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Have you heard talk of the “opioid epidemic?” Do you know what opioids are? In 2015, more Americans died from drug overdoses (over 52,000) than from traffic accidents or shootings, according to data from the Centers for Disease Control and Prevention (CDC). Of those fatal overdoses, more than 33,000 involved opioids (such as heroin, oxycodone, and fentanyl).
Even if you don’t think you know anyone who is affected by the opioid epidemic, you may, at some point, find yourself in a position to save a life. That’s because many opioid overdoses can be reversed with timely medical treatment. The more you know about opioid addiction and treatment, the more you can help if you encounter a friend or family member who needs it. Read on to find out what the opioid epidemic is all about, and how you may be able to help.
What is the opioid epidemic?
The opioid epidemic is how researchers are referring to the problem our nation is having with opioid addiction. In the past 15 years, the rates of prescription opioid misuse and heroin abuse have risen dramatically. As a result, the rate of overdose deaths from opioids has quadrupled, according to the CDC.
What are opioids?
Opioids (sometimes called opiates) are a class of drugs commonly used to treat pain. The illegal drug heroin is also an opioid. There are three common types of opioids:
These can be prescribed by a health care provider to treat moderate to severe pain. Common prescription opioids include hydrocodone (Vicodin®), oxycodone (OxyContin®), morphine, and methadone.
Fentanyl is the name of a synthetic opioid that is extremely powerful (about 50 times more so than heroin), and therefore highly dangerous. It is intended only to treat severe pain, such as from advanced cancer. Recently, fentanyl has been illegally manufactured to sell on the street. Street fentanyl is sometimes mixed with other drugs such as cocaine and heroin, and it isn’t always labeled as fentanyl. Researchers believe that the rapid increase in overdose deaths is in part due to the increase in people taking illegally made fentanyl. Methadone is also a synthetic opioid that can be prescribed for pain relief. Because it doesn’t give the same “high” associated with other opioids, it’s sometimes used in drug treatment programs to help people reduce their dependence on opioids.
Heroin is an illegal, highly addictive drug. It is usually injected but can also be smoked or snorted. In the past few years, the rate of heroin use has increased in most age groups and at all income levels.
How does opioid addiction happen?
“Addiction happens when a person uses a drug, starts needing more of the drug over time to feel the same effect, becomes physically dependent on it, and then does almost anything to get it,” says Dr. Margie Skeer, substance abuse prevention researcher and associate professor at Tufts University School of Medicine in Boston. This can happen to anyone, even when they are not intending to misuse opioids. Over time, repeatedly using opioids changes the way nerve cells work in the brain. These nerve cells become so used to having opioids around that when the opioid is taken away, the body experiences a negative reaction—called withdrawal—usually in the form of severe aching, fever, sweating, and chills. Because withdrawing from opioids can be extremely uncomfortable and painful, people will keep using the drug to avoid feeling sick.
“My brother was hooked on heroin when he was in the military. He tested positive on a drug test and they sent him to rehab. It cost him a lot: his career, his rank, his dignity. But he got clean. Now he is a nurse.”
—Rebekah, city and state withheld
How is the opioid epidemic affecting high school students?
Most high school students don’t abuse opioids. In fact, only about 1–3 percent of teens report having misused Vicodin® or OxyContin® in the past year, and less than 1 percent say they’ve used heroin, according to data from the 2016 Monitoring the Future study. Even though opioid misuse and deaths have continued to rise in the adult population, high school seniors’ rates of past-year prescription opioid misuse have gone down in the past five years.
That’s all good news. But 9 out of 10 adults who have a substance use disorder say they started using before they were 18, so it’s important to be aware of that risk now. Plus, getting in trouble for using drugs or alcohol as a teen could reduce the number of opportunities available to you now or in the future (e.g., college, playing sports, getting a good job). In the worst-case scenario, misusing prescription drugs (or heroin) could mean overdose or death. As you prepare for adulthood, it’s incredibly important that you understand the issues surrounding opioid abuse and dependence—so that you can help end the epidemic.
“The younger people are when they start using substances (even alcohol), the greater their chances of developing a problem with drugs when they get older. This is at least partly due to how drugs can impact the way the brain develops during the teen years. For example, the more often teens use drugs, the more the brain makes connections around drug use, making it more likely they’ll want to continue using drugs as they get older.”
