In 2019, the most recent year for which we have data, the number one cause of accidental death in the United States wasn&rsquo;t drownings, falls or even car accidents. It was drug overdoses.

There were more than 70,000 drug overdose deaths that year, according to the Centers for Disease Control and Prevention (CDC), with nearly 50,000 related to opioid painkillers. About 36,000 of those deaths involved synthetic (man-made) opioids like fentanyl.

The problem likely worsened during the COVID-19 pandemic, too. As of early 2021, the CDC estimates that over 81,000 people died of a drug overdose in the 12 months ending in May 2020. The surge was primarily driven by an uptick in synthetic opioid use.

How opioid addiction starts 
The road to opioid addiction often begins with a painkiller prescription from a healthcare provider (HCP), says Mark Cardillo, LCSW, program director for behavioral health and addictions at Tampa Community Hospital in Tampa, Florida. In a 2014 study published in JAMA, three quarters of the 1,600 participants who began abusing opioids in the 2000s&mdash;and two thirds of the 286 who began using between 2010 and 2013&mdash;started with a prescription.

Healthcare providers wrote 255 million opioid prescriptions in 2012, according to the CDC&mdash;enough for every adult in the U.S. They have been urged to prescribe fewer painkilling narcotics since then and, as a result, in 2019, prescriptions fell to about 153 million.

&ldquo;There may be some genetic predisposition,&rdquo; adds Cardillo. &ldquo;You also have a segment that may turn to drugs and alcohol because they have some issue, like trauma or their upbringing. In order to escape they turn to drugs. Another group has some sort of mental disorder and use drugs to deal with that. Usually there&rsquo;s some component in their lives that pushes them to addiction.&rdquo;

Why opioids are so addictive&mdash;and deadly 
Snorting, swallowing or shooting heroin or another opioid not only dulls the sensation of pain, but also causes a feeling of intense euphoria. At the same time, opioids affect parts of the brain that influence a number of body functions beyond pain sensation and pleasure, including the breathing instinct. If you take too many opioids, you may stop breathing.

Your body naturally produces opioids, but when you flood it with opioids from an outside source, it adapts to having that extra influx. Then, when you stop putting outside opioids into your body, the body&rsquo;s natural levels of opioids are no longer enough, and you go through withdrawal. This process is known as dependence.

Withdrawal symptoms include agitation, anxiety, muscle aches, insomnia, diarrhea, nausea and vomiting, among others. Many people, even those with the best of intentions, will go back to using opioids once withdrawal symptoms hit.

Getting clean and staying clean 
According to Cardillo, the first stage of recovery is detox, which involves withdrawal. &ldquo;You just have to get the drug out of your system, so you can think clearly,&rdquo; he says. Detox takes between five and seven days, says Cardillo, but it could take up to a month before you start feeling normal.

&ldquo;Once you tackle that, you work on the psychological part,&rdquo; Cardillo says. Treatment is vital to dealing with an opioid addiction, and behavioral therapy is widely acknowledged to be an effective approach&mdash;especially when it&rsquo;s combined with prescription medications. Treatment may also involve altering aspects of a person&rsquo;s environment that may trigger their drug use.

In fact, Cardillo says that the biggest mistake people recovering from an opioid addiction make is &ldquo;not changing the people, places and things that will put them in situations where they&rsquo;re going to use again.&rdquo; Not embracing therapy is another stumbling block. &ldquo;Therapy can be painful, so the first instinct is to go back to using,&rdquo; he says. &ldquo;The reality is that drugs and alcohol work. You take them and you don&rsquo;t have to think about your trauma.&rdquo;

&quot;You have to be extremely diligent to maintain sobriety,&rdquo; says Cardillo. &ldquo;Most people say you go &lsquo;into recovery,&rsquo; not necessarily that you&rsquo;re cured. People may have been in recovery for 30 years, but they&rsquo;re not cured. Any day something could trigger them and make them start using again. They have to take it one day at a time.&rdquo;

Medically reviewed in March 2021.

Sources:

Centers for Disease Control and Prevention. &ldquo;Drug Overdose Deaths in the United States, 1999&ndash;2019.&rdquo; December 22, 2020. Accessed March 4, 2021. 
Centers for Disease Control and Prevention. &ldquo;Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths &mdash; United States, 2013&ndash;2019.&rdquo; February 11, 2021. Accessed March 4, 2021. 
Centers for Disease Control and Prevention. &ldquo;Overdose Deaths Accelerating During COVID-19.&rdquo; December 17, 2020. Accessed March 4, 2021. 
National Institute on Drug Abuse. &ldquo;Opioid Overdose Crisis.&rdquo; February 25, 2021. Accessed March 4, 2021. 
Centers for Disease Control and Prevention. &ldquo;U.S. Opioid Dispensing Rate Maps.&rdquo; December 7, 2020. Accessed March 4, 2021. 
TJ Cicero, MS Ellis, et al. &ldquo;The Changing Face of Heroin Use in the United States:&nbsp;A Retrospective Analysis of the Past 50 Years.&rdquo;&nbsp;JAMA Psychiatry.&nbsp;2014;71(7):821&ndash;826. 
National Institute on Drug Abuse. &ldquo;Misuse of Prescription Drugs Research Report: How do opioids affect the brain and body?&rdquo; June 2020. Accessed March 3, 2021. 
National Institute on Drug Abuse. &ldquo;Misuse of Prescription Drugs Research Report: Understanding Dependence, Addiction, and Tolerance.&rdquo; June 2020. Accessed March 3, 2021. 
MedlinePlus. &ldquo;Opiate and opioid withdrawal.&rdquo; February 26, 2021. Accessed March 3, 2021. 
National Institute on Drug Abuse. &ldquo;Why is there comorbidity between substance use disorders and mental illnesses?&rdquo; April 2020. Accessed March 8, 2021. 
Centers for Disease Control and Prevention. &ldquo;Rx Awareness: Recovery Is Possible.&rdquo; August 12, 2020. Accessed March 8, 2021. 
SAMHSA. &ldquo;MAT Medications, Counseling, and Related Conditions.&rdquo; August 19, 2020. Accessed March 8, 2021.

How Does an Opioid Addiction Start?

When the Muppets&rsquo; Cookie Monster grumbles, &quot;Me want cookie! Me eat cookie! Om nom nom nom,&quot; his mouth-stuffing antics delight children and parents alike. But in Colorado, where <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/recreational-marijuana-how-safe-is-it">recreational marijuana</a> is legal, and marijuana-laced cookies&mdash;and other consumables&mdash;account for 45 percent of the drugs&rsquo; sales, marijuana cookies can turn into lethal monsters.

That&rsquo;s because some pot-laced cookie-eaters get impatient when there&rsquo;s a lag time between ingesting the drug and feeling its effects (it takes 30 to 60 minutes) and they eat more and more until they&rsquo;ve gobbled a mega-dose. The CDC released a report about an emotionally stable young man who started shaking, screaming and throwing things before leaping off a roof in Denver last year&mdash;all because he ate one or two THC-laced cookies. The recommended dose&mdash;1/6th of a cookie&mdash;didn&rsquo;t seem to be having an effect, so he ate 6 to 12 times that amount. And besides, who can eat 1/6th of a cookie? (Several states have approved capsules and gummy bears for people with end-stage disease, and Colorado and Washington are experimenting with them for the general public.)

Legal or not, around 20 million North Americans say they&rsquo;ve used marijuana in the past month. So it&rsquo;s important that you&mdash;and your kids&mdash;know the risks. Teens who use pot may permanently impair their brain&rsquo;s ability to retain learning, form memories and think clearly. And regular use is associated with depression, anxiety and relationship problems.

The best highs? Endorphins from exercise and dopamine and oxytocin from great-tasting-good-for-you-food, friendship, laughter and love.&nbsp;

Medically reviewed in May 2019.

Avoid the Marijuana Cookie Monster

Weed, ganja, pot&mdash;whatever you call marijuana, facts about its risks and benefits seem harder to come by than a sober fan at a Willie Nelson concert. But facts we need! More than 31 million U.S. adults <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/marijuana-facts-and-stats">smoke marijuana</a> and almost 8.5 million use pot a lot, according to a study published in The Lancet Psychiatry. Somewhere around 1,246,170 folks in 24 states have authorized prescriptions for <a href="https://www.sharecare.com/health/pharmaceuticals/article/what-need-to-know-about-medical-marijuana">medical marijuana</a> (that number includes estimates from states that don&rsquo;t require registration and New Hampshire and Maryland where no numbers are available yet). Plus, the National Institute on Drug Abuse (NIDA) estimates almost 45 percent of 12th graders and 16 percent of 8th graders have smoked marijuana at least once.

Ironically, the more folks smoke pot (the increase since 2002 is about 30 percent), the less people believe it delivers real physical and psychological risks. True, for folks who use it for medical benefits such as end-stage cancer pain relief, to stimulate appetite in the face of chemotherapy or to ease Parkinson&rsquo;s symptoms, the risks may be less significant than the benefits, but for purely recreational users&mdash;especially heavy users&mdash;well, some think it can send your health up in smoke.

Your lungs on pot 
Any smoke&mdash;from a wood fire, a cigarette or a joint&mdash;delivers toxins to the lungs. And inhaling deeply and holding your breath when smoking marijuana increases exposure. Additionally, researchers from Health Canada found ammonia in pot smoke at levels up to 20 times that of tobacco; hydrogen cyanide and aromatic amines at concentrations 3 to 5 times that of tobacco smoke and sidestream (secondhand) marijuana smoke with more carcinogenic polycyclic aromatic hydrocarbons (PAHs) than secondhand tobacco smoke. Frequent users risk developing chronic cough, phlegm production, wheezing and acute bronchitis. Those hydrocarbons also contribute to inflammation throughout your body, including in your joints, your back, your arteries and your brain. So while you may feel less back or joint pain while smoking, you may actually increase the pain from which you&rsquo;re seeking relief. These same inflammatory molecules don&rsquo;t seem to accumulate when marijuana is eaten.

