25% of all overdoses are from heroin

By Nadia Kounang, CNN

Updated 1906 GMT (0306 HKT) February 24, 2017

Prescription and illegal opioids are commonly abused because they are so addictive. <br /><br />Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain's reward areas and producing an intense feeling of euphoria.<br /><br />As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

Photos: Opioids: Addictive painkillers

Prescription and illegal opioids are commonly abused because they are so addictive.

Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain's reward areas and producing an intense feeling of euphoria.

As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

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Oxymorphone hydrochloride, under the name Opana ER, was at the center of an HIV outbreak in Indiana in 2015. Some addicts began injecting and shared needles increased the spread of HIV.<br /><br />In June, the Food and Drug Administration requested that Opana ER manufacturer Endo Pharmaceuticals pull the drug from the market. It was the first time the agency has asked that a opioid pain medication be pulled "due to the public health consequences of abuse." Endo announced in July that it would pull the drug.

Photos: Opioids: Addictive painkillers

Oxymorphone hydrochloride – Oxymorphone hydrochloride, under the name Opana ER, was at the center of an HIV outbreak in Indiana in 2015. Some addicts began injecting and shared needles increased the spread of HIV.

In June, the Food and Drug Administration requested that Opana ER manufacturer Endo Pharmaceuticals pull the drug from the market. It was the first time the agency has asked that a opioid pain medication be pulled "due to the public health consequences of abuse." Endo announced in July that it would pull the drug.

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Codeine is one of the weakest opioids, often given when painkillers such as acetaminophen or ibuprofen fail to work. Because it decreases activity in the part of the brain that controls coughing, it's frequently mixed with other liquids to develop cough syrups for colds and flu. It has frequently been used for pain relief after removal of tonsils and adenoids in children. <br /><br />After an investigation, the FDA restricted the use of codeine and tramadol in children under 12 and recommend against their use in children between 12 and 18 years of age. Additionally, the FDA has warned breastfeeding mothers not to take these medications due to the risk of serious adverse reactions in breastfed infants.

Photos: Opioids: Addictive painkillers

Codeine – Codeine is one of the weakest opioids, often given when painkillers such as acetaminophen or ibuprofen fail to work. Because it decreases activity in the part of the brain that controls coughing, it's frequently mixed with other liquids to develop cough syrups for colds and flu. It has frequently been used for pain relief after removal of tonsils and adenoids in children.

After an investigation, the FDA restricted the use of codeine and tramadol in children under 12 and recommend against their use in children between 12 and 18 years of age. Additionally, the FDA has warned breastfeeding mothers not to take these medications due to the risk of serious adverse reactions in breastfed infants.

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You can't get heroin by prescription, but many heroin users start off abusing prescription opioids, then turn to this illegal opioid.<br /><br />CNN's Chief Medical Correspondent Dr. Sanjay Gupta <a href="http://www.cnn.com/2014/08/29/health/gupta-unintended-consequences/">has reported on recent research </a>that shows today's typical heroin addict starts using at 23, is more likely to live in affluent suburbs and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor.<br /><br /><a href="http://www.cdc.gov/drugoverdose/" target="_blank">According to the CDC</a>, deaths from overdoses of prescription drugs and heroin continue to be the leading cause of unintentional death for Americans, rising 14% from 2013 to 2014.

Photos: Opioids: Addictive painkillers

Heroin – You can't get heroin by prescription, but many heroin users start off abusing prescription opioids, then turn to this illegal opioid.

CNN's Chief Medical Correspondent Dr. Sanjay Gupta has reported on recent research that shows today's typical heroin addict starts using at 23, is more likely to live in affluent suburbs and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor.

According to the CDC, deaths from overdoses of prescription drugs and heroin continue to be the leading cause of unintentional death for Americans, rising 14% from 2013 to 2014.

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Fentanyl citrate, pictured here, is a Class II controlled substance and one of the most powerful opioids on the market. It's often administered via injection or transdermal patch, or in lozenge form for pain after surgery, for difficult-to-manage chronic pain and for people who have developed a tolerance to other opioids. <br /><br />The type of fentanyl usually associated with overdoses is bought on the street in powder or pill form and is often mixed with heroin in a clandestine lab to increase the high it produces. Street names include Apache, China girl, goodfella, jackpot, murder 8, TNT and Tango and Cash.

Photos: Opioids: Addictive painkillers

Fentanyl – Fentanyl citrate, pictured here, is a Class II controlled substance and one of the most powerful opioids on the market. It's often administered via injection or transdermal patch, or in lozenge form for pain after surgery, for difficult-to-manage chronic pain and for people who have developed a tolerance to other opioids.

The type of fentanyl usually associated with overdoses is bought on the street in powder or pill form and is often mixed with heroin in a clandestine lab to increase the high it produces. Street names include Apache, China girl, goodfella, jackpot, murder 8, TNT and Tango and Cash.

