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Opioids

Opioids are a class of drugs that reduce pain by replicating naturally occurring chemicals in the opium plant. They include prescription pain medications such as OxyContin (oxycodone), Vicodin (hydrocodone), morphine and others. But they also include illegal street drugs like heroin and fentanyl.

Opioids are powerful painkillers, and health care providers typically prescribe them to patients to treat moderate-to-severe pain. Some uses include controlling pain from surgery, pain from an injury such as a broken bone or pain from cancer. But there has been a recent increase in opioid use for chronic, non-cancer pain including headaches, back pain and arthritis, despite serious risks and lack of evidence for long-term use.

Opioid Prescriptions in the United States
Health care providers prescribed about 168,158,611 opioid prescriptions to Americans in 2018.
Source: Centers for Disease Control and Prevention

While opioids can help people control severe, acute pain when taken for short durations, they are highly addictive and can be misused. Because of this, the U.S. Food and Drug Administration and Centers for Disease Control and Prevention discourage opioids for long-term use.

In 2018, health care providers prescribed about 51 opioid prescriptions for every 100 people in the United States, according to the most recent data from the Center for Disease Control and Prevention. That breaks down to about 168,158,611 prescriptions.

Alabama, Arkansas and Tennessee have the highest prescription rates at 81.8 to 97.5 prescriptions per 100 people, according to the CDC.

How Do Opioids Work?

The body has opioid receptors for endogenous opioids, natural opioids made by the body. Some parts of the body with receptors include the brain, gut and spinal cord. These natural opioids help control pain.

Opioid drugs attach to these receptors, block pain signals and release large amounts of dopamine, a chemical that controls how the body feels pleasure. This effect makes people feel relaxed and happy.

These drugs create various sensations by attaching to different receptors in the body, including the limbic system in the brain, the brainstem and the spinal cord.

Some effects of opioids in the brain and nervous system include:
Limbic System
Can create feelings of pleasure, contentment and relaxation
Brainstem
Can slow breathing, reduce feelings of pain and stop coughing
Spinal Cord
Can decrease feelings of pain

Types of Opioids

There are three different types of prescription opioids, according to the National Institute on Drug Abuse. These are: natural, semisynthetic and synthetic.

Natural opioids are based on chemical compounds that come from plants, like the opium poppy. Semisynthetic opioids are made from natural opioids in a lab. Many prescription drugs, as well as the illegal drug heroin, are semisynthetics.

Synthetic opioids are completely made in labs. Some are available by prescription, but they are also sold illegally, such as carfentanil and fentanyl. People sometimes use these types of drugs to get high.

List of Common Prescription Opioids
Active Ingredient/Generic Name Brand Names Opioid Type
Oxycodone OxyContin, Percocet, Roxicodone Semisynthetic
Hydrocodone-Acetaminophen Vicodin, Lorcet, Lortab Semisynthetic
Morphine Duramorph, MS Contin, Morphabond, Roxanol-T, Kadian Natural
Hydromorphone Dilaudid, Exalgo, Pelladone Semisynthetic
Fentanyl Duragesic, Subsys Synthetic
Codeine Only generic Natural
Tramadol Ultram Synthetic
Methadone Dolphine, Mathadose Synthetic
Buprenorphine Subutex, Buprenex, Butrans, Probuphine Semisynthetic

Opioids vs Opiates

The terms “opioids” and “opiates” may be used interchangeably, but they refer to different types of drugs. Opioids are all synthetic, semisynthetic and natural opioids. Opiates are specifically natural opioids such as codeine, heroin and morphine.

Side Effects of Opioids

Opioids can help relieve pain, but they also come with some harmful side effects. These effects can be both short term and long term. Taking opioids as prescribed at the lowest dose for the shortest amount of time will help avoid side effects.

Short-term side effects:
  • Confusion
  • Constipation
  • Feelings of calm
  • Nausea
  • Sleepiness
  • Slowed or stopped breathing
  • Vomiting

Long-Term Effects

Researchers are still studying the long-term side effects of opioids. But these effects can lead to serious health problems that can be fatal.

Long-term effects of opioids include:
  • Addiction
  • Depression
  • Heart infections
  • Liver or kidney damage
  • Low testosterone levels in men
  • Lung infections
  • Muscle pain
  • Rebound headaches

Drug Interactions

Opioids can interact with a number of medications, including many over-the-counter drugs. One of the most dangerous interactions happens with allergy and cold medicines that cause drowsiness. When taken with opioids, this effect intensifies. It can slow the heart and breathing, increasing the risk of death.

