Last updated: 06/25/2021
Author: Dr. Anjali Talcherkar
Reading Time: 7 minutes
Opioids have been used in pain treatment for close to 70 years and, for the most part, are relatively safe. However, in the last 2 decades, opioid overdose reports have sparked concern about the safety of these drugs.1
Most prescription opioids are Schedule II controlled substances, meaning they have a high potential for abuse dependency.2 Opioid addiction can include physical and psychological dependency and, in extreme cases, even lead to opioid overdose. It’s important to spot the signs and prevent opioid overdose.
In this Article:
How Does Opioid Overdose Occur?
Drug overdose is the leading cause of accidental death in the United States, with opioids being the most common drug. The Centers for Disease Control and Prevention (CDC) currently estimates that there are more than 1,000 emergency department visits daily related to the misuse of opioids and about 91 opioid overdose deaths every day.
The increased prescribing of opioids over the past several years has caused a spike in opioid overdose deaths.1 According to the CDC, “More than 191 million opioid prescriptions were dispensed to American patients in 2017—with wide variation across states.”3
Widely prescribed opioid drugs include:
An opioid overdose occurs when there is a high level of opioids in the system, leading to decreased respiratory effort and possibly death.1
The most common drugs involved in prescription opioid overdose deaths include:
When you increase your opioid dosage or switch from non-medical use to more potent opioid drugs like heroin, there’s a higher risk for overdose. This is especially true since heroin is bought on the street and often mixed with other substances, making it unsafe and unregulated.1
Fentanyl is a potent synthetic opioid that is used as a pain reliever and as an anesthetic. It is around 50-100 times more potent than morphine. Fentanyl comes in different forms (skin patch, liquid, pill form). However, fentanyl and its chemically similar analogs (including carfentanil, acetylfentanyl, butyrfentanyl, and furanyl fentanyl) have been associated with a spike in deaths from an opioid overdose.4
Drug dealers may add fentanyl to increase the potency of the other drugs they are selling (such as heroin). Evidence also shows an increase in sales of counterfeit fentanyl tablets, deceptively manufactured to look like authentic prescription medications.4
Some of these opioids are highly potent and can be fatal if taken inappropriately. Inappropriate use could be taking opioids more frequently than prescribed, taking larger amounts, taking multiple forms, and combining opioids with other illicit substances.
Signs and Symptoms of Opioid Overdose
If you are worried someone you know may be experiencing an opioid overdose, look out for certain opioid overdose symptoms. Opioid use can lead to death due to the effects of opioids on the part of the brain that regulates breathing. The 3 primary signs of opioid overdose are:4
- Dilated pupils
- Difficulty breathing
If you see someone exhibiting signs of opioid overdose, call 911 immediately.
Who Is At Risk of an Opioid Overdose
You may have a higher risk of overdosing on opioids if you:4
- Have an opioid use disorder (OUD) as defined by DSM-V criteria
- Inject opioids
- Retake opioids after an extended period of abstinence (e.g., following detoxification, release from incarceration, cessation of treatment)
- Misuse prescription opioids without medical supervision
- Are prescribed a high dosage of opioids (more than 100 mg of morphine or equivalent daily)
- Combine opioids with alcohol and/or other substances or medicines that suppress respiratory function such as benzodiazepines, barbiturates, anesthetics, or some pain medications
- Have concurrent medical conditions such as HIV, liver or lung disease, or mental health conditions
Males, older people, and people with low socioeconomic status are also at higher risk of opioid overdose than women, younger people, and people with higher socio-economic status.4
Regular non-medical use, prolonged use, and misuse of opioid drugs can lead to opioid dependence and other health problems. Opioid dependence results from repeated or long-term use of opioids. The defining trait of dependence is a strong craving or drive to use opioids.
You cannot control the urge to use, and opioid drug use becomes the priority over other activities despite harmful or negative consequences. Left untreated, opioid dependence can lead to full-blown addiction.4
Several additional factors—genetic, psychological, and environmental—play a role in addiction, which can happen quickly or after many years of opioid use.6
Known risk factors of opioid misuse and addiction include:
- Family history of substance abuse
- Personal history of substance abuse
- Young age
- History of criminal activity or legal problems, including DUIs
- Regular contact with high-risk people or high-risk environments
- Problems with past employers, family members, and friends (mental disorder)
- Risk-taking or thrill-seeking behavior
- Heavy tobacco use
- History of severe depression or anxiety
- Stressful circumstances
- Prior drug or alcohol rehabilitation6
Anyone who takes prescription opioids is susceptible to addiction. In fact, as many as 1 in 4 patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. Once addicted, it can be hard to quit.3 Even when you’re motivated to quit, withdrawal symptoms can make it even harder.