But if you&rsquo;re going to eat pot brownies, gummies or hard candies, beware of kids&rsquo; access to them. Overdoses are dangerous&mdash;and increasingly common&mdash;among children who pick up pot-laced foods left lying around.

Your brain on ganja 
The most serious cognitive risks from marijuana are to teens (especially girls) and guys up to age 24. One study in the Proceedings of the National Academy of Sciences showed frequent marijuana smokers LOST eight IQ points between the ages of 13 and 38. And even if they quit as adults, the researchers found the youthful indulgers&rsquo; mental ability did not fully recover. Fortunately, folks who start smoking pot as an adult do not show such a decline in IQ.

There are potential benefits 
When used in a well-regulated program to address specific medical issues, marijuana can convey <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/what-conditions-helped-medical-marijuana">some benefits</a>. For example, one study found users had 16 percent lower fasting insulin levels and smaller waist sizes than non-users&mdash;so marijuana may be helpful in controlling type 2 diabetes. Medical marijuana does seem to ease MS spasms and reduce vomiting from cancer medications, according to the NIDA. And some studies find marijuana extracts ease neuropathic diabetes pain, while others do not.

Don&rsquo;t go one toke over the line 
Whatever you think about smoking marijuana recreationally or taking it for medicinal purposes, clearly it is increasingly accepted by many people&mdash;and state legislatures. So what&rsquo;s needed is a realistic understanding of its risks. If you smoke or munch it, be aware of pot&rsquo;s ever-increasing potency and avoid heavy use. Discourage kids from using it at all. And treat it with the same understanding of its inherent risks and benefits as you do alcohol, which can be used in a recipe for a tasty fish stew or be a toxic substance that kills.

Medically reviewed in January 2019.

Can Marijuana Be Used Responsibly?

From eating to drinking, Americans have a problem with binging. One in six Americans <a href="https://www.sharecare.com/health/alcohol-and-health/article/binge-drinking-america-health-issue">binge drinks</a>&mdash;that means, having four or more drinks if you&rsquo;re a woman, and five or more drinks if you&rsquo;re a man within two hours. But when the Centers for Disease Control and Prevention examined data on 400,000 adults, they discovered that the average binge drinker binges 53 times annually. That&rsquo;s seven drinks each time.

Heart attack, high blood pressure, stroke, liver disease&mdash;the list of health risks for binge drinking goes on, but they also go beyond disease. Car crashes, falls, burns, homicide, suicide and domestic assault are common dangers.

<a href="https://www.sharecare.com/video/mental-health/binge-eating/what-are-the-effects-of-binge-eating">B</a><a href="https://www.sharecare.com/video/mental-health/binge-eating/what-are-the-effects-of-binge-eating">inge eating</a> affects 2.8 million Americans. Binge eaters are at risk for obesity (about two-thirds of bingers are obese), as well as arthritis, sleep apnea, some cancers, heart disease, high blood pressure and type 2 diabetes.

If you binge eat or drink, seek counseling and talk to your doctor about signing up for a 12-step program. Work with your doctor to improve your health, adopt good eating habits and learn mindful meditation to ease stress, <a href="https://www.sharecare.com/health/depression/slideshow/depression-treatment-questions">depression</a>&nbsp;and anxiety.

Do You Have a Binge Eating or Drinking Problem?

What do Alaska, Colorado, Oregon, Washington D.C., and Washington state have in common? They&rsquo;ve legalized <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/recreational-marijuana-how-safe-is-it">recreational marijuana use</a> for adults. And a total of 24 states allow medical marijuana in various ways: In New York you cannot smoke it, although you can inhale a vapor, eat it, use a tincture, or take pills! More than 12 states have decriminalized possession.

No wonder marijuana use more than doubled from 2001 to 2013. Unfortunately, according to a study in JAMA Psychiatry,&nbsp;in 2012-2013 nearly 30 percent of users had <a href="https://www.sharecare.com/video/sharecare-experts/devi-nampiaparampil/what-risks-if-any-are-there-for-using-medical-marijuana">marijuana use disorder</a>, otherwise known as MUD. That&rsquo;s a huge percentage. Symptoms include problems with normal functioning, cravings and withdrawal symptoms, such as inability to sleep, restlessness, nervousness, anger, or depression within a week of ceasing heavy use. This MUD treatment also makes you older.

There are also neurocognitive and psychiatric repercussions of MUD, especially in young people and young adults. When researchers at Columbia University Medical Center looked at the brains of folks who started smoking cannabis at 16, became dependent by 20, and have been dependent for the past seven years, they found that compared to non-smokers they had lower dopamine release in brain areas that affect learning and working memory tasks. The depression associated with withdrawal is also a likely result of alterations in dopamine availability. So don&rsquo;t get stuck in the MUD; if you or someone you love needs help with <a href="https://www.sharecare.com/video/health-topics-a-z/substance-abuse-and-addiction/what-does-research-show-about-marijuana-being-addictive">marijuana dependence</a>, go to www.findtreatment.samhsa.gov to get started creating a healthier, happier future.&nbsp;

Medically reviewed in January 2019.

Dope and Dopamine

Heroin and prescription opioid <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/heroin-addiction-what-you-should-know" target="_blank">abuse and overdoses</a> have soared in recent years. According to the Centers for Disease Control and Prevention (CDC), almost 2 million people were addicted to prescription opioids in 2014 (the latest year for which data is available.) Heroin overdose deaths nearly quadrupled in a decade, and more than four of five heroin abusers got their start with prescription opioids.

Stemming this tide will require efforts on multiple levels. But in the meantime there is a drug that can almost instantaneously reverse an opioid overdose. It&rsquo;s naloxone hydrochloride (called, more commonly, naloxone or by the brand name Narcan), and its effects can be sudden and powerful. &ldquo;I&rsquo;ve had occasion to give it myself from time to time, and people wake up in seconds,&rdquo; says Keith Roach, MD, Sharecare&rsquo;s chief medical officer. &ldquo;It&rsquo;s one of the most dramatic things you can see in clinical medicine.&rdquo;

Today the medication isn&rsquo;t just reserved for use by paramedics, EMT workers and doctors. There are some states where individuals who think they may need it for themselves, or for someone else at risk of overdosing, can have the medication on hand.

Anatomy of an Overdose 
When an opioid is taken, its molecules bind to cell receptors to make users feel euphoric and dull their perception to pain. Those receptors also blunt the body&rsquo;s ability to regulate breathing. If the opioid dose is high enough, breathing stops entirely. &ldquo;It&rsquo;s a powerful effect on the brain itself. The area of the brain that tells you to breathe stops working,&rdquo; says Dr. Roach. &ldquo;You die from opiates because you forget to breathe.&rdquo;

Signs of an opioid overdose include:

<ul>
	<li>Unconsciousness</li>
	<li>Pinpoint pupils</li>
	<li>Slow, shallow, or no breath</li>
	<li>Slow heartbeat or low blood pressure</li>
</ul>

How Naloxone Works 
Naloxone molecules bind to the same receptors as opioids. They basically muscle the opioid molecules out of the way, knocking them off the receptors like billiard balls. It allows the person to breathe again &ndash; but it may also induce <a href="https://www.sharecare.com/health/opiate-agonist/what-symptoms-opioid-medication-withdrawal" style="line-height: 1.6em;" target="_blank">withdrawal symptoms</a>.

&ldquo;Nobody likes to get naloxone because it&rsquo;s such an unpleasant wakeup call,&rdquo; says Roach. &ldquo;People are not happy about it because for whatever reason they took the opioid in the first place, all of the benefit would go away.&rdquo;&nbsp;

How to Use Naloxone 
Naloxone is sold as a nasal spray, an auto-injector or a pre-filled syringe. In a hospital, if the drug is given intravenously, it works almost instantly. The auto-injectors and pre-filled syringes are designed to be jabbed into a muscle, which works more slowly than an IV, says Roach. The nasal spray is the slowest, but &ldquo;the advantage of giving it nasally is anyone can do it,&rdquo; says Roach.

It&rsquo;s essential to be trained in the use of naloxone if you&rsquo;re expecting or expected to have to give a dose, says Roach. That means asking your doctor. &ldquo;Many communities in most states have the ability for citizens to give it, and have <a href="https://www.sharecare.com/health/first-aid-risks/good-samaritan-laws" target="_blank">Good Samaritan laws</a> to protect them. But you want to be sure you know exactly how to do it.&rdquo;

It goes without saying that you should call 911 in addition to administering naloxone in the event of an overdose. &nbsp;

How to Get Naloxone 
All 50 states allow paramedics to carry and use naloxone, which is classified as a prescription drug by the Food and Drug Administration (FDA). An increasing number of states allow EMTs to do the same, while police officers in select communities can carry the drug.

In January of 2017 Kaleo, the company that makes an auto-injector&ndash;a product known as Evzio&ndash;raised the price of a twin-pack from $690 when the product debut in 2014, to $4,500.

In a rapidly growing number of states, individuals can buy the life-saving medication -- and may not even need a prescription, thanks to what&rsquo;s called a standing order (and in some states that&rsquo;s not even needed). This allows a doctor to write a prescription for a pharmacy (not an individual), allowing the pharmacist to sell the medication to anyone who walks in and requests it. But, again, laws vary: In some states it&rsquo;s only distributed to a prescriber&rsquo;s patients, or those who are at risk of an overdose, or a family member. Typically a pharmacist dispensing it needs to be trained in its administration and teach the consumer. Currently the pharmacy chains Walgreens and CVS can distribute naloxone without a prescription in some states.

&ldquo;I think people should be able to get it more easily,&rdquo; says Roach. &ldquo;Studies show that in communities with more access, there&rsquo;s less deaths from opioids. Anything we can do to reduce the number of deaths is a good thing.&rdquo;&nbsp;

Medically reviewed in January 2019.

