Opioids are powerful narcotics that have contributed to a major epidemic in the United States. Opioid Misuse Prevention Day on August 30 and International Overdose Awareness Day on August 31 are reminders to physicians and the public of the harm opioids can present even when prescribed as needed.
How Common Is Opioid Misuse?
According to the Centers for Disease Control and Prevention (CDC), the quantity of prescription painkillers prescribed and sold in this country has more than quadrupled since 1999. It is estimated that between 1999 and 2014, more than 165,000 Americans died from prescription opioids. That is equivalent to three times as many deaths as U.S. military casualties during the Vietnam War. Every day nearly 7,000 people are treated in hospital emergency rooms for painkiller abuse. Although the number of drug overdose deaths has decreased by 4 percent from 2017 to 2018, the number of deaths was still four times higher in 2018 than in 1999, making it more probable for a person to die from an opioid overdose than from a car accident.
Opioids can include some illegal drugs, such as heroin, but at least half of all U.S. opioid overdose deaths are from prescription drugs. The most common prescription pain relievers are oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and fentanyl, drugs that have been prescribed for everything from pulled teeth to post-surgery recovery to end-of-life care.
Fentanyl abuse is part of the third wave in what the CDC calls the three waves of the rise in opioid overdose deaths. Fentanyl, a powerful synthetic opioid, is similar to morphine but 50 to 100 times 
more potent. According to the National Institutes of Health, synthetic opioids are now the most common drugs involved in overdose deaths in the United States. In 2017, 59 percent of opioid-related deaths were due to fentanyl compared to 14.3 percent in 2010. In a medical setting, fentanyl is used to treat patients with severe pain or pain from surgery. It takes a small amount of fentanyl to achieve a high, making it a cheaper option, so illegal drug manufacturers mix it with heroin, cocaine, methamphetamine, and MDMA, or Ecstasy.
Understanding Drug Misuse and Addiction
Most people first take prescription opioids under a doctor’s care for a medical condition. They may, however, continue taking the drugs for so long that the drugs contribute to brain changes that challenge self-control and interfere with the ability to turn away from the drugs.
Misuse occurs when people:
- take too much of a medication
- take other people’s medications
- take the medications in a different way than prescribed
- take medications to get high
Addiction is a chronic brain disease that causes a person to seek out the very drugs that harm them. Some people who misuse prescription opioids turn to heroin.
How to Tell if Someone Is Experiencing an Overdose
When too many opioids are in the body, they can cause slowed breathing that can lead to an overdose death. Call 9-1-1 immediately if you notice the following signs of overdose in a person:
- They have an extremely pale face and/or clammy skin
- Their body goes limp
- Their fingernails or lips turn shades of blue or purple
- They begin vomiting or make gurgling noises
- They cannot awaken or they are unable to speak
- Their breathing or heartbeat slows or stops
Naloxone is a prescription opioid antagonist, a medicine that can rapidly reverse the effects of an opioid overdose and prevent death if given in time. It works by binding to opioid receptors to reverse and block the effects of opioids. Naloxone is considered extremely safe for both illegal and legal opioid overdoses.
There are three types of Naloxone formulations approved by the Federal Drug Administration. They are:
- Auto-injectables, such as EVSIO, which can be injected by family members or emergency personnel into the upper thigh. Once activated, the device gives verbal instruction on how to deliver the medication.
- Prepackaged nasal spray, such as NARCAN, a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while the patient is lying on his or her back.
- Injectables for use by trained professionals
Treatment Options for Addiction
The main treatment plan for prescription opioid addiction is medication-assisted treatment (MAT). This approach includes medicines, counseling sessions, and support from loved ones. Detoxification, a supervised withdrawal plan, is necessary before treatment can begin. 
Treatment options include the following:
- Interim care can help when facilities are waitlisted. It provides daily medication and emergency counseling.
- Outpatient care allows patients to attend regular appointments and counseling sessions when living on their own.
- Hospital inpatient care offers round-the-clock care that lasts days or weeks.
- Residential care is live-in care that lasts from one month to a year.
- Transitional housing provides a temporary place to stay, such as a halfway house or sober-living facility, while transitioning from an intensive treatment setting.
- Co-occurring mental health and substance use treatment is integrated care that addresses substance use and mental illness.
