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What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

What are the side effects and risks of opioids?

Opioids can cause side effects such as drowsiness, mental fog, nausea, and constipation. They may also cause slowed breathing, which can lead to overdose deaths. If someone has signs of an overdose, call 911. These signs may include:

• Very small pupils of the eyes
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Vomiting
• Limp body
• Pale, blue, or cold skin
• Faint heartbeat
• Purple lips and fingernails

When using opioids, there is also a risk of opioid use disorder (OUD).

What is opioid use disorder (OUD)?

Opioid use disorder (OUD) means that you have a problematic pattern of using opioids. The pattern causes a lot of distress and impairment (meaning that it causes problems in and interferes with your daily life). Instead of OUD, sometimes people use the terms "opioid dependence" and "opioid addiction." Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm.

The risk of OUD is higher if you misuse the medicines. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

Opioid use disorder and overdoses are serious public health problems in the United States. As more people misuse opioids, more women are misusing opioids during pregnancy. This can lead to health risks for the mother and baby. The baby may be born with neonatal abstinence syndrome (NAS). NAS is a group of withdrawal symptoms that a baby has after being exposed to drugs during pregnancy.

Another problem with increased opioid misuse is that it can also lead to more heroin use. There are some people who switch from prescription opioids to heroin because heroin may be cheaper and easier to get.

How are opioid use disorder (OUD) and opioid overdose treated?

There are effective medicines to treat OUD. Using medicines to treat OUD is called medications for opioid use disorder (MOUD). MOUD can help you stop using the drug, get through withdrawal, and cope with cravings. It is often combined with behavioral therapy and counseling. Having support from family and friends can also help.

There is also a medicine called naloxone which can treat opioid overdoses. It can reverse the effects of the overdose and prevent death if it is given quickly.

How can I prevent problems when taking prescription opioids?

To prevent problems with prescription opioids, be sure to follow your doctor's instructions when taking them. Do not share your medicines with anyone else. Contact your doctor if you have any concerns about taking the medicines.

NIH: National Institute on Drug Abuse

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

What is an opioid overdose?

Opioids affect the part of the brain that regulates breathing. When people take high doses of opioids, it can lead to an overdose, with the slowing or stopping of breathing and sometimes death.

What causes an opioid overdose?

An opioid overdose can happen for a variety of reasons, including if you:

• Take an opioid to get high.
• Take an extra dose of a prescription opioid or take it too often (either accidentally or on purpose).
• Mix an opioid with other medicines, illegal drugs, or alcohol. An overdose can be fatal when mixing an opioid and certain anxiety treatment medicines, such as Xanax or Valium.
• Take an opioid medicine that was prescribed for someone else. Children are especially at risk of an accidental overdose if they take medicine not intended for them.

There is also a risk of overdose if you are getting medications for opioid use disorder (MOUD). MOUD is a treatment for OUD. Many of the medicines used for MOUD are also controlled substances that can be misused.

Who is at risk of an opioid overdose?

Anyone who takes an opioid can be at risk of an overdose, but you are at higher risk if you:

• Take illegal opioids
• Take more opioid medicine than you are prescribed
• Combine opioids with other medicines and/or alcohol
• Have certain medical conditions, such as sleep apnea, or reduced kidney or liver function
• Are over 65 years old

What are the signs of an opioid overdose?

The signs of an opioid overdose include:

• Very small pupils of the eyes
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Vomiting
• Limp body
• Pale, blue, or cold skin
• Faint heartbeat
• Purple lips and fingernails

What should I do if I think that someone is having an opioid overdose?

If you think someone is having an opioid overdose:

• Call 911 immediately.
• Give the person naloxone, if it is available. Naloxone is a safe medication that can quickly stop an opioid overdose. There are two forms. One is a nasal spray that you spray info the nose. The other type is injected into the muscle under the skin, or into the veins. Naloxone works by blocking the effects of the opioids on the body. It's important to read the product instructions and check the expiration date before you give it to someone.
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with the person until emergency workers arrive.

Naloxone won't harm someone if they're overdosing on drugs other than opioids, so it's best to use it if you think someone is overdosing.

Can an opioid overdose be prevented?

If you are taking opioid pain medicine, there are steps you can take to help prevent an opioid overdose:

• Take your medicine exactly as prescribed by your provider. Do not take more medicine at once or take medicine more often than you are supposed to.
• Never mix the pain medicines with alcohol, sleeping pills, or illegal substances.
• Store your medicine safely where children or pets can't reach it. Consider using a medicine lockbox. Besides keeping children safe, it also prevents someone who lives with you or visits your house from stealing your medicines.
• Dispose of unused medicine promptly.

It is also important to teach your family and friends how to respond to an overdose. If you are at higher risk of an overdose, you will want get naloxone and carry it with you wherever you go. You can buy naloxone at a pharmacy.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, opioid use disorder (OUD) is still a possible risk.

What is opioid use disorder (OUD)?

Opioid use disorder (OUD) means that you have a problematic pattern of using opioids. The pattern causes a lot of distress and impairment (meaning that it causes problems in and interferes with your daily life). Instead of OUD, sometimes people use the terms "opioid dependence" and "opioid addiction." Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm.

What are the treatments for opioid use disorder (OUD)?

Treatments for OUD include:

• Medicines; this kind of treatment is known as medications for opioid use disorder (MOUD)
• Counseling and behavioral therapies
• Residential and hospital-based treatment

Which medicines treat opioid opioid use disorder (OUD)?