Drug That Reverses Heroin Overdose

Sometimes, when people have a problem with drugs or alcohol, it&rsquo;s easy for them to recognize. They may spot the physical symptoms or mental health issues. They may grasp that it&rsquo;s affecting their day-to-day function or relationships with others. Or, they find themselves drinking more or using increasing amounts of drugs to get the same effect.&nbsp;

But in many cases,&nbsp;people don&#39;t recognize the signs of drug or alcohol addiction at all.&nbsp;

How is that possible? Brain damage from addiction may actually make it that much more difficult to realize you have a problem, says addiction psychiatrist Joel&nbsp;Holiner, MD, Executive Medical Director of Medical City Green Oaks Hospital in Dallas, Texas. &ldquo;We know that taking alcohol and drugs affects the frontal cortex of the brain and even the limbic region, which could affect judgment, impulse control problem-solving issues and even memory,&rdquo; he explains.&nbsp;

The&nbsp;signs&nbsp;of addiction&nbsp; 
There are many different indications of possible substance abuse. If you think you may be abusing drugs or alcohol, or are worried about a friend, look for these&nbsp;addiction warning signs:&nbsp;

<ul>
	<li>Loss of control: Addicts consume more alcohol or drugs than they intend to, and will continue using even though it may cause problems on the job, <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/side-effects-opioid-medication">with their health</a> or in relationships. &nbsp;</li>
	<li>Secrecy and social withdrawal: Addicts may hide their drugs or alcohol use, as well as withdraw from family and friends or other social interactions.&nbsp;</li>
	<li>Change in personality and appearance: Addicts may take more risks than normal, or quit their favorite hobbies or activities in favor of drugs or alcohol. They may skip showers, wear dirty clothes or stop caring about how they look&nbsp;</li>
	<li>Mood swings or depression: Feelings of anxiety, frustration, anger, bitterness and depression, as well as a bad temper, are common in addicts.&nbsp;</li>
	<li>Blackouts or memory loss: A person may have an addiction if they regularly forget things or experience blackouts.&nbsp;</li>
	<li>Higher tolerance: Addicts tend to consume more and more to get the feeling they&rsquo;re craving. At times they may need far more than they originally intended.&nbsp;</li>
</ul>

How to get treatment for substance abuse&nbsp; 
&ldquo;If you think you are an addict, the first step is realizing you have a problem and being willing to get help,&rdquo; Dr.&nbsp;Holiner&nbsp;says. Surround yourself with friends and family who will support your new lifestyle, and make sure your daily routines eliminate temptations. &ldquo;If you were in a pattern of stopping by a convenience store on your way home from work and getting a six-pack every night, you need to change your route,&rdquo; says&nbsp;Holiner.&nbsp;

While substance abuse treatment is not one-size-fits-all, all <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/navigating-healthcare-facing-addiction">plans</a> do emphasize one thing: talking it out. The road to recovery usually involves a combination of the following:&nbsp;

<ul>
	<li>Psychotherapy: One-on-one or family therapy sessions can help cope with cravings and handle possible relapses.&nbsp;</li>
	<li>Self-help groups: Groups like&nbsp;<a href="https://www.sharecare.com/health/alcohol-and-health/article/simple-ways-cut-back-alcohol">Alcoholics Anonymous</a>&nbsp;(AA) and Narcotics Anonymous (NA) help addicts talk through their issues with people experiencing the same problems.&nbsp;</li>
	<li>Individual sponsors: Many people involved with AA or NA choose to pair with an individual sponsor that serves as a confidant and mentor during the recovery process.&nbsp;</li>
	<li>Treatment programs: Inpatient and outpatient rehab programs help addicts focus on getting sober through individual or group sessions, depending on the severity of the addiction. &nbsp;</li>
</ul>

If you&rsquo;re still having problems with withdrawal, cravings or depression, you may need non-addictive medication to help you quit for good, says&nbsp;Holiner. Talk to your healthcare provider to create a treatment plan that works best for you.&nbsp;

Medically reviewed in July 2019. Updated in March 2021.&nbsp;

6 Warning Signs of Addiction

Picture in your mind a heroin addict and chances are you&rsquo;re picturing him or her wrong. Anyone can be addicted to heroin. In fact, according to the Centers for Disease Control and Prevention (CDC), heroin use has risen across most age groups and all income levels in recent years&mdash;women, the privately insured and people with higher incomes are among those who have seen the greatest increase.&nbsp;

&ldquo;Heroin availability is a lot more widespread,&rdquo; says Mark Hutchinson, a mental health counselor who specializes in addiction at St. Mark&rsquo;s Hospital in Utah. &ldquo;Maybe 20 or 30 years ago it was something you&rsquo;d only find in a big city, but now it&rsquo;s just everywhere.&rdquo;&nbsp;

Heroin use increased 62.5 percent between 2004 and 2013. Heroin-related overdose deaths have risen over the years, too, according to the CDC.&nbsp;

So, what gives? Here&rsquo;s what you need to know about heroin addiction.&nbsp;

What Is heroin?&nbsp; 
Heroin belongs to a class of drugs called opioids. Opioids are derived from or related to substances in poppy plants and include methadone, morphine, oxycodone, hydrocodone and fentanyl. These drugs are mostly used as powerful painkillers. Heroin is synthesized from&nbsp;morphine and comes in the form of a white or brown powder or as a black sticky substance. It can be injected intravenously, smoked or snorted.&nbsp;

Highs and lows of heroin&nbsp;&nbsp; 
Not only does heroin block out pain, it totally blocks out stress and worry, says Hutchinson. &ldquo;The high is an escape that&rsquo;s deep and intense,&rdquo; he explains. It starts with intense euphoria that can last several minutes and users generally feel relaxed, drowsy and &ldquo;out of it&rdquo; for three to five hours afterward.&nbsp;

After the high, though, comes the crash. Coming off a heroin high brings a severe reaction, like an intense flu, says Hutchinson. &ldquo;Aches and pains, throwing up, high anxiety, the shakes. Sometimes people&nbsp;have hallucinations,&rdquo; he says.&nbsp;&nbsp;

The emotional and psychological&nbsp;effects of withdrawal follow. Users feel &ldquo;a real emptiness, like a hole in their soul,&rdquo; Hutchinson says. &ldquo;They have no motivation or hope or thought that they can overcome these feelings.&rdquo;&nbsp;

A big factor in continuing to use heroin and thus becoming addicted is&nbsp;<a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/ways-beat-opioid-withdrawal">avoiding withdrawal symptoms</a>, says Hutchinson. &ldquo;It&rsquo;s very intense and no one wants to be that sick, so the only thing in their mind is they have to use to not have those side effects,&rdquo; says Hutchinson.&nbsp;

Making an addict&nbsp; 
Reasons for trying heroin for the first time vary greatly among addicts. Because the drug&nbsp;<a href="https://www.sharecare.com/health/chronic-pain/article/taking-opioids-provide-function-chronic-pain">temporarily relieves pain</a>&nbsp;both physical and psychological, many users turn to it to escape trauma, says Hutchinson. &ldquo;Or they started with marijuana or alcohol and found they needed more and more to get high. Heroin is a more efficient high,&rdquo; he says.&nbsp;

Prescription opioids can lead people down the path of heroin addiction as well. A person can start prescription painkillers for a legitimate reason like intense back pain or a broken femur, get addicted, and use heroin as a substitute when they can&rsquo;t get a prescription.&nbsp;

&ldquo;Oxycontin is expensive, plus it&rsquo;s in a locked safe in the pharmacy and you usually have to wait to pick it up,&rdquo; explains Hutchinson. They may want Oxycontin but either can&rsquo;t afford it or can&rsquo;t get it without a prescription, so they turn to sources that are affordable and easily attainable, says Hutchinson. &ldquo;Heroin is a lot cheaper; for $5 or $10 you can get a hit,&rdquo; he says.&nbsp;

Heroin addiction and the brain&nbsp; 
Addiction&mdash;not just drug addiction&mdash;is a medical disease and not just a human weakness, according to experts from the National Institute on Drug Abuse (NIDA).&nbsp;

&ldquo;There are parts of the brain that are more affected by addiction, such as the hypothalamus and the amygdala, which are connected to the frontal lobe, the judgment and responsibility area of the brain,&rdquo; explains Hutchinson. &ldquo;When someone is addicted to anything, the amygdala and hypothalamus start to deteriorate physically.&rdquo;&nbsp;

It becomes a feedback loop, explains Hutchinson. &ldquo;When that happens, people will continue to use even though they know it&rsquo;s high risk and will end badly,&rdquo; he says. &ldquo;It gets to the point where using doesn&rsquo;t even bring pleasure, it just allows them to function.&rdquo;&nbsp;

Heroin addiction help and recovery&nbsp; 
If you or a loved one is using heroin, seek help as soon as possible. In the case of an overdose, call 9-1-1 right away.&nbsp;

There are a variety of&nbsp;<a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/how-choose-addiction-treatment-center">inpatient and outpatient programs</a>&nbsp;available for those who want to recover. Hutchinson suggests starting heroin addiction treatment at an intensive inpatient program and then joining an outpatient program to stay clean.&nbsp;

The first thing&nbsp;someone with&nbsp;an&nbsp;addiction&nbsp;will have to do in order to kick the habit for good is go to detox to get the heroin out of their system safely and under supervision. After detox, therapy becomes a main focus of treatment. Group therapy is particularly helpful.&nbsp;

&ldquo;Patients bond with one another, not just because they have people who know what they&rsquo;re going through, but also in sharing what&rsquo;s happened in their lives to bring them to this point,&rdquo; says Hutchinson. &ldquo;They trust one another and want to spend time with each other.&rdquo;&nbsp;

If you have a loved one&nbsp;with a heroin addiction, it&rsquo;s absolutely essential to care for and support them in their efforts to get clean, says Hutchinson. It might not be easy, as addiction can lead people to lie, steal and generally be irresponsible or unreliable because part of the brain isn&rsquo;t functioning the way it should. But Hutchinson says&nbsp;they&nbsp;simply will not get better without support.&nbsp;

&ldquo;If I did a sampling of 10 of my patients undergoing treatment&mdash;those with strong bonds and relationships&mdash;about&nbsp;6&nbsp;out of 10 will be successful,&rdquo; says Hutchinson. &ldquo;Probably&nbsp;9&nbsp;out of 10 people who don&rsquo;t have those supportive relationships will go right back to addiction.&rdquo;&nbsp;

Medically reviewed in January 2019. Updated in March 2021.&nbsp;

Heroin Addiction: What You Should Know

The use of <a href="https://www.sharecare.com/health/quit-smoking/health-effects-smoking-hookah-pipe?myAttribute=yay">hookahs</a> -- pipes that bubble tobacco smoke through water before you puff -- doubled among middle- and high-schoolers in just one year. Now it&rsquo;s on par with cigarette use in school-age kids, a troubling new Centers for Disease Control and Prevention report reveals. Fueling the craze: Peer pressure, of course, plus the dangerous myth that these exotic pipes are harmless.

