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Opioid Overdose

Opioid overdose is a growing concern in the United States. The number of fatal overdoses has been increasing significantly, primarily fueled by synthetic opioids such as fentanyl.1 Statistics on opioid overdose in the United States show that as of 2020:

  • Overdose deaths in the United States are increasing each year.1, 2, 3
  • There were nearly 92,000 deaths from overdose in 2020 and of these, 68,630 involved opioids.3
  • There were 56,516 deaths associated with synthetic opioids, not including methadone.3
  • There were 16,416 deaths from prescription opioids.3
  • There were 13,165 deaths associated with heroin, and nearly 70% of these also include a synthetic opioid, typically fentanyl.3

If you or a loved one struggles with opioid misuse, it’s important to understand the risks of opioid overdose and what to do if someone is experiencing an overdose. This page will discuss:

  • What happens when you overdose on opioids.
  • What causes an opioid overdose.
  • How to identify an overdose.
  • Risk factors that increase the likelihood of overdose.
  • What to do if someone is overdosing on opioids.
  • How to prevent opioid overdose.

What Are Opioids?

Opioids are a diverse class of drugs that are derived from the opium poppy.4 These drugs reduce pain and promote relaxation.4

Prescription opioids are prescribed by a medical doctor to treat pain, such as from injuries, surgery, cancer, dental work, or chronic pain, and to manage coughing or diarrhea.4 However, these drugs are commonly misused for their euphoric effects.1, 5 Heroin and illicitly manufactured fentanyl are illegal opioids sold on the streets.

Opioids are further divided into three categories: natural, synthetic, and semi-synthetic. Natural opioids are derived from plant materials, synthetic opioids are man-made, mimicking the effects of natural opioids, and semi-synthetic opioids are a combination of naturally derived and man-made compounds.4 The most commonly encountered opioids include:1, 4

  • Codeine.
  • Buprenorphine (Suboxone).
  • Fentanyl.
  • Heroin.
  • Hydrocodone (Vicodin).
  • Methadone.
  • Morphine.
  • Oxycodone (OxyContin, Percocet).
  • Tramadol.

In addition to the risk of overdose, misusing opioids can cause physiological dependence and lead to addiction.1, 4 An overdose on opioids can cause permanent damage to the brain, coma, or death.1, 4

What is an Opioid Overdose?

An opioid overdose is when enough opioids are taken to overwhelm the system, and side effects become dangerous or potentially fatal.4, 6 Overdose can occur anytime to anyone who is prescribed opioids or who uses or misuses opioids or takes illicit opioids. The risk of overdose increases as a person takes higher doses of opioids, combines opioids with other substances, or if the opioids are laced with other substances, such as fentanyl.5

Since opioids affect the part of the brain that controls breathing, one of the most common issues associated with overdose is depressed breathing. When breathing is significantly slowed or stopped, the loss of oxygen to the brain can cause hypoxia, which can lead to irreversible brain damage, coma, and death.1, 4, 6

What Causes an Opioid Overdose?

An opioid overdose can be caused by several factors, either singularly or in combination. Some of the most common reasons for opioid overdose include:

  • Misusing opioids. This means taking them more often or in larger amounts than prescribed, taking opioids that aren’t prescribed to you, using them in a different way than intended, such as crushing and snorting pills or injecting them, or taking them simply to get high.4, 7
  • Accidental misuse. This means forgetting that a dose was taken and taking another one.7
  • Combining opioids with other substances, especially depressants, such as alcohol, benzodiazepines, sleep aids, or other sedatives.6, 7
  • Taking opioids that are cut with stronger opioids, such as fentanyl or heroin, or illicitly sold prescription opioids.6

Signs of an Opioid Overdose

Opioid overdose can be identified and treated if you know what to look for and get help early.8 There are some warning signs that someone may be overdosing on opioids to be aware of. These include:

  • Extremely small, pinpoint-sized pupils.1, 6
  • Loss of consciousness, or inability to wake the person.1, 5
  • Trouble breathing, including breathing that is slow, shallow, labored, or has stopped.1, 5
  • Choking or gurgling noises.5, 6
  • Limp body.7
  • Blue or purple lips, skin, and/or fingernails.5, 6
  • Pulse that is very slow or has stopped.5, 7
  • Skin that is pale and/or clammy.5, 8
  • Vomiting.7

The first three are important to remember because they are known as the opioid overdose triad. When you see these three symptoms, it is likely someone has overdosed on opioids: pinpoint pupils, respiratory depression, and a decreased level of consciousness (where the person can’t be awakened by speaking to them or by applying painful stimuli, such as moving your fist in a grinding motion across the person’s chest).12

Risks Factors for an Opioid Overdose

An opioid overdose can happen to anyone who takes opioids, but there are some factors that can increase the likelihood of an overdose. These risk factors include:

  • Combining opioids with alcohol, other prescribed medications, or illicit drugs. Taking opioids when you also take other depressants, such as alcohol, sedatives, muscle relaxers, other opioids, or benzodiazepines, can increase the effects of each substance and significantly raise the risk of overdose, and make it more likely to be fatal.1, 9 Using opioids with stimulants, such as Adderall, cocaine, or crystal meth can also increase the risk of physical harm and overdose.10
  • Gender. Males are statistically more likely to overdose than females.1
  • Increased age. Older adults (65 or older) are more likely to experience an overdose than young people because they often have other health issues and take multiple medications, as well as a decrease in how effectively the metabolism clears medications from the system.4
  • Misusing prescription opioids. This can include taking them differently than prescribed, using them when they aren’t prescribed or monitored by a medical professional, or ingesting them differently than intended, which can make an overdose more likely to occur.1, 9
  • Presence of other health conditions, including mental health and physical health problems.1 People who have breathing issues or problems with their liver or kidneys are at much greater risk for overdose.9 Heart issues, an impaired immune system, or malnutrition can also raise the risk for overdose.10
  • Previous history of overdose. People who have survived a prior overdose are more likely to experience another overdose.10
  • Taking large amounts of opioids, whether they are illicit or prescribed, can increase the risk of overdose.1, 9
  • The way in which the opioid is taken. People who inject opioids are more likely to overdose.1
  • The presence of an opioid use disorder (OUD). If you have an addiction to opioids, you are more likely to experience an overdose.1
  • Using illicit opioids. Since these aren’t regulated and controlled, they can include (or be “cut with”) other substances, such as fentanyl, which is much stronger than other opioids.9 The purity and potency of illicit opioids, and any cutting agents, can vary widely.10
  • Using opioids after a period of abstinence. After a person stops the regular or daily use of opioids, their tolerance is reduced, which means that taking the same amount they used to could increase the effects, leading to a greater risk of overdose.1, 10

How to Respond to an Opioid Overdose

An opioid overdose is a medical emergency. Prompt care and treatment can potentially save a person’s life. If someone is overdosing (pinpoint pupils, nonresponsive, slow, shallow, or stopped breathing), here are some steps to take:

  • Call 911. This should be the first thing that you do. The operator can get professional assistance to you and direct you through any other steps you can take.4, 6 Be honest with the operator if you know what the person has been using.
  • If you have access to naloxone, administer it. This medication can temporarily reverse the effects of any opioids that are in the system.8 If the person isn’t overdosing on opioids, it won’t harm the person, but it could save their life if they are overdosing on opioids.1, 8 Naloxone is available as an intramuscular injection or a nasal spray (Narcan, Kloxxado), and can be obtained without a prescription in most states.1, 4 If there is no response after one dose, you can administer a second dose after 2 to 3 minutes.5 However, be aware that the effects of naloxone may wear off before the effects of opioids will. A person needs to receive professional monitoring and medical care after an overdose to ensure they are stable and that they don’t continue to have overdose symptoms.5
  • If the person is awake, try your best to keep them awake.9 If they aren’t awake, roll the person onto their side so that they do not choke.9
  • Try to keep the person breathing.5 If they are not breathing, you may have to perform rescue breathing, and the 911 operator can help direct you as needed.5
  • Stay with the person until first responders arrive.9

Opioid Overdose Prevention

If you or someone you care about are at risk for overdosing on opioids, attending training on how to identify an overdose early, as well as carrying and learning to use naloxone can be especially beneficial.5

Ensuring that someone else is present when you use naloxone can allow you to receive prompt care in the event of an overdose.10 However, the most effective means of overdose prevention is to avoid using opioids. If you have difficulty stopping on your own, attending a treatment program can help you stop using, avoid overdose, and improve the quality of your life.8

An opioid use disorder (the diagnostic term for opioid addiction) is a complex condition that affects the body, brain, and behavior.11 It is characterized by the uncontrollable and compulsive use of opioids despite significant negative consequences. While addiction can’t be cured, it can be treated effectively.11

Opioid use disorder is typically treated through a combination of behavioral therapy and medication.4 OUD treatment may include one or more of the following types of treatment:

  • Detox is typically the first phase of treatment and can occur in a variety of settings depending on a person’s needs.11 Medications such as methadone and buprenorphine are available to assist with the difficult withdrawal process by eliminating or lessening cravings and other symptoms of withdrawal.11
  • Inpatient treatment typically involves several treatment interventions like detox, behavioral therapy, medication, support groups, and amenities. People stay in the facility for the duration of treatment.
  • Outpatient treatment allows you to live at home and participate in your regular responsibilities while receiving scheduled treatment appointments in both group and individual counseling sessions at a treatment center or other facility. Outpatient treatment programs can vary in intensity depending on your needs.11
  • Treatment medications: There are medications available to assist with recovery from OUD. These prescribed medications include methadone, buprenorphine, and naltrexone, and can help reduce cravings, the risk of relapse, and the risk of overdose.4, 11 Although medication alone is beneficial, it is typically combined with behavioral therapy to impact a person’s recovery more positively.11
  • Behavioral therapy: Since addiction can cause changes in how the brain works, it is important for behavioral therapies to address motivation, learned behaviors, impulse control, and the way you think.11 These treatments, including cognitive-behavioral therapy (CBT) and contingency management (CM), are generally provided in individual and/or group therapy formats. They are designed to help you stay motivated toward recovery, recognize and change thoughts and behaviors that lead to drug use, manage stressors, improve relationships with others, change unhealthy patterns of thought, and reduce the risk of relapse.11