The nation is in the midst of an unprecedented opioid epidemic. More than 130 people a day die from opioid-related drug overdoses.

The opioid epidemic is a national health crisis. Overdoses involving opioids killed nearly 50,000 people in 2019, according to the Centers for Disease Control and Prevention (CDC).

Opioids are a class of drugs that include prescription pain relievers such as oxycodone, hydrocodone, codeine, and morphine; heroin; and synthetic opioids such as fentanyl.

The crisis began in the 1990s, when pharmaceutical companies heavily marketed prescription opioids to doctors to reduce pain associated with things like surgery, chronic back pain, or dental pain. Pharmaceutical companies also reassured healthcare providers that patients would not become addicted to the pain relievers. This led to widespread use of highly addictive medications, and opioid overdoses began to increase.

The number of deaths related to drug overdoses has quadrupled since 1999. From 1999 to 2019, nearly half a million people died from opioid overdoses, according to a CDC report.

According to a paper published in the American Journal of Public Health, Purdue Pharma, the maker of OxyContin, used aggressive approaches to market the drug to physicians, including a lucrative bonus system for sales representatives to increase their sales of OxyContin.

Purdue Pharma targeted doctors who prescribed drugs at higher rates than others and drastically misrepresented OxyContin’s risk of addiction, saying in brochures and audiotapes directed at physicians that the risk of addiction was extremely low. Doctors began prescribing opioids at greater rates, leading to an increase in the misuse of these highly addictive drugs.

Research shows that opioid use disorder can lead people to move on to stronger, illicit drugs, like heroin. Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and an estimated 4 to 6 percent who misuse prescription opioids transition to heroin. Eighty percent of people who use heroin first misused prescription opioids.

As a result, opioid overdoses have skyrocketed in recent years. From 1999 to 2019, 247,000 Americans died from overdoses related to prescription opioids, according to the CDC.

Who Is Most at Risk of Opioid Use Disorder?

Opioid addiction can strike anyone, regardless of age, race, or socioeconomic background.

Still, certain populations are at a higher risk of opioid use disorder than others. These include people who:

Are of younger age, particularly teens and young adults in their early twenties
Have a personal or family history of substance abuse
Are living in stressful circumstances, such as being unemployed or living below the poverty line
Have had legal troubles in the past
Are in contact regularly with others who are addicted to drugs, or are frequently exposed to environments where there's drug use
Have a history of severe depression or anxiety
Tend to engage in risky behavior
Use tobacco heavily

Common Questions & Answers

How big is the opioid epidemic?

The opioid epidemic is a national health crisis affecting hundreds of thousands of Americans. About 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and an estimated 4 to 6 percent of those transition to heroin. According to the CDC, from 1999 to 2019 nearly 247,000 Americans died from overdoses related to prescription opioids.

Who is most at risk for opioid use disorder?

Opioid addiction can affect anyone at any age. Still, someone is more likely to have opioid use disorder if they are in their teens or early twenties; have a history of substance abuse; have had legal troubles; are unemployed or living in poverty; have a history of severe depression or anxiety; engage in risky behavior; or use tobacco heavily.

How can I tell if a loved one is addicted to opioids?

People who are addicted to opioids may feel they need the drug daily or several times a day; have intense urges to use the drug to block out other thoughts; take large amounts for longer than intended; borrow drugs from others; over time, need more of the drug to get the same effect; fail to meet work obligations; and engage in risky behaviors.

What’s the best way to treat opioid use disorder?

Many healthcare providers will suggest medication-assisted therapy (MAT) to treat opioid use disorder. This approach also includes cognitive behavioral therapy (or talk therapy), counseling through community support groups and with one’s family members, and sometimes residential or inpatient hospital treatment. This "whole patient" approach can increase the likelihood of a successful recovery.

Symptoms of Opioid Use Disorder

It’s important to be aware of the signs of an opioid addiction in order to recognize a problem in yourself or a loved one.

People who are addicted to drugs may:

Feel they need to use the drug regularly, daily, or even several times a day
Have intense urges for the drug that block out any other thoughts
Take the drug “just in case,” even when there is no medical need
Take larger amounts of the drug over a longer period of time than intended
Borrow the drug from others or “lose” it so that more prescriptions need to be written
Seek the prescription from multiple doctors in order to have a “backup” supply
Spend large quantities of money on the drug, even when they can't afford it
Over time, need more of the drug to get the same effect
Fail to meet work obligations
Cut back on social or recreational activities as a result of drug use
Experience a change in sleep patterns
Continue the drug use, despite its causing problems in life or physical or psychological harm
Do things to get the drug that they normally wouldn't do, such as stealing
Drive or engage in other risky behaviors under the influence of the drug
Fail in attempts to stop using the drug

Learn More About Symptoms of Opioid Use Disorder

Treatment Options for Opioid Use Disorder

There are a number of different options available to treat opioid use disorder, including medication, counseling and behavioral therapies, and residential and hospital-based treatment.

Medication These include methadone and buprenorphine, two drugs that work together to decrease withdrawal symptoms and cravings. They act on the same targets in the brain as other opioids, but they do not make the person taking them feel high. Naltrexone is another option, which works differently from methadone and buprenorphine. It doesn’t help with withdrawal symptoms and cravings but rather takes away the high that you would normally get while on opioids.