The truth: Hookahs are dangerous. Research shows they deliver 100 times more lung-clogging tar, four times more nicotine -- tobacco&rsquo;s most addictive chemical -- and eleven times more heart-threatening carbon monoxide than one cigarette. Hookah-users are also exposed to <a href="https://www.sharecare.com/health/cancer-causes-and-risk-factors/can-hookah-smoking-cause-cancer">high levels of carcinogens</a>&nbsp;including benzene and acrolein, according to researchers from the University of California San Francisco.

These scientists are leading the way in uncovering hookahs&rsquo; hidden health risks. In one remarkable study, they convinced 55 hookah users to abstain for a week. They then analyzed their urine the morning after they spent one evening in the hookah bar of their choice. In this real-world study, smokers&rsquo; nicotine levels increased 73-fold after their hookah night and levels of cancer-causing compounds increased 41 to 93%! But surveys show that teens mistakenly believe that the water in these pipes filters out the toxins in tobacco smoke. Truth is, these water pipes may make the smoke less irritating, but that just encourages users to smoke more!

Typically shared with several others, a hookah user sucks in the smoke through a mouthpiece and tube attached to a pipe. A session may last a half-hour to an hour or longer, leading to inhaling as much smoke as you&rsquo;d get from up to 100 cigarettes (that&rsquo;s five packs), the World Health Organization warns. The charcoal used to keep the tobacco burning also poses substantial health risks.

The manufacturing and marketing of hookah tobacco (and the charcoal) is currently not regulated by the FDA. That leaves the door open for sales of flavored hookah tobaccos -- also called shisha, narghile and hubble-bubble -- that are especially attractive to young users. We agree with experts who are calling on the FDA to approve a pending rule to regulate these and other new tobacco products. We also want to see more states and communities close legal loopholes that allow hookah bars, lounges and cafes to open their doors to underage smokers. Until that happens, here&rsquo;s what you should know about this dangerous new craze.

<a href="https://www.sharecare.com/health/cancer-causes-and-risk-factors/can-hookah-smoking-cause-cancer?myAttribute=yay">Hookahs</a> can hook you on tobacco for life. At this point, 9% of teens say they smoke cigarettes and an equal number say they&rsquo;ve used a hookah at least once in the past month! And 13% &ldquo;vape&rdquo; or puff on electronic cigarettes. We&rsquo;ve warned you about those before. But a Dartmouth College School of Medicine survey of 1,050 young smokers, age 15-23, found that within two years, 39% who had smoked a hookah had graduated to cigarettes. The young and impressionable get hooked at a more than 30% rate.

Share a pipe and you&rsquo;re sharing disease-causing germs. Sharing saliva means sharing herpes or the flu. Health groups warn that hookahs may even spread chronic diseases such as hepatitis and tuberculosis as well as acute infections!

Hookah smoke contains an alarming variety of harmful chemicals. Yes, hookah smoking is an ancient tradition. It dates back at least 600 years. And so does the falsehood that they&rsquo;re a healthy way to smoke. There&rsquo;s nothing healthy or natural about it. We mentioned a bunch of the risks already. Others toxins in the smoke include heavy metals, formaldehyde and a nasty radioactive compound called &ldquo;Po.&rdquo; Short for polonium-210, this radioactive stuff concentrates in the delicate airways of the lungs and can course its way throughout the body, causing genetic damage, early and premature aging. Not a good situation!

Don&rsquo;t use e-cigs, snus or other &ldquo;alternative tobacco products,&rdquo; either. Plenty of the same risks are present in those, too. Say no to Big Tobacco by steering clear of them all.

Medically reviewed in May 2019.

Hidden Hookah Dangers

The holidays are meant to be a time of rest and enjoyment, surrounded by warmth and loved ones. But in reality, it tends to be a time of last-minute shopping and racing through crowded airports.&nbsp;

&ldquo;There&rsquo;s an enormous pressure on us to have the holidays be like a Hallmark card: everyone getting along, everyone getting the best gifts and you having the perfect outfit for every event,&rdquo; says Joel&nbsp;Holiner, MD, a psychiatrist specializing in addiction medicine at Medical City Green Oaks Hospital in Dallas Fort Worth, Texas. &ldquo;That pressure makes the season stressful for everyone, but it can be especially difficult if you&rsquo;re in recovery or you have a history of addiction.&rdquo;&nbsp;

Not only is your stress level higher at this time of the year, but you&rsquo;re also suddenly faced with powerful triggers. Whether it&rsquo;s running into high school friends, coworkers popping bottles in your office or having to spend time with judgmental relatives, the season can cause difficult emotions to resurface.&nbsp;

Holiday&nbsp;relapse&nbsp;prevention tips&nbsp; 
This year, do the holidays on your own terms. Here are expert-approved tips&nbsp;for&nbsp;sidestepping&nbsp;triggers, coping&nbsp;with the stress and preventing&nbsp;a relapse.&nbsp;

You&rsquo;re in control of your social calendar&nbsp; 
&ldquo;First off, there&rsquo;s no event that you actually have to go to,&rdquo; says&nbsp;Holiner. &ldquo;You may feel obligated to attend a friend&rsquo;s party or a family function, but if you know it&rsquo;s a setup for relapse&mdash;based on the people who will be there or previous experiences at the same event&mdash;do everything you can to stay home.&rdquo;&nbsp;

It&rsquo;s especially important to avoid high-risk situations during the early days of recovery, when your mind may still follow the pattern of craving substances when faced with stress.&nbsp;

&ldquo;<a href="https://www.sharecare.com/health/alcohol-and-health/article/simple-ways-cut-back-alcohol">Alcoholics Anonymous</a>&nbsp;has a saying that to stay sober, you need to change your playmates and your playpen,&rdquo; says&nbsp;Holiner. Stay away from the friends with whom you used alcohol or drugs in the past and avoid triggering settings like areas of your hometown where you have painful memories.&nbsp;

Bring your own&nbsp; 
Before sending in your RSVP, ask the family member or friend who&rsquo;s throwing the party to make it a drug or alcohol-free event. Most people will respect your recovery process and serve alcohol alternatives.&nbsp;

If you aren&rsquo;t 100 percent sure that an event will be substance free, bring a holiday &ldquo;mocktail&rdquo; like a non-alcoholic mulled punch. Make it your contribution to the potluck or a gift for the host. That way, you can feel more comfortable turning down drink offers and even reciprocate with your own.&nbsp;

Bring along a fellow sober person as well. If people bring alcohol or other substances without the host&rsquo;s permission, you and your holiday buddy can enjoy each other&rsquo;s company in an area away from the crowd. But don&rsquo;t stick around if the party&rsquo;s getting out of hand or you&rsquo;re starting to feel tempted.&nbsp;

Prepare your script&nbsp; 
&ldquo;I think it&#39;s very reasonable when a person is trying to hand you a drink to tell that friend, coworker or even your boss, &lsquo;I&#39;m sorry, I&#39;ve had a problem with drinking in the past and my doctor doesn&#39;t want me to drink at all.&rsquo; If you don&rsquo;t feel like you could be open with the person, try a simple, &lsquo;My doctor won&rsquo;t let me drink because of a medical issue&rsquo;&mdash;which is what addiction is,&rdquo; says&nbsp;Holiner.&nbsp;

Practice turning down offers ahead of each event. Think through the different scenarios you might encounter and say your responses out loud in front of the mirror until they sound confident. You could run through the lines with your sponsor or counselor, as well.&nbsp;

Cope with holiday stress&nbsp; 
With everything that&rsquo;s on your plate around the holidays, it&rsquo;s typical for your schedule to change, including your counseling and support group days. But this is a time when you want to actually increase the number of meetings you go to and spend more time talking with your counselor, says&nbsp;Holiner.&nbsp;

Around the holidays, we also find all kinds of excuses to stop taking care of ourselves&mdash;stress, busyness, saying, &lsquo;it&rsquo;s too cold out to exercise.&rsquo; But physical activity is one of the best ways to control stress and can keep relapses at bay. And it&rsquo;s not just about fitting in exercise:&nbsp;Remembering to eat, skipping fattening holiday foods and <a href="https://www.sharecare.com/health/sleep-health/slideshow/ways-fall-asleep-faster">getting enough sleep</a> all reduce stress and protect your self-esteem&mdash;helping you to avoid a relapse, he adds.&nbsp;