How have opioids become such a problem?
It’s never easy to pinpoint the exact causes of a drug epidemic, but research has shed some light on a few of the factors that are contributing to it:
- The number of opioids prescribed for pain has risen dramatically in the past 15 years. According to a study in the journal Pediatrics, the rate of heath care professionals prescribing opioids to teens nearly doubled between 1997 and 2010.
- People sometimes share their prescription pain medications with others, often without realizing that this could harm the other person. Most teens and adults who abuse prescription drugs get them from a friend or relative, according to the National Institute on Drug Abuse and a 2014 study in JAMA Internal Medicine.
- The synthetic opioid fentanyl has become much more prevalent because of an increase in the illegal manufacturing of it. Fentanyl contributed to a 72 percent increase in overdose deaths caused by synthetic opioids (other than methadone) between 2014 and 2015.
- When people become addicted to a prescription opioid pain medication, they sometimes switch to using heroin because it produces a similar effect, can be cheaper, and doesn’t require a doctor’s prescription, according to the National Institute on Drug Abuse.
- Childhood trauma is a major contributing factor to the opioid epidemic. This doesn’t mean most people who experienced childhood trauma will become addicted to opioids—but according to a 2012 study published in Addiction, most people who develop opioid addiction experienced severe childhood trauma. This is a reminder that it’s important to prioritize self-care and seek out other supports following traumatic experiences.
“Two-thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes,” wrote Maia Szalavitz in Scientific American. “We need to help abused, neglected, and otherwise traumatized children before they turn to drugs for self-medication when they hit their teens.”
Other risk factors for opioid abuse include:
- Alcohol use disorder, or heavy use of alcohol and/or other recreational drugs
- Personality disorder
Can a single dose of a prescribed opioid lead to opioid addiction?
Not likely. If you’ve ever broken a bone or had your wisdom teeth pulled, there’s a chance you’ve been prescribed an opioid for the pain. When used exactly as they are prescribed, opioid medications can be helpful in reducing pain. Addiction occurs when someone repeatedly uses a substance to the point that the reward system in their brain becomes desensitized to that substance. This is why a person may start to need the substance in larger amounts to get the same (or reduced) effect.
- A single dose of heroin or an opioid painkiller (if it’s not prescribed to you, or if you overdose) can cause death.
- Some people are genetically predisposed to addiction; their first experience of a drug may be especially powerful, increasing the chance that they will use again.
What are the red flags for people using pain medications?
For people who are taking an opioid medication that’s been prescribed to them, red flags may include if they feel like they can’t stop using the meds, or are taking them for general feel-good reasons, rather than to reduce the pain. If this is happening to you or someone you know, seek help (see below). Patients who know they are at higher risk of addiction can choose to refuse opioid prescriptions for pain, opting for non-narcotic medications instead. Some pain may also be managed with physical activity, meditation, or massage.
“When I was little I always wondered what my dad was doing going to the bathroom so often and why he would go from being in a really good mood to sometimes a bad mood very quickly. My dad died when I was eight from a drug overdose at his house, and I will never forget that day. Addiction is a nasty thing that I never want to see someone go through ever again.”
—Camryn, Memphis, Tennessee
What can you do to help stop the opioid epidemic?
Never share your medications with anyone, and dispose of prescription pills properly.
Any time you have unused, expired, or unwanted prescription medications, dispose of them as soon as possible and don’t give them to anyone else. This helps reduce harm from others intentionally or accidentally taking the medication, according to the Food and Drug Administration.
- Contact your local police station or fire department to find out if they have a prescription drug take-back program, or if they know of one in your community.
- Check disposemymeds.org to find a pharmacy near you that will take them.
If your only option is to throw the medicine away, follow these FDA guidelines:
- Mix the medication with something inedible, such as coffee grounds, kitty litter, or dirt
- Place the mixture in a sealed plastic bag
- Throw the bag in the trash
- Scratch out all of your personal information from the prescription bottle so it can’t be read, and dispose of it
What does an opioid overdose look like?
The signs of opioid overdose are pretty consistent and predictable. They include:
- Small pupils
- Droopy arms and legs, and the inability to stand or walk
- Slurred speech
- Shallow and uneven breathing
- Being unresponsive (e.g., not answering to their name, not responding to physical stimulation such as rubbing your knuckles into their sternum)
- Loss of consciousness
When time is running out and the person may be dying, signs include:
- Pale face
- Blue lips
- Gurgling chest sounds
“People are at highest risk for overdose after they have a period of time when they weren’t using opioids and then they use again. The body isn’t used to the drug anymore, and if they use the same amount that they did before stopping, it can overload the brain and body and lead to an overdose.”