Drugs that may interact with opioids include:
  • Alcohol
  • Ambien (zolpidem) and other sleeping aids
  • Antidepressants
  • Antifungals
  • Antipsychotics including Abilify (aripiprazole) and Haldol (haloperidol)
  • Benzodiazepines including Valium (diazepam) and Klonopin (clonazepam)
  • Carbatrol (carbamazepine), Lamictal (lamotrigine), Topamax (topiramate) and other anti-seizure medications
  • Clarithromycin and some other antibiotics
  • Muscle relaxers
  • Other opioids

Overdose

An opioid overdose happens when too much of the drug overwhelms the body. Opioid overdoses interfere with the body’s ability to breathe and can be fatal.

Nearly 450,000 people died from opioid overdose between 1999 and 2018, according to the CDC. The first wave of deaths occurred in the 1990s with prescription opioids. In 2010, the deaths were linked to heroin. From 2013 to the present day, most opioid overdoses involve synthetic opioids such as fentanyl.

Overdose deaths remain high. In 2018, nearly 70 percent of the more than 67,000 drug overdose deaths involved an opioid, according to the CDC.

Symptoms of an opioid overdose include:
  • Choking
  • Cold, pale or blue skin
  • Falling asleep
  • Gurgling sounds
  • Loss of consciousness
  • Pupils that look like pinpoints
  • Shallow, slow breathing

What to Do

If you suspect someone is overdosing, the CDC recommends calling 911 immediately. If you have access to naloxone, a drug that can stop an opioid overdose, administer it by injecting it into a muscle or spraying it in the nose.

Keep the overdose victim awake and breathing and lay them on their side to prevent them from choking. Wait for emergency personnel to arrive.

Opioid Crisis

The opioid crisis or opioid epidemic began in the 1990s when medical providers began prescribing opioid pain relievers at greater rates.

According to the Department of Health and Human Services, this occurred because pharmaceutical companies told the medical community that these drugs were not addictive. But increased prescribing led to misuse of the medication and addiction to non-prescription and prescription opioids.

HHS declared the opioid crisis a public health emergency in 2017.

More than 130 people die each day from opioid overdoses, and about 10.3 million people misused prescription opioids in 2018, according to HHS.

The crisis led several states, cities, towns and counties to file opioid lawsuits against drug manufacturers. These lawsuits claim drug companies misled the public about the addictive nature of opioids.

Opioids spilling out of pill bottle
Opioid Facts
  1. Uses Pain relief from moderate-to-severe pain from injuries, surgeries or cancer pain
  2. Side Effects Confusion, constipation, feelings of calm, nausea, sleepiness, slowed or stopped breathing, vomiting, overdose, death
  3. Common Slang Terms Happy Pills, OC, Oxy, Oxycotton, Percs, Vikes

Please seek the advice of a medical professional before making health care decisions.

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Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for seven years. She specializes in fluoroquinolone antibiotics and products that affect women’s health such as Essure birth control, transvaginal mesh and talcum powder. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • American Medical Writers Association (AMWA) Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine
Edited By

16 Cited Research Articles

Drugwatch.com writers follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and interviews with qualified experts. Review our editorial policy to learn more about our process for producing accurate, current and balanced content.

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  5. Centers for Disease Control and Prevention. (2020). Commonly Used Terms. Retrieved from https://www.cdc.gov/drugoverdose/opioids/terms.html
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  11. Deaconess Comprehensive Pain Center. (n.d.). Understanding Opioids and Other Pain Treatment Options. Retrieved from https://www.deaconess.com/Services/Pain-Management/Understanding-Opioids
  12. Johns Hopkins Medicine. (n.d.). What Are Opioids? Retrieved from https://www.hopkinsmedicine.org/opioids/what-are-opioids.html
  13. Mayo Clinic. (n.d.). Opioids and other drugs: What to watch out for. Retrieved from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/opioids-interactions/faq-20381271
  14. National Institute on Drug Abuse. (2014). Mind Over Matter. Retrieved from https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/mom_opioids.pdf
  15. National Institute on Drug Abuse. (n.d.). Mind Matters: The Body’s Response to Opioids. Retrieved from https://teens.drugabuse.gov/teachers/mind-matters/opioids
  16. National Institute on Drug Abuse. (n.d.). Opioids. Retrieved from https://www.drugabuse.gov/drug-topics/opioids
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