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These pills are a more powerful form of codeine, called hydrocodone, and are often mixed with acetaminophen. Hydrocodone is the most frequently prescribed opioid painkiller, <a href="http://www.dea.gov/druginfo/drug_data_sheets/Hydrocodone.pdf" target="_blank">according to the U.S. Food and Drug Administration</a>, and the most abused. An overdose of hydrocodone can cause "cold and clammy skin, severely constricted pupils, and slow breathing that can lead to a loss of consciousness and death."

Photos: Opioids: Addictive painkillers

Hydrocodone – These pills are a more powerful form of codeine, called hydrocodone, and are often mixed with acetaminophen. Hydrocodone is the most frequently prescribed opioid painkiller, according to the U.S. Food and Drug Administration, and the most abused. An overdose of hydrocodone can cause "cold and clammy skin, severely constricted pupils, and slow breathing that can lead to a loss of consciousness and death."

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Oxycodone is a powerful narcotic pain reliever prescribed for moderate to high pain relief. It's often given in an extended-release formula for patients who will need to be on pain medications for long periods of time.<br /><br />Patients are warned not to break, chew, crush or dissolve extended-release tablets because the rush of oxycodone into the system could cause serious health problems, including overdose and death.<br /><br />Though highly addictive, oxycodone is not thought to be as frequently abused as hydrocodone. OxyContin, Percocet, Percodan and Tylox are some trade-name oxycodone products.

Photos: Opioids: Addictive painkillers

Oxycodone – Oxycodone is a powerful narcotic pain reliever prescribed for moderate to high pain relief. It's often given in an extended-release formula for patients who will need to be on pain medications for long periods of time.

Patients are warned not to break, chew, crush or dissolve extended-release tablets because the rush of oxycodone into the system could cause serious health problems, including overdose and death.

Though highly addictive, oxycodone is not thought to be as frequently abused as hydrocodone. OxyContin, Percocet, Percodan and Tylox are some trade-name oxycodone products.

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Morphine is another powerful opioid often administered via syringe for severe pain. It can come in pill form, usually as extended-release tablets and capsules, and is prescribed only to relieve difficult, chronic pain that cannot be controlled by the use of other pain medications.<br /><br />As with most opioids, mixing medications, drinking alcohol or taking other meds that contain alcohol, or using street drugs while taking morphine, increases the risk of breathing problems or other serious, life-threatening side effects.

Photos: Opioids: Addictive painkillers

Morphine – Morphine is another powerful opioid often administered via syringe for severe pain. It can come in pill form, usually as extended-release tablets and capsules, and is prescribed only to relieve difficult, chronic pain that cannot be controlled by the use of other pain medications.

As with most opioids, mixing medications, drinking alcohol or taking other meds that contain alcohol, or using street drugs while taking morphine, increases the risk of breathing problems or other serious, life-threatening side effects.

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Photos: Opioids: Addictive painkillers

Meperidine – Meperidine is another narcotic analgesic, similar to morphine. It's often used to help put people to sleep before an operation and to provide pain relief after childbirth.

The most common brand name is Demerol, which comes in both tablet and liquid forms. It is usually taken with or without food every three or four hours as needed for pain.

As with all opioids, meperidine can cause drowsiness, so never drive a car or operate machinery after taking it until you know how you will react.

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Photos: Opioids: Addictive painkillers

Hydromorphone – Hydromorphone is another highly potent prescription painkiller. It's most commonly known by the brand names Dilaudid, pictured here, and Exalgo.

Liquid hydromorphone holds the dubious honor of being frequently mistaken for morphine in hospital "wrong drug" medication errors because of the similarity of the names and appearances.

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Though methadone is used to relieve severe chronic pain, it's most commonly known for preventing withdrawal symptoms in patients who were addicted to opioid drugs, as a part of their recovery process.<br /><br />Methadone has many of the same side effects as other opioids, including weakness, headache, nausea and vomiting, stomach pain, sweating, difficulty urinating, mood changes and vision problems, and difficulty falling asleep or staying asleep.

Photos: Opioids: Addictive painkillers

Methadone – Though methadone is used to relieve severe chronic pain, it's most commonly known for preventing withdrawal symptoms in patients who were addicted to opioid drugs, as a part of their recovery process.

Methadone has many of the same side effects as other opioids, including weakness, headache, nausea and vomiting, stomach pain, sweating, difficulty urinating, mood changes and vision problems, and difficulty falling asleep or staying asleep.

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Photos: Opioids: Addictive painkillers

Buprenorphine – Buprenorphine is a opioid used as an alternative to methadone to help addicts recovering from heroin use. Buprenorphine is different from other opioids because it's a "partial opioid agonist," which means that when taken in proper prescribed doses, it should produce less euphoria and physical dependence, and therefore a lower potential for misuse. It's also supposed to have a relatively mild withdrawal profile.

However, if abused by crushing and snorting or injecting, it can suppress breathing and cause dizziness, confusion, unconsciousness and death.