Taking care of yourself also means sticking to a routine. Schedule healthy activities like gym time and meal prep, along with enough counseling sessions and support group meetings. If you&rsquo;re facing a high-risk situation in the near future, include a plan for how you&rsquo;ll stay sober at that event: which people you&rsquo;ll avoid, what time you&rsquo;ll leave, how you&rsquo;ll answer questions from nosy relatives, how you&rsquo;ll help the host if you need a distraction.&nbsp;

Another way to keep your stress level&nbsp;down?&nbsp;&ldquo;Avoid setting unrealistic expectations for yourself,&rdquo; says&nbsp;Holiner. &ldquo;Let go of the pressure to create this perfect holiday. Stop overemphasizing the gifts, the decorating, the meals. Remember that the people matter most.&rdquo;&nbsp;

After the holidays&nbsp; 
When the excitement settles on January 2, it can feel like a bit of a letdown. If you&rsquo;re no longer busy and your calendar is suddenly empty, it&rsquo;s easy to become <a href="https://www.sharecare.com/health/depression/article/depression-symptoms-shouldnt-ignore">depressed</a>&mdash;especially in the dead of winter.&nbsp;

&ldquo;I recommend making post-holiday plans, because after six to eight weeks of shopping, cooking, decorating, partying, it&#39;s hard to suddenly stop and not feel a big void in your life. Don&#39;t wait 364 days to start making plans and having fun again,&rdquo; says&nbsp;Holiner.&nbsp;

Sign up for a class you&rsquo;ve always wanted to take or join a meet-up group that enjoys sober activities like hiking or cooking. It will give you something to look forward to and help to build healthy activities into your schedule.&nbsp;

The holidays can be trying when you&rsquo;re overcoming addiction, but&nbsp;if you follow these tips on how to prevent a relapse,&nbsp;you will get through them. Avoid high-risk situations, plan ahead and lean on your counselor or support group when stress starts to build.&nbsp;

Medically reviewed in January 2019. Updated in March 2021.&nbsp;

How to Avoid a Relapse During the Most Stressful Time of Year

Seeking substance use disorder treatment is a difficult step, but can also be one of the most important and best steps to take. Only 1 in 10 individuals with a substance use disorder actually receives treatment, despite the known health consequences.&nbsp;&nbsp;

Studies show that receiving treatment early, before the condition can advance, is crucial for effectively managing a substance use problem or disorder. However, receiving treatment at any stage of substance misuse is better than not receiving any type of treatment at all. Treatment services aim to enable individuals to become sober and maintain a healthy lifestyle through methods such as medication, counseling or other supportive services.&nbsp;

Substance use disorders can be classified as mild, moderate or severe, with effective treatment options for each level of severity and type of substance misuse. The most common substances reported for substance use disorders are alcohol, marijuana, cocaine, prescription pain relievers and&nbsp;<a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/anatomy-opioid-addiction">heroin</a>.&nbsp;

Steps of treatment&nbsp;

<ol>
	<li>Assessment and diagnosis:&nbsp;The first step in treatment of a substance use disorder is recognizing the issue and visiting a professional clinician for proper diagnosis. The clinician will conduct an interview to assess the severity and will then determine if there is a substance use disorder present. This is very important for determining the treatment plan.&nbsp;</li>
	<li>Individualized treatment planning:&nbsp;Following diagnosis, the clinician and the patient will set out together to develop personalized treatment goals for the substance use disorder. When developing a plan, the clinician and patient should consider all aspects of the individual, which will increase the likelihood of success. During the treatment, the patient and clinician should consistently check in to make any adjustments to the plan. Various factors impact the customization of treatment, including gender, sexual orientation, ethnicity, race, economic status, faith, religion or lack of religion.&nbsp;</li>
	<li>Maintaining treatment engagement and retention:&nbsp;Patients that are open to building a relationship with the clinician show more engagement and retention in treatment programs, and therefore often experience more success with the treatment plan.&nbsp;</li>
	<li>Treatment setting and the continuum of care:&nbsp;Treatment for substance use disorders can be given in hospitals, outpatient settings or in residential facilities, with varying frequencies (daily, weekly, monthly) and types of care provided.&nbsp;<a href="https://www.sharecare.com/health/mental-health-therapies/slideshow/how-to-find-right-therapist">Therapy</a>&nbsp;and rehabilitation for individuals suffering from substance use disorders typically occurs in an outpatient setting, but may also take place in a residential setting for more severe cases.&nbsp;</li>
</ol>

Types of substance use disorder treatment programs&nbsp; 
There are&nbsp;many different ways to treat substance use disorders, as well as&nbsp;<a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/how-choose-addiction-treatment-center">places you can go</a>&nbsp;for help. They include the following.&nbsp;

Medically monitored and managed inpatient care.&nbsp;This intensive service, typically in a hospital, provides treatment 24 hours a day and is necessary for individuals who need medical care, withdrawal management or have mental or physical health conditions, which are sometimes referred to as co-occurring disorders.&nbsp;

Residential services:&nbsp;This 24-hour service provides support outside of a hospital setting and is typically for those who lack an environment that allows for recovery, have relapsed before or have mental or physical health conditions.&nbsp;

Intensive outpatient services:&nbsp;This provides structure for services such as counseling and education and is less restrictive than residential services, typically with options before or after work or on weekends.&nbsp;

Outpatient services:&nbsp;Usually the first level of care for mild substance use disorders or the final step of intense treatment, this service provides behavioral support and medication when necessary.&nbsp;

Speak to a clinician today if you feel you may have a substance use disorder and are ready to begin treatment. After you speak with a clinician, look to join a support group. Support groups are an important way to be successful in treatment, no matter what type of treatment being received.&nbsp;

Medically reviewed in January 2019. Updated in March 2021.&nbsp;

How to Treat Substance Use Disorders

You&rsquo;ve probably heard about opioids in the news, since abuse and overuse of these powerful pain relievers has contributed to a national crisis of addiction and overdose.&nbsp;

And while opioids have the potential to be misused, they are common medicines that can be helpful for relieving short-term pain, like the kind experienced after major surgery. They can also help with pain management for patients at the end stages of a terminal condition such as cancer. The evidence is not good, however, that opioids relieve long-term chronic pain (such as from arthritis, lower back pain or migraine) any better than other standard drug or non-drug therapies.&nbsp;

Safe opioid use&nbsp; 
If you&rsquo;re prescribed opioids, it&rsquo;s crucial to take them only in the amount and duration specified by your healthcare provider (HCP) because the potential downsides to inappropriate use of the drugs are severe. They lead to addiction in up to 25 percent of long-term users, according to some estimates, and are implicated in the overdose deaths of more than 46 Americans each day.&nbsp;

Here are some key things to keep in mind for safe opioid use.&nbsp;

Ask if you really need them at all&nbsp; 
Many experts are concerned that opioids are being prescribed when they&rsquo;re not medically necessary. A study published in September 2018 in the Annals of Internal Medicine found that&nbsp;nearly 30 percent of the time when doctors prescribed opioids, a diagnosis of pain was not included with the prescribing documentation&mdash;and a missing pain diagnosis was even more common in the case of prescription renewals.&nbsp;

Even for patients who do have chronic pain, opioids are usually of limited use. A study published in March 2018 in JAMA found that patients who took opioids for chronic back, knee or hip pain didn&rsquo;t do any better&mdash;and in some cases had worse pain&mdash;than those who took non-opioid pain medications.&nbsp;

While some physicians prescribe opioids for migraines, the American Headache Society recommends that they only be used as a last resort or in cases in which first-line treatments aren&rsquo;t a viable option. The potential downsides to using opioids for headaches are that they can lead to more frequent and severe headaches as well as opioid dependency.&nbsp;

Keep&nbsp;opioids safe from others&nbsp; 
If you are prescribed an opioid, it&rsquo;s important to keep your medication away from anyone in your household who shouldn&rsquo;t be taking them, especially children. Never leave your pills or containers lying around where others can access them. Instead, keep them stowed in a secure, out-of-the-way medicine cabinet, ideally one with a lock. It&rsquo;s also a good idea to count your pills after each use to keep track if any go missing.&nbsp;

Anticipate side effects&nbsp; 
It&rsquo;s critical to speak to your HCP about the potential side&nbsp;effects you&nbsp;may experience while on the drugs&mdash;such as headaches, fogginess, sleepiness, nausea, vomiting and constipation&mdash;so you know what to expect and when to report anything that&rsquo;s out of the ordinary. &nbsp;

Stick to the shortest and lowest dose opioid possible&nbsp; 
Your HCP should prescribe your medication for the shortest course and at the lowest dose she thinks will be effective to treat your pain. The Centers for Disease Control and Prevention (CDC) says that most of the time, you won&rsquo;t need to take opioids for more than three days and that it&rsquo;s rare for people to need them for more than seven.&nbsp;

If you take them longer than that, you have a much higher risk of becoming dependent, according to a 2017 study from the CDC. Only 6 percent of patients taking an opioid prescription for a day or more were still using it a year later, but that number jumped to 13.5 percent for patients using an opioid for eight or more days&mdash;and to nearly 30 percent for those whose first experience taking a prescription opioid ran for 31 days or longer.&nbsp;

If this is your first opioid prescription and you&rsquo;re being treated for acute pain, it&rsquo;s generally recommended that you take immediate-release opioids rather than an extended-release/long-acting (ER/LA) version. ER/LA opioids, which stay in the body longer and are typically stronger, are usually reserved for patients with severe, ongoing pain who have already taken immediate-release opioids for a week or more.&nbsp;

Don&rsquo;t try to adjust your own dose&nbsp; 
If you&rsquo;re taking an opioid and the medication seems to have worn off&mdash;in other words, if you&rsquo;re still in pain&mdash;don&rsquo;t increase your dose. Instead, call your HCP. Taking more than&nbsp;you&rsquo;re&nbsp;prescribed can depress your breathing, setting you on the path toward serious life-threatening complications.&nbsp;

