What Are Prescription Opioids?
Prescription opioids, also known as prescription painkillers, are at the center of America’s current health crisis, the opioid epidemic. As a class of drug, they are derived from the opium poppy plant, typically grown in Asia, Central America, and South America. Semi-synthetic opioids are made from opium as well as man-made compounds with chemical structures similar to opium. Synthetic opioids (like fentanyl), though chemically similar, are fully man-made in pharmaceutics laboratories (though increasing amounts are illicitly manufactured by drug trafficking organizations). The most common prescription opioids are semi-synthetic variants hydrocodone (i.e. Vicodin) and oxycodone (i.e. Percocet).
Prescription opioids like morphine have been used to treat pain for hundreds of years, though the opium plant it comes from has been cultivated since prehistoric times. Opioids can also be used to treat coughing and diarrhea. The “high” individuals experience during use has led to misuse of and addiction to prescription opioids. Because of the highly-addictive nature of opioids, and the effect they have on the body, the risk of overdose and death is high.
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Common Prescription Opioids
|Codeine||A weak opioid prescribed when acetaminophen and ibuprofen don’t work.|
|Hydrocodone||Vicodin®, Norco®, Lortab®||A more powerful form of codeine often mixed with acetaminophen.|
|Oxycodone||OxyContin®, Percocet®||An extended-release, strong opioid for moderate to high pain relief that lasts long periods of time.|
|Morphine||Roxanol®, Avinza®||A strong opioid; comes in pill and injection form.|
|Meperidine||Demerol®||Similar to morphine; often used prior to surgery as anesthesia or during childbirth.|
|Hydromorphone||Dilaudid®, Exalgo®||A powerful, semi-synthetic painkiller. Hydromorphone is to morphine as hydrocodone is to codeine.|
|Fentanyl||Actiq®, Duragesic®||A surgical, fully-synthetic anesthetic up to 100 times stronger than morphine (counterfeit versions are also manufactured illegally).|
|Methadone||Dolophine®, Methadose®||Used to treat withdrawal symptoms of opioid addiction and treat severe, chronic pain.|
|Buprenorphine||Subutex®, Suboxone® (with naloxone)||Alternative to methadone in addiction treatment; produces less euphoria and physical dependence.|
Effects of Use and Overdose of Prescription Opioids
All opioids are central nervous system depressants, meaning they slow automatic processes like breathing. The primary, desired effect of prescription opioid use is pain relief. The “high,” or feelings of euphoria that accompany certain doses of opioids, has contributed to the misuse of these drugs and resulted in countless overdoses and death. Opioid overdose occur when side effects escalate to fatal levels. Specifically, fatal opioid overdose is usually caused by a person’s becoming unable to breathe completely as a result of opioids slowing down the respiratory system, leading to a lack of oxygen and death.
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Harmful side effects of Prescription Opioids
Typically, prescription opioids are administered orally with a pill, sublingually under the tongue, or injected intravenously. When opioids enter the body, they move through the blood stream to the brain and spinal cord, where they bind to active opioid receptors on cells. By attaching to these receptors, pain signals are blocked and dopamine (a “feel good” chemical) is released. This kind of chemical interaction is highly addictive, and people may become dependent on opioids to feel good, or even normal.
- Drowsiness or reduced consciousness
- Nausea or vomiting
- Dry mouth
- Slowed breathing
- Itching or sweating
- Low testosterone (result is lowered sex drive, energy, and strength)
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Who Is at Risk of Prescription Opioid Addiction?
Anyone taking a prescription for opioids is at risk of developing a tolerance to their medication, in addition to increasing sensitivity to pain. In a relatively short period of time, the body becomes used to opioid medication and you will need to take more to get the same effect. According to the Centers for Disease Control (CDC), the risk of developing an opioid dependency greatly increases after 5 normal days of use, as prescribed by a doctor.
Between 1999 and 2016, over 200,000 Americans died of prescription opioid-related overdose. Fatalities relating to prescription opioids increased by 500% in that time. Rates of overdose are highest among people over the age of 40. Comparatively, non-Hispanic whites and Native Americans have the highest rates of abuse and overdose. West Virginia, Ohio, Maryland, Maine, and Utah are some of the states states with the highest rates of prescription-opioid-related overdose. Most people who develop an addiction, report obtaining pills from either (1) a friend or family member or (2) through a prescription from a healthcare provider.
Prescription Opioid Dependency vs. Addiction
A physical dependence on opioids is characterized by the onset of symptoms of withdrawal when the substance is stopped. While dependence is one part of addiction, opioid addiction and abuse also encompass the inability to quit usage despite negative consequences, and (sometimes) tolerance and withdrawal.
Not everyone who takes prescription painkillers will develop an addiction. In 2015, over one-third of adults in the US took opioid medication and only 12 million did so without approval from a doctor. As prescription drug monitoring programs take effect across the country, fewer pills are being abused or sold illegally on the streets. However, prescription opioid addicts are having to turn to more easily obtainable illegal alternatives in order to replace the pills that they can no longer acquire. Because of this, heroin and illicitly-manufactured fentanyl (counterfeited to look like prescription pills) have flooded neighborhoods nationwide, causing increases in overdoses and deaths at a time when prescription opioid deaths had leveled off.
The CDC’s four biggest risk factors for a dependence developing into addiction are:
- Obtaining overlapping prescriptions from multiple providers and pharmacies.
- Taking high daily dosages of prescription pain relievers.
- Having mental illness or a history of alcohol or other substance abuse.
- Living in rural areas and having low income.
Prescription Opioid Statistics
deaths per day
More than 46 people die every day in the US from an overdose involving a prescription opioid.
40% of all opioid-related deaths include a prescription opioid.
In 2016, prescribed opioids contributed to approximately 17,087 overdose deaths.
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Since 2016, drug overdose is responsible for more deaths than guns or car accidents; it’s the leading cause of death for Americans younger than 50. Overdose rates have climbed faster than the HIV outbreak at its peak. In 2017, the Opioid Epidemic was declared a national health crisis in the US, and over $1 billion was granted to states for addiction treatment and prevention.
Treatment for an opioid addiction typically starts with medically-assisted detox (withdrawal symptoms, such as seizures, can be fatal). There are also a variety of evidence-based therapies and addiction treatment medications that can improve the comfortability and chances for a successful recovery. Buprenorphine and methadone, two types of prescription opioid, may be prescribed to ease withdrawal symptoms and reduce cravings. Whether individuals attend inpatient drug rehab or outpatient rehab, cognitive behavioral therapy can be beneficial in recognizing personal issues and working through them.
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