Subutex, the brand name for buprenorphine, is taken as a tablet placed under the tongue and allowed to dissolve.

The brand Suboxone is a combination of buprenorphine and naloxone, an opioid antagonist. Antagonists block the opiate receptors in the brain, keeping the narcotic from creating the high abusers crave.

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08 demerol100mg-dea dangerous painkillers

Story highlights

One in four overdoses in 2015 involved heroin, CDC numbers show
The rate of heroin involved overdoses tripled from 1999 to 2015

(CNN)America's opioid epidemic continues: The latest numbers from the Centers of Disease Control and Prevention, released Friday, show that one in four drug overdoses in 2015 was related to heroin. In 1999, just 6% of all overdoses were related to the drug.

When looking at overdoses overall, opioid-related deaths represented the majority. In 2015, overdoses involving opioids represented 60% of all overdose deaths, a significant jump from about 50% in 2010. Opioids include heroin as well as drugs with a similar chemical structure, such as oxycodone and illicit synthetics like fentanyl.

Dr. Holly Hedegaard of the National Center for Health Statistics, who co-authored the study, also noted that this was the first time the number of overdose deaths in the United States exceeded 50,000. In 2010, there were 38,329 overdose-related deaths, and by 2015, that number had climbed to 52,404. By comparison, in 2015, there were 36,252 total firearm-related deaths across the country.

As with heroin, there was also a significant increase in deaths involving synthetic opioids such as fentanyl, the drug that was blamed for pop star Prince's death. In 2010, these types of drugs were involved in just 8% of all overdose deaths, and by 2015, they were involved in 18% of all overdose deaths.

While there were increases in heroin and synthetic drug-related deaths, there was a drop in overdose deaths involving natural and semisynthetic opioid analgesics, including prescription drugs like oxycodone and hydrocodone. Although these drugs were involved in 29% of drug overdose deaths in 2010, they represented 24% of all drug overdose deaths in 2015.

China's fentanyl ban a 'game-changer' for opioid epidemic, DEA officials say

This shift in numbers may in part be due to a change in user habits, with some starting out with prescription drugs and moving on to heroin because of cost and crackdowns on illegal use of prescription drugs. However, Dr. Andrew Kolodny, co-director of Brandeis University's Opioid Policy Research Center, said that switching is only part of the story.

"Starting in 2011, overdoses involving heroin has really skyrocketed. There's a really good chance the increase involving heroin has to be involved with fentanyl," he said.

Search for solutions

In an attempt to stem the tide of opioid-involved deaths, state and federal governments have implemented new laws and regulations directed at the epidemic. This month, New Jersey Gov. Chris Christie signed a law that would limit initial prescriptions of opioids to just five days. In Arizona, a similar law limits prescriptions to seven days.

The Drug Enforcement Administration has listed a number of fentanyl variations or analogues as schedule I, drugs that have "no currently accepted medical use and a high potential for abuse."

Dr. Larissa Mooney, director of the University of California Los Angeles Addiction Medicine Clinic, said the new study highlighted the need for opioid addiction treatment. "We need to improve access to treatment and remove barriers," she said.

When Congress passed the 21st Century Cures Act last year, it also dedicated $1 billion toward fighting the epidemic, including expanding buprenorphine treatment, a medication-assisted treatment for opioid dependency.

Unlike methadone, which can be administered only in specific settings, buprenorphine -- commonly used under the brand name Suboxone -- can be provided outside a clinical setting, which can make it more easily accessible.

Why opioid overdose deaths seem to happen in spurts

But while medical-assisted treatment is considered the gold standard, as with any treatment, it isn't 100% effective.

A study published this week in the journal Addiction found that 43% of all buprenorphine users filled an opioid prescription during treatment and that another 67% filled an opioid prescription after treatment. However, buprenorphine can also be prescribed to deal with chronic pain, and the study wasn't able to determine which users were trying to treat their dependency versus to treat pain.

Medically assisted treatment

"The bottom line: It's no surprise that some people receiving buprenorphine are also receiving prescriptions of other opioids, but we were surprised by the number of patients receiving buprenorphine and other opioids," said study author Dr. Caleb Alexander. Alexander is Associate Professor of Epidemiology and Medicine at the Johns Hopkins Bloomberg School of Public Health.

Alexander pointed out that the study did not aim to assess the effectiveness of buprenorphine but rather "raises (the) question about how we can improve the quality and continuity of this treatment. "

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The study looked at 38,096 buprenorphine users between January 2010 and July 2012, with an average treatment length of 55 days.

"When prescribed appropriately," Kolodny said, "more than 75% of patients do very well" on buprenorphine. He noted that success from buprenorphine treatment was based on long-term use of at least a year.

In addition, since 2012, awareness of the opioid epidemic has been visibly increased. Last year, the CDC issued new guidelines to physicians on prescribing opioids, including recommending against using narcotics as a first-line therapy for chronic pain.