
Call 911.

If lightly tapping, shaking, and shouting at the person or rubbing your knuckles on their breastbone (per Step 1 above) does not elicit a response, take the following actions:

Call 911. If you have naloxone, a medication that can rapidly reverse the effects of an overdose, administer it according to the instructions on the package (in addition to calling 911).
If breathing is shallow or nonexistent, or if the person’s skin is blue and they have dark-colored lips, perform mouth-to-mouth rescue breathing by tilting the head back and lifting up the chin until the mouth opens, clearing the airway. Give two quick breaths to start and then a strong breath every 5 seconds.
If the person does not have a pulse or is not breathing, perform CPR. Deliver two rescue breaths, then 30 chest compressions at a rate of 100–120 times per minute, depressing at least 2 inches. Repeat these steps until emergency responders arrive. Performing continuous chest compressions, without giving rescue breaths, is also an option. This is called hands-only CPR.
While waiting for emergency responders, stay with the person. If you must leave them alone or if vomiting occurs, place the individual in the recovery position—on their side, with the top arm bent at the elbow and the hand placed under the head to support it, mouth facing to the side and down, and top leg bent with knee resting on the floor to keep the person from rolling onto their stomach.

Opioid Overdose Resuscitation Guide

Download and print a convenient visual reference of the steps you shoudl take if you encounter someone who may be experiencing an opioid overdose.

Download

What is naloxone and how can it help with an overdose?

Naloxone (also sold under the brand name Narcan) is a lifesaving medication that can rapidly reverse the effects of an opioid overdose. Nearly all naloxone products are single-use nasal sprays that are easy to administer. An injection is also available, but it is used mostly by rehab facilities, emergency medical services, and police. If you have naloxone when responding to an overdose, call 911 and administer the medication according to the package instructions.

Access to naloxone is expanding on a state-by-state basis. It can be prescribed by a physician, is often carried by police officers and emergency medical responders, and is increasingly available over the counter at some pharmacies.

How should you store and dispose of opioids to protect family members?

If you are taking opioids, you are not the only one in your household who is in danger of misuse, addiction, and overdose. Other members of your household, including children, are also vulnerable. Here’s how to protect them:

Always store opioids in a safe and secure place. Do not leave opioids in the medicine cabinet. Keep them in a locked cabinet or drawer out of the reach of others, particularly young children. Children sometimes confuse medications with candy and end up swallowing them, which can lead to overdose. Other family members and visitors could also find prescription medications in the house and use them inappropriately.
Never share your prescriptions. More than half of people who misuse prescribed opioids get them from a friend or relative, according to SAMHSA.
Don’t throw unused opioids in the trash. Improper disposal of prescription medicines can lead to other people finding and taking them.

If you have leftover or expired prescription medications, follow these drug disposal tips:

Remove the prescription label that contains your name and other identifying information.
Check with your municipal trash and recycling program providers about approved disposal drop-off options in your community, such as police stations.
Look for pharmacies and health care clinics that take back medication, provide drop-off boxes, or sell specially designed drug disposal envelopes that you can seal and mail to an approved facility. Most communities also have take back days, when they will collect leftover or expired medication and dispose of it properly.