Opioids are the most powerful drugs available in the United States with some of the deadliest consequences. Found as both prescription medications for pain and illicit street drugs, opioids have the ability to cause changes in the body that can lead to physical dependence in a very short period of time. Because of the euphoric effects of the drug, users frequently seek out this pleasure: this can lead to substance use disorder. The potency of these drugs, their overprescription, and their potential for misuse have made opioids the leading cause of overdose death in the U.S.
What Are Opioids?
Opioids are a class of drug that is chemically related to and interact with, opioid receptors in nerve cells in the brain and the nervous system to produce pleasurable effects and reduce the intensity of pain signals. They also affect areas of the brain that control emotions, which can assist in reducing the effects of pain. This class of drugs includes both synthetic opioids, which are often prescribed to manage pain, and illicit street drugs, such as heroin, fentanyl, oxycodone, codeine, hydrocodone, and morphine.
Most commonly used to relieve chronic pain, opiates have become the most popular form of pain relief, despite a lack of evidence that they are effective in the treatment of long-term pain. In fact, when used long-term, some patients complain of increased sensitivity to pain. Because these drugs affect the pleasure center of the brain, causing euphoria, they have the greatest potential for misuse, meaning they can lead to the brain becoming addicted and subsequently cause substance use disorder. Opioids can also lead to the body becoming physically dependent. This can mean that unpleasant side effects, or withdrawal symptoms, are experienced when use of the drug is reduced or stopped.
What is Substance Use Disorder?
Dependence occurs as a result of changes in the body and brain when someone is chronically exposed to the drug. Substance use disorder (SUD) is defined as compulsively seeking a drug despite negative consequences. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a range of resources and factual information about substance use and mental health. SAMHSA explains that SUD is a complex condition that occurs with recurrent use of drugs and alcohol. Varying in severity — mild, moderate, or severe — SUD can cause significant clinical and functional impairment in terms of health, disability, and failure to meet day-to-day responsibilities at home, work, or school.
In 2015, of the 20.5 million Americans who had a substance use disorder, 2 million included addiction to prescription pain relievers and over half a million had a substance use disorder involving heroin. The overprescription of opioids for pain relief has led to a sharp increase in opioid addiction, which has, in turn, led to a rise in overdose deaths and heroin use. At the end of 2017, it was estimated that over 100 people die of opioid-related overdoses every day in the U.S.
Public health authorities have voiced their growing alarm at the unprecedented increase in death rates associated with opioid medications. Many public agencies and health authorities are working to address the crisis, and the government has now declared it a public health emergency. The Center for Disease Control and Prevention (CDC) has said the increase in opioid usage has led to the “worst drug overdose epidemic in [U.S.] history.”
What Are The Most Powerful Opioids?
Opioids fall into two categories: synthetic opioids available by prescription to manage pain and chronic conditions, and illicit drugs. While they vary in potency, they are all powerful drugs that have the ability to cause dependency and substance use disorder, and when misused they can lead to death.
Some of the most potent opioids that are prescribed include hydrocodone, oxycodone, oxymorphone, morphine, fentanyl, and carfentanyl. Between 1999 and 2011, the consumption of hydrocodone more than doubled and the use of oxycodone increased by nearly 500%.
- Codeine is used for mild pain relief, such as migraines and is available in liquid and tablet form. It is available by prescription and it is contained within cough syrup and some versions of Tylenol.
- Hydrocodone (brand name Vicodin) is the most commonly prescribed painkiller in the U.S. and is used for dental and other injury-related pain. It is made of acetaminophen (Tylenol) and codeine. According to the CDC, hydrocodone is themost abused synthetic opioid.
- Oxycodone (brand names OxyContin and Percocet) and Oxymorphone (brand name Opana) are prescribed for moderate to severe pain relief. Oxycodone is a powerful narcotic pain reliever that is often prescribed in a slow release formula for patients who need extended pain relief. Those who abuse this drug often snort or inject it because it can provide a quick release of the drug in the system. In June 2017, the Food and Drug Administration requested that the drug manufacturer of Oxymorphone, Endo Pharmaceuticals, withdraw the drug due is misuse. This it did in July “due to the public health consequences of abuse.”
- Morphine (brand names Kadian and Avinza) is used before and after surgery to alleviate severe pain. It is available in extended release pills and intravenously.
- Hydromorphone (brand names Dilaudid and Exalgo) is available as a pill and as a concentrated solution that can be injected.
- Fentanyl is a Class II controlled substance and is one of the most powerful synthetic opioids available at 50 to 100 times stronger than morphine. It was first made in Belgium in the 1950s and introduced into medical practice in 1960 as an intravenous anesthetic. Later, two further types of fentanyl were produced to be used as pain relievers in heart surgery. Fentanyl is used exclusively for anesthesia and pain relief today. It is now available as a skin patch (Duragesic) and as a solid lozenge (Actiq) that dissolves slowly in the mouth. Actiq is used in cancer patients with breakthrough pain who have developed a tolerance to other opiates.
- Carfentanil or carfentanyl (brand name Wildnil) is a type of fentanyl that is 100,000 times stronger than morphine and is used in veterinary practice to immobilize large animals. Both types of fentanyl are commonly injected but they can also be smoked or snorted.
- Heroin is a fast-acting potent opioid available as a street drug. Often injected, it can also be snorted or sniffed. Many of those who use heroin were initially addicted to prescription opioids who switched to heroin due to its availability and lesser cost. Sometimes heroin is laced with fentanyl, which makes it even more deadly as users are often unaware of its potency. This can lead to a greater risk of overdose.
- Fentanyl has also been produced as a street drug and is available as a powder or pill. It is often referred to by the street names Apache, Tango, China Girl, Goodfella, Jackpot, Cash, TNT, and Murder 8.
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