- Telemedicine is care that is given by phone or online to support treatment and recovery.
How to Prevent Problems with Prescription Drug Misuse
Misuse and overdose are preventable by: 
- Discussing the necessity of taking the opioid with your doctor and asking if over-the-counter pain medications will suffice
- Following the doctor’s instructions when taking the drugs, not taking more than is prescribed
- Not sharing the medications or leaving them in a place where other people, including children and teens, have access to them
- Properly disposing of the drugs when they are no longer needed
If you find you need more of the drug than prescribed to fight pain, immediately contact your doctor.
What Is Being Done to Correct Opioid Misuse?
The National Safety Council (NSC) has created a plan to address opioid misuse and save lives. The comprehensive plan offers solutions to cover the life cycle of addiction, from prevention to recovery.
The plan, which the NSC is pitching to the presidential candidates in 2020, addresses the role prescribers play in the opioid crisis and how to improve training and education of medical professionals in primary care, emergency care, acute care, and mental health.
Where to Get Help
The U.S. Department of Health and Human Services offers a national helpline. Call 800-662-4357 for immediate help. To find a health-care provider, click on the HHS.gov/OPIOIDS website. The following local resources can also help:
- Narcotics Anonymous, San Diego/Imperial Counties: In English, dial 619-584-1007 or 800-479-0062, 24 hours a day/7 days a week or visit the Narcotics Anonymous website; in Spanish, dial 619-546-0774 or visit the Narcotics Anonymous website.
- SMART Recovery: This abstinence-based nonprofit offers a self-help program. Separate programs for those in recovery and for loved ones are available. Call 866-951-5357 or visit the SMART Recovery website or SMART Recovery Family & Friends website.
- Stepping Stone of San Diego Inc. is a nonprofit alcohol- and drug-treatment program specializing in the lesbian, gay, bisexual, and transgender (LGBT) community. Call 619-278-0777 or visit the Stepping Stone website.
Herrick Library Resources
To learn more about the topic, please explore these books and videos that reflect the theme of opioid misuse and overdose awareness, which can be reserved and checked out with curbside pickup:
- Ben Is Back (Rated R, review to come later in the week): This 2018 film starring Julia Roberts explores one family’s peril when a member who is addicted to opioids returns home one Christmas.
- Drugs and Society by Glen Hanson: This book offers a thorough look into the major types of commonly used and abused drugs, including a chapter on opioids: their history; their pharmacological effects; their abuse, tolerance, and withdrawal symptoms; and prevention and treatment options.
- Painkillers, Heroin, and the Road to Sanity, by Joani Gammill: This book offers guidance for those in long-term recovery and includes new approaches to treatment and the possibility of a healthy, drug-free life.
- Warning: This Drug May Kill You: This 2017 HBO production is an unflinching look at the devastation caused by opioid addiction in America and profiles four families who have seen their lives tragically changed by abuse.
Also available to stream in Overdrive:
- Do No Harm: The Opioid Epidemic: This film, narrated by actor Ed Harris, shines the spotlight on the causes of the opioid crisis in America and offers hope on how America can get through this epidemic. (Stream here: https://herricklibrary.overdrive.com/media/5099151.)
Sources: CDC, Opioid Overdose, Understanding the Epidemic, https://www.cdc.gov/drugoverdose/epidemic/index.html; Foundation for Chiropractic Progress, F4CP Opioids Toolkit 1.0, https://www.f4cp.org/package/public/F4CP_Opioids_1.0_Toolkit.pdf; MedlinePlus, Opioid Misuse and Addiction, https://medlineplus.gov/opioidmisuseandaddiction.html; National Institutes of Health (NIH), Fentanyl DrugFacts, https://www.drugabuse.gov/publications/drugfacts/fentanyl; NIH Opioid Overdose Reversal with Naloxone, https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-reversal-naloxone-narcan-evzio; NIH, FindTreatment.gov, https://findtreatment.gov/content/treatment-options/types-of-treatment/; U.S. Department of Health and Human Services, What Are Opioids?, https://www.hhs.gov/opioids/prevention/index.html
Graphics: directorsblog.nih.gov; cdc.gov; nysenate.gov; https://www.aacp.org/article/opioid-crisis-call-action
