Opioid << OH pee oyd >> is any drug made from or containing opium, or a synthetic or semisynthetic drug with a similar chemical structure. Opium is a substance obtained from the opium poppy. Physicians prescribe opioids mainly for people with severe pain, such as patients receiving cancer treatment or recovering from surgery. An opioid called codeine stops coughing. Opioids are frequently misused because they make people feel relaxed.
Natural opioids, also called opiates, are made from opium. Codeine, heroin, and morphine are natural opioids. Synthetic opioids are artificially created. These drugs include fentanyl, meperidine, methadone, and tramadol. Semisynthetic opioids are made by chemically processing natural opioids. Semisynthetic opioids include buprenorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, and tapentadol.
Opioids are generally safe for short-term medical treatment. However, with continued use, all opioid drugs can be addictive. The United States Centers for Disease Control and Prevention (CDC) advises doctors not to prescribe opioids unless nonopioid drugs are unlikely to relieve a patient’s pain.
Opioids are controlled substances. This means that in most cases, they can be obtained lawfully only with a prescription. United States federal law totally prohibits the sale and use of heroin.
Effects of opioids.
Opioids produce analgesic (pain-relieving) and calming effects. A person who takes an opioid drug feels euphoria (a feeling of well-being), accompanied by a warm flushing of the skin, a dry mouth, and a sensation of heavy limbs. Following the initial euphoria, thinking becomes clouded. Common side effects of opioids include constipation, nausea, and vomiting.
People who take opioid drugs can develop opioid use disorder (an addiction to opioids). Opioid use disorder can result from the use of any opioid, whether it is prescribed or illegally obtained. Opioid addiction can lead to serious health conditions, including collapsed veins, infectious diseases such as AIDS and hepatitis, and fatal overdoses.
Opioid overdoses kill by making it difficult to breathe. The chief signs of opioid overdose are “pinpoint” (extremely contracted) pupils, unconsciousness, and very slow or no breathing. Having an opioid use disorder, taking opioids by injecting them, and mixing opioids with other drugs or alcohol increase the risk that a person will overdose.
Naloxone, a drug sold under the brand name Narcan, can prevent death from opioid overdose if it is given as soon as possible. Naloxone blocks opioid drugs from taking effect in the body.
In the long term, opioid use disorder can be effectively treated. Methadone and buprenorphine are medications that, when used as part of a carefully planned treatment, stabilize the patient, relieve the patient’s craving and withdrawal symptoms, and allow the patient to engage in a recovery program.
The opioid use epidemic.
Public health experts have declared that there is an epidemic of opioid use disorder in the United States. An epidemic occurs when a disease attacks many people at about the same time. In 2020, about 2.7 million people in the United States had opioid use disorder.
In the 1990’s, drug companies began to heavily promote the use of prescription opioids to treat a wide variety of health conditions. They claimed opioids were safe for long-term treatment. One of the most important of these drugs was oxycodone, marketed under the brand name OxyContin. OxyContin’s marketers claimed it was less addictive than other opioids.
The number of opioid prescriptions in the United States tripled between 1991 and 2011. Despite the claims of drug companies and marketers, many patients became dependent on the drugs and developed an addiction. Fatal and nonfatal drug overdoses drastically increased.
Federal courts found that Purdue Pharma, the company that marketed OxyContin, contributed directly to the development of the epidemic. In 2007, Purdue Pharma pleaded guilty to fraud for its misleading marketing of the drug. In 2020, the company pleaded guilty to financially rewarding doctors for prescribing OxyContin.
Since 2014, local governments, states, and Native American tribes, as well as the United States federal government, have sued various drug and health care companies for their involvement in the opioid use epidemic. Some lawsuits claim companies continued to supply drugs to certain locations despite evidence it would result in the drugs being illegally resold. Others claim companies allowed opioids to be distributed without a prescription.
Companies involved in the lawsuits agreed to pay a total of more than $50 billion. Generally, these payments were intended to help governments fund addiction treatment and other health care. Companies required to pay included the largest American drug distributors; the drug manufacturers Johnson & Johnson, Purdue Pharma, and Teva Pharmaceutical Industries; and major pharmacy chains, including CVS, Walgreens, and Walmart.
As the epidemic became more widely known, people addicted to prescription opioids could not obtain them as easily. They began using heroin instead. By the late 2010’s, however, more overdose deaths were caused by fentanyl and other synthetic opioids than by heroin. Synthetic opioid overdose deaths increased each year after 2013. The number of deaths increased particularly sharply from 2019 to 2020, the first year of the COVID-19 pandemic (see COVID-19 (The COVID-19 pandemic)). 
Public health organizations have adopted creative approaches to combating the opioid use disorder epidemic. Many fatal overdoses result from contaminated drugs. In response, some organizations work to prevent overdoses by offering free tests to detect contamination. In addition, the World Health Organization recommends that anyone who is likely to encounter an opioid overdose be trained to administer naloxone. Such people include health care workers, as well as opioid users and their friends and family members.
A few cities have safe injection sites or safe consumption sites where people can use illegal drugs without being arrested. These facilities typically offer supervision by medical staff, sterile needles, addiction treatment, and mental health care. Studies have found that such sites prevent fatal overdoses, and that they do not increase drug misuse. The first approved safe injection sites in the United States opened in New York City in 2021.