What to do if someone may have overdosed on opioids: Call 911 immediately
- Act quickly: Most deaths occur one to three hours after the overdose, so you have a window where you can help. You do not need to be positive the person has overdosed on opioids (or any other substance) before calling 911.
- Get medical help: Any suspected overdose requires emergency medical help. When people survive an overdose, it is because professional help was available.
- Tell the 911 dispatcher: Let them know if the person’s breathing has slowed or stopped and if they are unresponsive. Give the dispatcher the exact location.
- Be aware of Good Samaritan laws: In most states, people who seek help with a suspected overdose are protected against drug-related criminal charges under “Good Samaritan” laws (also known as 911 Immunity Laws). For information about your state, see Get help or find out more below.
Can an opioid overdose be reversed?
Yes—many opioid overdoses can be reversed with treatment. The opioid reversal medications naloxone (also called Narcan®) and naltrexone (also called Revia® or Vivitrol®) can be delivered via a nasal spray or injection, or intravenously (injected into a vein).
How quickly does the antidote work?
This depends on several factors, including how the reversal drug is delivered. When it is given intravenously in the hospital, naloxone begins reversing an opioid overdose within about two minutes (other methods may take a few minutes longer). Naloxone displaces the opioid in the brain, and can immediately reverse the potentially lethal effects of the opioid on the brain, lungs, and heart.
How long does antidote treatment take?
The treatment may take several hours or longer. Naloxone treatment varies in how long it lasts; the effects may last 20–90 minutes. The effects of opioids last much longer than this, and vary according to the type of opioid. Typically, many doses of naloxone are needed to sustain the reversal until the person is out of danger. This is why professional medical care is so important.
Where can opioid antidote treatment be accessed?
Naloxone treatment can be accessed in several ways:
- At hospital emergency rooms
- Via police departments and paramedics (ambulance responders), after calling 911
- Via some fire departments
- In most states, via some trained laypeople (not medical professionals) who may have a history of opioid abuse or family members who are abusing opioids
- Purchased without a prescription at some Walgreens and CVS pharmacies in some states, though accessibility varies widely. If you or someone you know is dealing with opioid addiction, having naloxone (often known by its brand name, Narcan®) on hand could save their life.
Could I be at risk for opioid abuse?
- Opioid addiction is difficult to treat; avoiding abuse and addiction is the safest strategy.
- If you are using an opioid prescription medication, be self-aware about your reasons: Opioid medications are prescribed for long-term pain associated with serious illnesses and conditions or for short-term pain control after surgery or an injury. If you are using opioids for other reasons—e.g., to get high or buzzed—seek help.
- If you are using opioids for pain relief, and your pain is becoming more difficult to control, discuss that with your doctor immediately.
- If you are abusing opioids or may be addicted, you will need support with your recovery.
Where can I get help with opioid abuse or addiction?
Look for programs and specialists who work specifically with teens—research shows these are the most effective. Ask your parent for help in finding a treatment program. You can also:
- Call this confidential 24/7 helpline: 1-800-662-HELP (4357).
- Use this free search tool from the Substance Abuse and Mental Health Services Administration to find programs near you.
- Ask your doctor or other health care provider for a referral to an addiction specialist.
- Ask at your school nurse’s office, counseling center, church, or community center about finding help for addiction.
- Call your local hospital for help finding medical professionals with addiction expertise.
- Ask your parent to check the insurance company website for addiction specialists covered by your plan.
- Look at community directories or online for programs and specialists in your area. Make sure the person or program is licensed and/or certified in mental or behavioral health. Counseling that includes motivational interviewing and/or functional family therapy (which involves other family members in the counseling session) has been shown to be effective.
- Go to a detox center. Many offer a free initial consultation.
Get help or find out more
Free, confidential, 24/7 helpline (English and Spanish): SAMHSA
Margie Skeer, ScD, MPH, MSW, associate professor of Public Health and Community Medicine at Tufts University School of Medicine, adolescent substance use prevention researcher, Boston, Massachusetts.
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