Counseling Talking to others about an addiction can be extremely beneficial in the treatment process. Counseling can include individual, group, and family counseling, and often includes a combination of these plus medication. For more severe situations, residential/hospital-based treatment is advised.

Individual — Cognitive Behavioral Therapy Also known as CBT, cognitive behavioral therapy is an example of a form of individual talk therapy that helps patients recognize and stop negative patterns of thinking and behavior that can lead to the desire to use opioids.

Peer Support Groups For example, a community group that meets regularly, like a 12-step program such as Narcotics Anonymous

Family Therapy includes partners or spouses and other family members who are close to the patient. It can help to repair and improve family relationships, which often can contribute to addiction issues.

Residential and Hospital-Based Treatments Residential programs combine housing and treatment services. Inpatient hospital-based programs combine healthcare and addiction treatment services for people with medical problems and some offer intensive outpatient treatment to help less severe issues or to help transition out of inpatient care. All these types of treatments are very structured and usually include several different kinds of counseling and behavioral therapies. They also often include medicines and medical care to transition off of the prescription or illicit opiate substance.

Learn More About Treatment Options for Opioid Use Disorder

Opioid Use During the COVID-19 Pandemic

In 2020, the CDC recorded over 85,000 drug overdose deaths, the highest amount in any 12-month period. One December 2020 report from the CDC found that deaths tied to the use of opioids had increased by 38.4 percent compared with the previous year.

The COVID-19 lockdown interrupted many people’s treatment regimens, while social isolation and financial insecurity may have worsened addiction. Being alone in one’s home, with little to do but worry about what’s going on in the world, caused many to relapse.

Addiction facilities were not prepared to cope with the challenges of social distancing, either. According to one study published in December 2020 in the Journal of Addiction Medicine, only 27 percent of U.S. addiction facilities had telehealth options at the start of the pandemic.

Learn More About Opioid Use During the COVID-19 Pandemic

How to Prevent Opioid Abuse

In an effort to combat the opioid epidemic, many in the scientific community are looking at ways to prevent addiction before it takes hold.

Doctors play an important role in helping curb the opioid epidemic by practicing safer and more responsible prescribing of opioids, and screening patients for opioid misuse at routine medical visits.

The majority of states have implemented prescription drug monitoring programs, which are electronic databases that track controlled substance prescriptions. These programs can help identify patients who may be misusing prescription opioids and those at risk for an overdose. Doctors can then use this information to assess patients’ history of controlled substance use before prescribing medication.

Patients can also play a role in preventing addiction: Patients should never share their prescription drugs, nor should they stop or change a drug regimen without discussing it with their doctors first.

Patients should also be careful to discard medication responsibly, as research shows that most people get the opioids they use for free from friends or family.

The U.S. Department of Justice’s Drug Enforcement Administration (DEA) holds National Prescription Drug Take Back Day twice a year, to provide the public with a safe way to discard opioids. If you miss those days, the DEA also offers year-round locations where controlled substances can be thrown away.

Finally, researchers are looking at novel strategies to prevent opioid abuse and overdose, including opioid-blocking vaccines and gaining Food and Drug Administration (FDA) approval for opioid alternatives.

Learn More About How to Prevent Opioid Abuse

Can CBT Work for Chronic Pain?

Cognitive behavioral therapy (CBT) is a form of psychotherapy aimed at increasing mindful awareness, changing destructive thought patterns, and helping patients bring a rational frame of mind to life’s challenges.

It’s most often used to treat mood disorders, like anxiety or depression. But some researchers believe it can also play a role in alleviating chronic pain without the sometimes detrimental effects of opioids.

Experts say patients’ thoughts and beliefs play a pivotal role in how they experience their pain and how that pain affects their lives. Patients might, for example, avoid activities they enjoyed because they worry about aggravating their pains. Adults with chronic pain are often prescribed opioids to manage their pain, but CBT can give patients strategies they can use to disrupt some of chronic pain’s psychological complications.

But doctors emphasize CBT does not cure the underlying pathology for pain and it may not be effective for everyone.

There is mounting evidence that trauma (for example, physical, psychological, sexual), especially in childhood, and the resulting PTSD can contribute to someone developing addiction issues later in life like opiate and other substance abuses and that therapies like CBT and other trauma-informed approaches can potentially address some of the root drivers of the addiction state.

Learn More About CBT

Is Marijuana a Good Substitute for Opioids for Pain Relief?

There are over 100 clinical trials currently being conducted to test whether cannabinoids like marijuana could be a good substitute for opioids in patients with chronic pain.

While more research is needed, in 2017 the National Academies of Science, Engineering, and Medicine (NASEM) decided that there was evidence that cannabinoids could be used to treat chronic pain in adults and called for further research.

Cannabis was found to help with patient’s quality of life and ability to sleep. While more research is needed, the outlook is promising. One study, published in September 2020 in Cannabis and Cannabinoid Research, found that out of 180 adults who had been dependent on opioids, almost half were able to use cannabinoids to stop all opioid usage.

Cannabinoids are less addictive than opioids, with side effects that are far less severe. But while the research suggests marijuana may be an effective way of curbing opioid use, more studies are still needed.

Editorial Sources and Fact-Checking

References

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What to Know About the Opioid Epidemic and Opioid Use Disorder