Don&rsquo;t mix opioids with certain meds&nbsp; 
Combining opioids with other drugs&mdash;such as over-the-counter or prescription sleep medications or anti-anxiety medications&mdash;can increase potentially deadly side effects such as depressed breathing. The same is true with alcohol. Always tell your prescribing HCP about all the other medications and supplements you&rsquo;re taking, so they can help make sure you&rsquo;re not setting yourself up for any dangerous drug interactions.&nbsp;

Don&rsquo;t stop cold turkey&nbsp; 
If you&rsquo;ve been prescribed an opioid to deal with acute pain for less than two weeks, you should be able to stop taking the drug when your prescription runs out. But if you&rsquo;ve been taking one for more than two weeks, you may need to stop gradually. Discuss the process of tapering your prescription with your HCP.&nbsp;

When weaning off the drugs, you may experience withdrawal symptoms&mdash;including anxiety, increased pain, trouble sleeping, nausea or rapid heart rate. But most people who do taper off have improved day-to-day function without worse pain. You should be able to stop completely once you&rsquo;ve gotten down to the lowest possible dose less than once a day.&nbsp;

Remember: Only attempt to alter, reduce or stop taking a drug in consultation with your HCP.&nbsp;

Discard leftover pills immediately&nbsp; 
More than 60 percent of Americans prescribed opioids keep the extras around, according to a study published in 2016 in JAMA Internal Medicine. That&rsquo;s a bad idea for several reasons.&nbsp;

For one, you may decide to take a pill when you don&rsquo;t really need it for something outside of your original prescription&mdash;for example, to relieve the pain of a pulled back muscle. Keeping extra pills around also increases the risk that loved ones around you could become addicted. Forty percent of people who misused opioids got them from friends and family members, according to results of a national survey published in 2017 in the Annals of Internal Medicine.&nbsp;

If you have the remainders of an opioid prescription, don&#39;t just toss the pills into the garbage, because they could end up in the wrong hands. You can contact your local police department or trash service to see if they have medicine takeback programs.&nbsp;

If a takeback opportunity is not immediately available, however, the U.S. Food and Drug Administration (FDA) recommends that you flush most opioids down the toilet right away to dispose of them as soon as they&rsquo;re no longer needed. Learn more about safe disposal of medications from the FDA and consult the agency&rsquo;s &ldquo;flush list.&rdquo;&nbsp;

Know the signs of an incorrect dose and overdose&nbsp; 
Overdoses aren&rsquo;t always the result of illicit use (in other words, trying to get high). They are sometimes caused by inadvertent mistakes, such as taking too large a dose, taking it too soon after a previous dose or mixing it with another drug or alcohol.&nbsp;

If after taking your prescription, you feel intoxicated, dizzy, especially groggy or sleepy or are having trouble waking up and staying alert, call your HCP, as these are signs that you may have taken the wrong dose of your medication.&nbsp;

And be on the lookout for any of the following signs of an overdose in a loved one who&rsquo;s taken an opioid:&nbsp;

<ul>
	<li>Loss of consciousness&nbsp;</li>
	<li>Breathing or heartbeat that slows or stops&nbsp;</li>
	<li>Vomiting or gurgling noises&nbsp;</li>
	<li>Limp body&nbsp;</li>
	<li>Pale, clammy skin and/or blue lips or fingernails&nbsp;</li>
	<li>&ldquo;Pinpoint&rdquo; or constricted pupils&nbsp;</li>
</ul>

In these cases, call 911 immediately for emergency help, and administer naloxone if available.&nbsp;

Medically reviewed in November 2018. Updated in March 2021.&nbsp;

9 Keys to Safe Opioid Use

What do Rob Lowe, Nicole Richie and Demi Lovato have in common? They each have struggled with addiction(s) and are now in long-term recovery&mdash;providing inspiring examples of how sustained recovery is possible. That message, <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/what-is-addiction-recovery">recovery</a> can happen, is one of the main points in the 428-page, landmark report on addiction recently released by the Surgeon General.

&ldquo;Facing Addiction in America: The Surgeon General&rsquo;s Report on Alcohol, Drugs, and Health,&rdquo; is the first report on addiction from a Surgeon General and it&rsquo;s meant to change the conversation around this public health issue&mdash;much as the 1964 Surgeon General&rsquo;s Report on Smoking launched a public health attack on smoking, causing rates to progressively decline over the last 52 years. And it comes at an important time.

<ul>
	<li>Seventy-eight people die every day in the U.S. from an opioid (heroin, OxyContin, etc.) overdose.</li>
	<li>Over 66 million Americans (nearly a quarter of all adults and adolescents) report binge drinking in the past month.</li>
	<li>Only one in five people who currently need treatment for opioid-use disorders is actually receiving it. Overall only 1 in 10 people struggling with any addiction receive treatment they require.</li>
</ul>

Addiction: A Treatable Chronic Brain Disease, Not a Moral Failing 
The report stresses that winning the battle against addiction must start with an attitude change. Too many people consider addiction a moral failing, when in reality it&rsquo;s a chronic disease of the brain.

We saw this disconnect when The Dr. Oz Show and Today Show conducted a survey of over 1,000 men this fall. About half said they have friends with addiction problems&mdash;and that people addicted to drugs had poor self-control. This was a vivid example of how, despite current scientific knowledge about treating addiction diseases, so many of you don&rsquo;t yet accept that it is a medical condition.

If you know someone struggling with addiction, it&rsquo;s important to tell them&mdash;and yourself&mdash;&ldquo;It&rsquo;s not something to be ashamed of. It&rsquo;s a disease like any other and it can be treated.&rdquo;

What Goes on in the Brain of an Addict? 
Chronic use of alcohol or drugs makes changes in various brain areas where neurons cluster (basal ganglia), reward perception is processed (extended amygdala), and problem solving, complex thoughts and emotions happen (prefrontal cortex). This alters brain systems influencing learning, stress-response, decision-making, self-control, and pleasure. That&rsquo;s why addiction entices a person to continue using an addictive substance, despite its negative effects on health and wellbeing&mdash;and why relapse can happen long after discontinuing the use of the substance.

What You Can Do to Help 
Keeping the next generation from facing the challenges of addiction is a great place to start! Kids who have good relationships with their parents, live in a safe environment and have honest conversations are less likely to use drugs.

Have Family Dinners: Research shows just sitting down regularly to a family dinner reduces the risk of childhood drug abuse by 50 percent. This is important, because 9 out of 10 people with substance abuse problems started using alcohol or drugs before the age of 18. For every year that the initiation of substance use is delayed, the risk of addiction is decreased. (Kids who use alcohol before the age of 15 are four times more likely to develop an alcohol use disorder later in life than those who have their first drink at age 21 or older.)

Use This Guide: To help you make sure your children feel safe talking with you about alcohol and drugs, the Dr. Oz Show worked with the government&rsquo;s Substance Abuse and Mental Health Services Administration to create a guide, based on the findings of the Surgeon General&rsquo;s report, called &ldquo;Facing Addiction Over Dinner&rdquo;. It takes the leading science on what causes addiction and how to prevent and treat it and puts it into a format that can help you turn this knowledge into action in your own dining room.

Medically reviewed in January 2019.

Redefining Addiction as a Disorder

Substance misuse, or the improper use of a substance that may cause harm, is an important issue that needs to be addressed in the United States. In general, substance misuse typically begins during adolescence, but may begin at any time in an individual&rsquo;s life. If substance misuse becomes a regular occurrence, it may transition to a substance use disorder (or addiction), during which the individual becomes dependent on the substance.

Substance misuse is associated with a variety of poor health outcomes, such as cancer, high blood pressure, heart disease and stroke, along with other problems, such as injuries, violence and crime. Substance misuse is also associated with death when action to prevent substance misuse is not taken soon enough. Drug overdose related specifically to opioid or heroin use caused 29,000 deaths in 2014 alone, many of which could have been avoided if the proper preventative measures had been taken.

It&rsquo;s very important to identify risk factors that could make you or a loved one susceptible to substance use disorders. Once risk factors are identified, it&rsquo;s easier to prevent substance use disorders or recognize them before it&rsquo;s too late. Risk factors for substance use disorders include mental health problems, positive attitudes about substance use, stressful life events, exposure to alcohol or drugs during pregnancy, lack of family discipline, family history of substance use and parental unemployment.

Different kinds of preventative programs are designed to target a variety of ages and demographics. Programs for parents of infants or children focus on reducing risk factors by encouraging healthy relationships between the parent and child. As children get older, the focus of prevention programs shifts to educating adolescents on best practices for refusing substances. Programs for young adults, college students and working adults are focused on educating individuals on the negative health outcomes of alcohol misuse and substance use.

Overall, programs that are specific to each population are the most effective. Every dollar invested in prevention of substance use disorders produces a savings of $2 to $10 related to costs in health care, criminal justice system, educational system and lost productivity. Therefore, recognizing risk factors and selecting the correct program for yourself or for a loved one is extremely important to ensure prevention of a substance use disorder before it happens.

Find the right program for you:

Ages 0-10 
<a href="https://www.nursefamilypartnership.org/" target="_blank">Nurse-Family Partnership</a> 
This program is designed to improve low-income, first-time mothers&rsquo; parenting skills, focusing on those with children less than 5 years old. It has been effective in reducing alcohol use among teens who received this intervention as infants.

<a href="http://goodbehaviorgame.org/" target="_blank">The Good Behavior Game</a> 
This school-based program focuses on behavior management in a 1st and 2nd grade classroom setting and has successfully shown reduced rates of substance use and alcohol use among high-risk populations.

<a href="http://www.blueprintsprograms.com/factsheet/raising-healthy-children" target="_blank">Raising Healthy Children</a> 
This is just one example of the many effective programs that involve both schools and parents to prevent substance misuse. These programs involve social, emotional and behavioral learning and management for children in 1st to 6th grade, and have been shown to reduce alcohol and marijuana misuse at age 18.