Treating an Opioid Overdose
Death is preventable if opioid overdose is handled immediately. Initial treatment of overdose begins with:
- Supportive care including assistance in respiration
- CPR if someone is unconscious
- Removal of the opioid agent if a patch or infusion is being used.
If the medical professional suspects an opioid overdose has occurred and you show signs of respiratory and CNS depression, no time should be wasted on laboratory studies. Instead, naloxone should be administered as soon as possible.1 Naloxone is a medication designed to reverse the effects of an overdose.5 Naloxone can be given in the following ways:
- Injectable (Naloxone): A variety of companies offers generic brands of injectable naloxone vials.
- Auto-injectable (EVZIO): This prefilled auto-injection device makes it easy for families or emergency personnel to inject naloxone quickly into the outer thigh.
- Intranasal routes (NARCAN): Pre-packaged nasal spray
Depending on the state you live in, friends, family members, and others in the community may give the auto-injector and nasal spray formulation of naloxone to someone who has overdosed. Some states require a physician to prescribe naloxone. In other states, pharmacies may distribute naloxone in an outpatient setting without a prescription from a physician.5
Opioid overdose is serious and can be life-threatening. There are measures you can take immediately if an overdose has occurred. Additionally, if you feel you are at risk for opioid addiction, it’s best to understand these risk factors and get to the root of the problem. Call (800) 662-HELP (4357) to speak to a treatment advisor about your rehab options.
Prevention of Opioid Overdose
Beyond using preventative approaches to lower drug use in the community, there are specific measures to prevent opioid overdose. These include:4
- Increasing the availability of opioid dependence treatment, including for those dependent on prescription opioids
- Reducing unnecessary opioid prescribing or finding alternatives to treatment
- Strict monitoring of opioid prescribing and dispensing
- Limiting inappropriate over-the-counter sales of opioids
- Cracking down on unregulated and illegal sales of street opioids
- Opioid and prescription pill education and awareness community programs
If you or a loved one struggles with opioid dependence or opioid addiction, you can reduce the chances of an opioid overdose. Many treatment options are available to help your situation before it becomes life-threatening. Call (800) 662-HELP (4357) to speak to a rehab specialist today.
Treating Opioid Addiction
Formal addiction treatment can provide safe detox, help address the underlying issues driving opioid addiction, and establish a foundation for long-term recovery. Finding the right treatment could make or break your future. Luckily, with so many treatment options available, recovery is absolutely possible.
Detox, the first stage of addiction treatment, is usually 3-7 days but can be longer depending on the length of use. Detox helps to stabilize the individual and manage the uncomfortable effects of coming off of opioids.
This initial phase may or may not include the use of medications to ease the detox process. Doctors usually start by gradually lowering the dosage until the user is completely free from the drug. Statistically, people who do not receive treatment beyond detox usually cannot stay abstinent from the drug.7
Inpatient and Outpatient Treatment
Once detox is complete, inpatient or outpatient treatment may be recommended, especially if you have experienced an opioid overdose and survived. This could be your wake-up call to get help. Available treatment options include:
- Inpatient treatment: Provides intensive management of chemical dependence symptoms and medical management and monitoring of physical or mental complications from chemical dependence to people who cannot be effectively served as outpatients and who do not need medical detoxification or acute care.
- Outpatient treatment: Provided in a freestanding setting or may be located in various other health and human service settings.
- State-funded rehabs: These treatment centers accept state insurance plans such as Medicaid or Medicare and are more affordable options if you cannot pay out of pocket.
- 12-step groups: These are free support groups found in your local community and online.
- Online recovery forums: These may include virtual support groups or apps that connect you to a recovery community and help you track your sobriety.
Opioid overdose is a serious issue. If you or someone you know is vulnerable to opioid drug overdose or displays opioid overdose symptoms, get help immediately. You can also call us at (800) 662-HELP (4357) for more help on locating treatment services.
- Schiller, E.Y., Goyal, A., & Mechanic, O.J. (2020). Opioid Overdose. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
- United States Drug Enforcement Administration. (n.d.). Drug scheduling. (n.d.).
- Centers for Disease Control and Prevention. (2017). Prescription Opioids.
- World Health Organization. (n.d.). Opioid overdose.
- National Institute on Drug Abuse. (2021, April 02). Opioid overdose reversal with Naloxone (narcan, evzio).
- Mayo Clinic. (2018, February 16). How opioid addiction occurs.
- National Institute on Drug Abuse. (2020, July 24). Treatment approaches for drug addiction drugfacts.