Scribble

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.

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 —

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.

From Opana.com

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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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 —

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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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 —

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 —

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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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.

DEA

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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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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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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Opioids: Addictive painkillers

CNN —

Drug overdose deaths in the United States declined 5.1% in 2018, according to preliminary data released Wednesday by the US Centers for Disease Control and Prevention’s National Center for Health Statistics.

The slight decline in drug overdose deaths marked the first such drop in decades.

“The reason to be hopeful is that for the past 25 years every year we experienced an increase in overdose deaths. This is the first time in 25 years that overdose deaths will not have increased and have come down a little bit,” said Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University in Massachusetts. Kolodny was not involved in the new data.

The National Center for Health Statistics estimates there were 68,557 drug overdose deaths in 2018. An estimated 47,590 involved opioids, and 31,897 involved synthetic opioids, such as fentanyl and tramadol.

The data will not be finalized until next year.

“There’s light at the end of the tunnel,” Kolodny said, but he added, “there’s certainly nothing to celebrate because even with the slight reduction we’re still experiencing an enormous death toll.”

Additionally, “when you look at the national data, it masks what’s happening on a regional level and on a state level,” he said.

For instance, the mortality rate from synthetic opioidsin 28 states more than doubled every two years from 1999 to 2016, according to a study published in the medical journal JAMA Network Open in February. At the national level, opioids were responsible for shaving 0.36 years off Americans’ life expectancy in 2016, the study said. That’s a greater loss of life than caused by guns or motor vehicle accidents.

Opioid prescribing has dropped since the CDC issued opioid prescribing guidelines in early 2016, which resulted both in doctors prescribing fewer opioids as well as insurers providing less coverage for opioids. Many experts have pointed to the overprescribing of painkillers as the root of the US opioid crisis, but say it then evolved into a heroin crisis and a fentanyl crisis.

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In a statement, US Health and Human Services Secretary Alex Azar said that the Trump administration’s efforts and community responses around the United States had increased the number of patients receiving medication-assisted treatment and overdose-reversing drugs, while opioid prescriptions had fallen.

“The latest provisional data on overdose deaths show that America’s united efforts to curb opioid use disorder and addiction are working. Lives are being saved, and we’re beginning to win the fight against this crisis,” Azar said.

“While the declining trend of overdose deaths is an encouraging sign, by no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades and it will not be solved overnight.”

CNN’s Nadia Kounang contributed to this report.

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US drug overdose deaths fell slightly in 2018

Opioids: Addictive painkillers

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