<a href="http://fasttrackproject.org/">The Fast Track Program</a> 
This intensive, 10-year long program is specific to children with high aggression in 1st grade and focuses on improving social skills of children through the school setting, home visits and parental support groups. The program has shown decreased alcohol and substance misuse after a 10-year follow up.

These DailyStrength support groups are specific to parents with young children: 
<a href="https://www.dailystrength.org/group/parenting-newborns-infants-0-1" target="_blank">Parenting Newborns &amp; Infants Support Group (Ages 0-1)</a> 
<a href="https://www.dailystrength.org/group/parenting-toddlers-1-3" target="_blank">Parenting Toddlers Support Group (Ages 1-3)</a> 
<a href="https://www.dailystrength.org/group/parenting-preschoolers-3-5" target="_blank">Parenting Preschoolers Support Group (Ages 3-5)</a> 
<a href="https://www.dailystrength.org/group/parenting-big-kids-5-8" target="_blank">Parenting Big Kids Support Group (Ages 5-8)</a>

Ages 10-18 
<a href="http://www.blueprintsprograms.com/factsheet/lifeskills-training-lst" target="_blank">LifeSkills Program</a> 
Implemented over the course of three years, this school-based program focuses on substance refusal through building social, cognitive and emotional skills. This program has been effective in delaying the early use of substances, including alcohol and tobacco.

<a href="http://www.strengtheningfamiliesprogram.org/" target="_blank">Strengthening Families Program: For Parents and Youth 10-14</a> 
This family-based program addresses parents&rsquo; communication and limit-setting skills, as well as children&rsquo;s substance refusal skills, and has reduced use of alcohol, tobacco and drug use, including prescription drug use.

<a href="http://www.copingpower.com/" target="_blank">Coping Power</a> 
Specific to children in 5th and 6th grade, this 16-month long internet-based program targets student who have been exposed to early substance use or have shown aggressive behavior, and has proven to reduce substance misuse.

These DailyStrength support groups are specific to parents with tweens and teens: 
<a href="https://www.dailystrength.org/group/parenting-tweens-9-12" target="_blank">Parenting Tweens Support Group (Ages 9-12)</a> 
<a href="https://www.dailystrength.org/group/parenting-teenagers-12-18" target="_blank">Parenting Teenagers Support Group (Ages 12-18)</a>

Young Adults 
<a href="http://www.blueprintsprograms.com/factsheet/brief-alcohol-screening-and-intervention-for-college-students-basics" target="_blank">Brief Alcohol Screening and Intervention for College Students (BASICS)</a> 
Designed to motivate college students to reduce alcohol consumption through education on the negative consequences, this program provides personalized feedback based on the student&rsquo;s current drinking behaviors. Studies have shown a decrease in alcohol consumption after students completed this program.

<a href="https://www.fairfield.edu/media/fairfielduniversitywebsite/documents/student/lf_healthsafety_parentalcoholhandbook_6-22-15.pdf" target="_blank">Parent Handbook</a> 
This is just one example of the Parent Handbook program, which focuses on educating parents about best practices for speaking with their children about drinking the summer before their child leaves for college. This program has shown a reduction in the chances of their child becoming a heavy drinker.

<a href="http://thehavenatcollege.com/index.html" target="_blank">The Haven at College</a> 
This is a on-campus program for addiction treatment and support that offers a range of services, including a recovery residence, outpatient center, and mentoring and monitoring programs at universities. &nbsp;

Adult Workplaces 
Team Awareness 
This program is implemented in a variety of workplace settings and consists of three 2-hour long sessions, decreasing the rate of heavy drinking among employees.

Medically reviewed in January 2019.

Preventing Drug Addiction Before It Starts

Headlines declaring life expectancy in the U.S. have declined for the first time since 1993 because of deaths from opioids is a major red-flag warning that, as a nation and individually, we need to change our approach to managing pain, taking opioids and addressing illicit drug use.

The CDC reports that, between 2015 and 2016, there was a 28 percent increase in fatal opioid overdoses! In 2016, more than 63,000 Americans died of drug overdose&mdash;and 42,249 of those deaths involved <a href="https://www.sharecare.com/health/central-nervous-system-drugs/what-is-an-opioid">opioids</a>.

To focus the country&rsquo;s healthcare providers on the problem, the FDA asked the National Academies of Sciences, Engineering and Medicine to develop a plan to curb the epidemic. Their report, &ldquo;Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use,&rdquo; is out, as are additional publications, Congressional testimonies and journal editorials based on the findings.

What you need to know about opioid use 
If you or a loved one is dealing with acute, chronic or surgery-related pain, it&rsquo;s important to understand the <a href="https://www.sharecare.com/health/opiate-agonist/what-risks-opioid-pain-medication">risks and benefits of using opioids</a> and to learn about the full range of pain-management alternatives that are available. A study shows that 60 percent of opioid overdose deaths involve people who suffer from chronic pain.

The benefits of opioid use: Severe pain interferes with healing, quality of life and overall health and wellbeing. Opioids can eliminate severe pain and allow you to heal or participate in activities (such as physical therapy) that will help you to alleviate pain.

The risks of opioid use: Unless pain medications are administered within a pain management plan that targets tapering off the drugs as you heal and feel better, it is possible to become addicted even at low doses. (Management of chronic pain associated with end of life is another matter; hospice targets comfort for whatever time remains.)

Steps to take to effectively manage your pain:

<ol>
	<li>If opioids are the right medication for your pain control, ask your physician to refer you to a pain-management specialist who will guide you through your medication regimen and protect you from addiction.</li>
	<li>Be conscientious about physical therapy, changing your diet to decrease pain/inflammation, adding stress management and other at-home activities when prescribed. It may seem counter-intuitive that the strain (and sometimes pain) of physical therapy, along with diet and meditation, can ease chronic pain, but it can!</li>
	<li>Ask your doctor about taking non-opioid analgesics, including ibuprofen and prescription NSAIDs like celecoxib (Celebrex) and indomethacin (Indocin). A study in JAMA found that for &ldquo;patients presenting to the ED [emergency department] with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at two hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics.&rdquo; Why does this matter? It has been reported that nearly 19 percent of people leave EDs with an opioid prescription&mdash;and even short-term use can trigger dependence. We suggest that, even for persistent pain, some <a href="https://www.sharecare.com/health/pain-treatment/article/opioid-free-ways-beat-pain">NSAIDs are more or less equivalent in effectiveness to low-dose opioids</a>.</li>
	<li>Explore medical massage to ease distress. Consider trying acupuncture, pain management group therapy, gentle stretching, water therapy or exercises such as tai chi or yoga (if the doc says they&rsquo;re okay).</li>
</ol>

What the government needs to do 

<ol>
	<li>Make sure pain management therapies that do NOT rely on drugs are covered by insurance. Insurance companies are more likely to cover an oxycodone prescription than acupuncture treatments.</li>
	<li>Adopt a wide-ranging public health perspective that targets both prescription pain medication abuse and heroin/fentanyl abuse. And institute evidence-based guidelines for allowing opioid prescriptions. One study found that, post-surgery, 43 percent of opioid prescriptions were not necessary for patients&rsquo; wellbeing.</li>
	<li>Make sure that an overdose medication such as naloxone is widely available to EMTs, healthcare facilities, etc.</li>
</ol>

Medically reviewed in January 2021.

Managing Your Pain to Protect From Opioid Addiction

Millions of Americans have developed addictions to prescription opioid painkillers in recent years, and hundreds of thousands more have become addicted to heroin. People with this drug addiction could be your neighbor, your friend or even a close family member.&nbsp;

The first step to helping someone is recognizing there&rsquo;s a problem. Here&rsquo;s how to&nbsp;spot the&nbsp;signs of opioid use&nbsp;before it&rsquo;s too late.&nbsp;

Signs of&nbsp;opioid&nbsp;intoxication&nbsp; 
When someone takes opioids, molecules of the drug attach to sections of cells called opioid receptors. This serves to block pain a person is experiencing, but it also creates a pleasurable sensation of euphoria and can even affect breathing. Here&rsquo;s what to look for if you suspect someone is high on opioids.&nbsp;

<ul>
	<li>Drowsiness&nbsp;</li>
	<li>Euphoria&nbsp;</li>
	<li>Constricted pupils&nbsp;</li>
	<li>Confusion&nbsp;</li>
	<li>Flushing and itching&nbsp;</li>
	<li>Nausea, vomiting&nbsp;</li>
	<li>Low blood pressure&nbsp;</li>
	<li>Slow heart rate&nbsp;</li>
	<li>Slow and shallow breathing&nbsp;</li>
</ul>

If a person has overdosed and has stopped breathing, a drug called naloxone can reverse the overdose and help the person start breathing again. The naloxone replaces the opioid attached to opioid receptors, so the person begins breathing again and goes into withdrawal almost instantly.&nbsp;

How to spot withdrawal symptoms&nbsp; 
Withdrawal from opioids is so uncomfortable that many people will go to extreme lengths to get another hit. Withdrawal can start as early as four hours after the last dose and will subside after about a week. Though uncomfortable, withdrawal is not fatal.&nbsp;

While an opioid high causes constipation and the pupils to constrict, withdrawal reverses those two symptoms, causing diarrhea and dilated pupils. Anxiety and agitation are common, as are muscle aches, a runny nose, insomnia and sweating. Nausea, vomiting and abdominal cramps are considered late-stage symptoms of withdrawal.&nbsp;

Methadone, naltrexone and buprenorphine are all opioid medications that are often used to ease withdrawal symptoms. Speak to a healthcare provider about being prescribed one of these or other medications if you&rsquo;re serious about quitting.&nbsp;

An addicted mind&nbsp; 
Every person with this addiction is different and these behaviors are far from universal. But if someone is dependent on opioids&mdash;or anything else&mdash;and possibly trying to hide that addiction, there are some patterns and thought processes to look for, like loss of self-control, risky sexual behavior, or theft and other criminal acts.&nbsp;

Addiction to an illegal substance becomes an obsession. The life of someone who is addicted to opioids revolves around getting their next opioid fix. Other priorities, even important things like family and work, matter less to someone in the grip of addiction. People with an opioid addiction will compulsively seek out their drugs, even if they don&rsquo;t want to and even though they know the risks and harm.&nbsp;

Deception is another part of the problem. People trying to hide opioid&nbsp;use&nbsp;will often lie about where they&rsquo;re going and what they&rsquo;re doing; they may ask for money under false pretenses; they may sell belongings to finance their addiction. If the money runs out, they may turn to criminal means, like theft of money or goods to sell.&nbsp;

You can&rsquo;t make someone quit; that person has to&nbsp;get help for an opioid addiction&nbsp;on his or her own. What you can do is support your loved one without enabling him or her. You can help monitor the person&rsquo;s health, be a source of stability and try to keep him or her busy and provide a purpose. &nbsp;

Medically reviewed in January 2019. Updated in March 2021.&nbsp;

Know the Signs of Opioid Use and Addiction

When Hofstra University&rsquo;s departments of Earth Sciences and Geology helped put together a teaching guide for GeoTeach to sort out the facts from science fiction in the Jurassic Park movies, they acknowledged that the filmmakers got many things right&mdash;and a few facts wrong. For example, a Pteranodon, the name itself means &ldquo;wings with no teeth,&rdquo; couldn&rsquo;t have swooped down, teeth bared, and plucked a 12-year-old boy off the ground and flown away!

It was also a mistake when The Center for Science in the Public Interest (CSPI) stated they included kratom in their investigation titled &ldquo;Crackdown Urged on Supplements Marketed as Opioid Withdrawal Aids.&rdquo; Their study specifically excluded kratom, the <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/what-is-an-opioid">opioid</a> substitute that&rsquo;s also being touted on the Internet as a healthy alternative. This product was the target of an FDA warning to consumers. To set the record straight: kratom was not part of the CSPI investigation.

What CSPI did urge authorities to crack down on were companies who produce products such as Mitadone Anti Opiate Aid Plus, Opiate Detox Pro and TaperAid Complete.&nbsp;Both CSPI and the FDA stress that there are three approved FDA medically-assisted treatments for <a href="https://www.sharecare.com/health/opiate-agonist/how-prevent-opioid-medication-withdrawal">opioid addiction withdrawal</a>: methadone, buprenorphine and naltrexone. These are treatments consumers can depend on.

Consider this our &ldquo;Redactyl&rdquo; to our Pteranodon. We look forward to the continued good work the Center for Science in the Public Interest accomplishes year in and year out.

The Truth Behind Kratom, Touted Opioid Alternative

Opioids are powerful and addictive painkillers that can create a sense of euphoria&mdash;and stop your breathing&mdash;and their abuse is on the rise.

According to a preliminary report released by the Centers for Disease Control and Prevention in August 2018, an estimated 72,000 Americans died as a result of a drug overdose in 2017 (more than 49,000 of which were caused by opioids).&nbsp;This represents a significant increase from the 62,632 drug overdose deaths reported in 2016 (of which more than 42,000 were caused by opioids).&nbsp;

These climbing numbers have public health experts alarmed.&nbsp;

The changing crisis 
In years past, the <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/anatomy-opioid-addiction">opioid epidemic</a> was dominated by heroin and prescription medications, but other drugs have crept in. Dealers are mixing powerful and dangerous new compounds, such as fentanyl, with heroin in a quest for greater profit.

&ldquo;Heroin and prescription opioids, those are the base elements. What&rsquo;s changed is what they&rsquo;re mixed with,&rdquo; says Mark Cardillo, LCSW, behavioral health program director at <a href="https://www.sharecare.com/group/tampa-community-hospital">Tampa Community Hospital</a> and its addiction recovery center in Tampa, Florida. &ldquo;That can change rapidly based on what&rsquo;s available to the dealers and what they can concoct. A lot of time they&rsquo;re doing it to stay one step ahead of the Drug Enforcement Administration (DEA).&rdquo;

Here&rsquo;s what you need to know about the potent, dangerous new opioids being mixed with heroin and sold on the black market.

Stronger and deadlier 
Chris Green, a police officer in East Liverpool, Ohio, had just returned to his station after a traffic-stop-turned-drug-bust in May 2017 when a fellow officer noticed some white powder on Green&rsquo;s shirt. Green brushed it off with his hand and soon fell ill, slurring his speech and finally, collapsing. That powder was fentanyl, an opioid estimated to be 50 to 100 times more potent than morphine. (Green made a full recovery.)&nbsp;

Clinically, fentanyl is used to treat severe or post-surgical pain, and usually comes as a lozenge, skin patch or injection. But, according to Cardillo, when you mix it with heroin, you get a product that&rsquo;s up to 50 times stronger than heroin alone&mdash;and less expensive.

&ldquo;If you&rsquo;re mixing fentanyl with heroin, profits go up and costs go down,&rdquo; says Cardillo. &ldquo;A kilogram of fentanyl costs $4,000 to $5,000 but on the street you can profit $1.4 or $1.5 million. If you&rsquo;re diluting your heroin with it but still calling it heroin, it costs less for you to make and you make more money.&rdquo; Dealers are starting to realize that fact; law enforcement encounters with fentanyl jumped from 5,343 in 2014 to 13,882 in 2015.

Fentanyl is increasingly being combined with cocaine, as well, though it&#39;s not clear whether the mixing is intentional&mdash;for &quot;speedballing&quot; purposes&mdash;or accidental. While it&#39;s believed the vast majority of cocaine does not contain the opioid, overdose deaths involving a blend of the two drugs have risen in certain areas. In Connecticut in 2012, for instance, a mix of cocaine and fentanyl factored into two deaths. Five years later, in 2017, the combination caused 220 deaths.

For some dealers, 50 times stronger is not strong enough. Carfentanil is one of the newer substances found mixed with heroin at the scene of overdoses. It&rsquo;s chemically similar to fentanyl&mdash;but about 100 times stronger&mdash;and is the strongest commercially used opioid. It&rsquo;s too powerful for humans; instead, it&rsquo;s typically used as a tranquilizer for elephants and other large mammals.

What else is out there? 
Fentanyl and carfentanil get a lot of press, but there are lesser-known and equally deadly additives out there. U47700, also known as &quot;pink,&quot; is one. The DEA classified it as a Schedule I drug in 2016, which means it has a high potential for abuse, no medical treatment and no safety protocols. Like fentanyl and carfentanil, it&rsquo;s sometimes mixed in with heroin in order to give dealers and their customers more bang for the buck.

Finally, there&#39;s gray death. Sometimes found in concrete-like chunks, it&rsquo;s usually a combination of heroin, fentanyl, carfentanil and U47700. &ldquo;Even touching the stuff can cause people problems,&rdquo; says Cardillo. &ldquo;The biggest problem with gray death is you have to use three or four times the amount of <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/drug-that-reverses-heroin-overdose">naloxone</a> to bring someone back. That&rsquo;s how potent it is.&rdquo; Naloxone, or Narcan, is a drug used to stop overdoses by blocking the effects of opioids, triggering instant withdrawal and jump-starting breathing.

Naloxone, or Narcan, is a drug used to stop overdoses by blocking the effects of opioids, triggering instant withdrawal and jump-starting breathing. It&#39;s often used by emergency personnel, though everyday Americans increasingly have it on hand. In April 2018, the Surgeon General issued an advisory asking more people to keep naloxone around, especially if they&#39;re currently taking opioids or are at high risk of coming into contact with people who may overdose.

From the lab to the street 
Fentanyl and carfentanil can be purchased on the black market in the US or online from overseas distributors. &ldquo;A lot is produced in China,&rdquo; says Cardillo, &ldquo;but China has stepped up a little in terms of what they&rsquo;re outlawing.&rdquo; The country banned carfentanil in March 2017. &ldquo;Mexico is where most operations have moved,&rdquo; says Cardillo. &ldquo;The cartels can be pretty sophisticated in how they produce drugs. They can create labs.&rdquo;

This mix of cheap overseas and illicit stateside production helps dealers stretch their batches of heroin, reaching more people. As a result, more become addicted, more develop a tolerance to ever-more-potent synthetics, and more die. Between 2015 and 2016, overdose deaths from synthetic opioids more than doubled from 9,580 to 19,413.

&ldquo;The synthetic opioids are supposed to create a more intense, long-lasting high, but there are a lot of risks,&rdquo; says Cardillo. &quot;To get into an addict&rsquo;s mind, figure out why they&rsquo;re willing to take it, that&rsquo;s tough. Their <a href="https://www.sharecare.com/health/substance-abuse-addiction-recovery/article/why-addicts-relapse-how-to-help">brain chemistry changes</a> and they&rsquo;re not thinking of the consequences.&rdquo;&nbsp;

One of the biggest tragedies is that opioid users aren&rsquo;t necessarily even looking for these synthetics. &ldquo;I&rsquo;m not positive that they even know what&rsquo;s in there,&rdquo; says Cardillo.

Fortunately, authorities are responding. The DEA has distributed warnings about fentanyl, carfentanil and other synthetics to law enforcement officers around the country, and the National Institute on Drug Abuse is working on a more effective national response for health officials, law enforcement, and people who are addicted. If you or someone you love has a problem with opioids, contact the Substance Abuse and Mental Health Services&rsquo; national helpline at 800-662-HELP.

Medically reviewed in January 2019.

The Next Wave of the Opioid Epidemic

In this video, Dr. Oz discusses who is at risk for opioid addiction, how to recognize the symptoms of opioid addiction and why you need to work with your healthcare provider to develop an individualized treatment plan.

Medically reviewed in February 2021.

Addiction Recovery