The medicines used in MOUD are methadone, buprenorphine, and naltrexone:

• Methadone, buprenorphine, and lofexidine, which can decrease withdrawal symptoms and cravings. They work by acting on one or another of the targets in the brain that opioids act on. But these medicines are different because they do not make you feel high. Some people worry that if they take methadone or buprenorphine, it means that they are substituting one addiction for another. But it is not; these medicines are a treatment. They restore balance to the parts of the brain affected by addiction. This allows your brain to heal while you work toward recovery.

  You may safely take these medicines for months, years, or even a lifetime. If you want to stop taking them, do not do it on your own. You should contact your provider first, and together you can work out a plan for stopping.

• Naltrexone works differently than methadone and buprenorphine. It does not help you with withdrawal symptoms or cravings. Instead, it takes away the high that you would normally get when you take opioids. Because of this, you would take naltrexone to prevent a relapse, not to try to get off opioids. You have to be off opioids for at least 7-10 days before you can take naltrexone. Otherwise you could have bad withdrawal symptoms.

• A combination drug that includes buprenorphine and naloxone. Naloxone is a drug to treat an opioid overdose. If you take it along with buprenorphine, you will be less likely to misuse the buprenorphine.

How does counseling help treat opioid use disorder (OUD)?

Counseling for OUD can help you:

• Change your attitudes and behaviors related to drug use
• Build healthy life skills
• Stick with other forms of treatment, such as medicines

There are different types of counseling for OUD, including:

• Individual counseling, which may include setting goals, talking about setbacks, and celebrating progress. You may also talk about legal concerns and family problems. Counseling often includes specific behavioral therapies, such as
• Cognitive-behavioral therapy (CBT), which helps you recognize and stop negative patterns of thinking and behavior. It teaches you coping skills, including how to manage stress and change the thoughts that cause you to want to misuse opioids.
• Motivational enhancement therapy, which helps you build up motivation to stick with your treatment plan.
• Contingency management, which focuses on giving you incentives for positive behaviors such as staying off the opioids.
• Group counseling, which can help you feel that you are not alone with your issues. You get a chance to hear about the difficulties and successes of others who have the same challenges. This can help you learn new strategies for dealing with the situations you may come across.
• Family counseling, which includes partners or spouses and other family members who are close to you. It can help to repair and improve your family relationships.

Counselors can also refer you to other resources that you might need, such as:

• Peer support groups, including 12-step programs like Narcotics Anonymous
• Spiritual and faith-based groups
• HIV testing and hepatitis screening
• Case or care management
• Employment or educational supports
• Organizations that help you find housing or transportation

What are residential and hospital-based treatments for opioid use disorder (OUD)?

Residential programs combine housing and treatment services. You are living with your peers, and you can support each other to stay in recovery. Inpatient hospital-based programs combine health care and OUD treatment services for people with medical problems. Hospitals may also offer intensive outpatient treatment. All these types of treatments are very structured, and usually include several different kinds of counseling and behavioral therapies. They usually also include MOUD.

You may need to take medicines while you are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking your opioid medicines in greater amounts or more often than you are supposed to, using them to get high, or taking someone else's opioids.

What are the risks of taking opioids during pregnancy?

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include:

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms such as irritability, seizures, vomiting, diarrhea, fever, and poor feeding in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 completed weeks of pregnancy
• Stunted growth, leading to low birthweight
• Problems with the placenta (the organ that brings oxygen and nutrients to the baby)

If your provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include:

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If I am already taking opioids and I become pregnant, what should I do?

If you have been taking opioids and you become pregnant, contact your provider. But don't stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

Can I breastfeed while taking opioids?

If you regularly take opioid medicines, you may be able to breastfeed. It depends on which medicine you are taking. But you should not breastfeed if you have HIV or take illegal drugs. Check with your provider before breastfeeding.

What is the treatments for opioid use disorder (OUD) in pregnancy?

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your provider so you can get help. The treatment for opioid use disorder (OUD) is called medication for opioid use disorder (MOUD). For MOUD during pregnancy, providers prescribe either buprenorphine or methadone. These medicines can reduce your cravings and help prevent withdrawal.

Counseling, including behavioral therapies, can also help you to change your attitudes and behaviors related to drug use and build healthy life skills.

During pregnancy, there are many things you can do to keep yourself and your baby healthy. They include getting regular prenatal care, eating healthy, and staying active. But it's also very important to avoid substances that could be harmful to you and your baby, such as tobacco, alcohol, and drugs.

Tobacco

Smoking during pregnancy passes nicotine, carbon monoxide, and many other harmful chemicals to your baby. Nicotine is not only a health danger for you, but it can also damage your developing baby's brain and lungs. Carbon monoxide can keep the developing baby from getting enough oxygen.

If you smoke while pregnant, it raises the risk of your baby being born too small, too early, or with birth defects. During the first year of life, there is a higher risk of your baby dying from sudden infant death syndrome (SIDS). And later in life, your child may be more likely to have health problems, such as asthma and obesity.

Other tobacco products, including e-cigarettes, also contain nicotine and are not safe to use during pregnancy. And some of the flavorings used in e-cigarettes may be harmful to developing babies.

You will also want to try to avoid secondhand smoke, which has some of the same risks as smoking during pregnancy.

Alcohol

There is no known amount of alcohol that is safe for you to drink during pregnancy and while trying to get pregnant. All types of alcohol are equally harmful, including all wines and beer. The risks from drinking during pregnancy include problems with the growth of the developing baby and fetal alcohol spectrum disorders (FASD). FASD is a life-long condition that can cause a mix of physical, behavioral, and learning problems.

Illegal drugs

Using illegal drugs, such as cocaine, methamphetamines, and club drugs, during pregnancy can cause problems for both you and your baby. They may cause low birth weight babies, birth defects, or miscarriage. Your child may be more likely to have learning and developmental disabilities. And if you are injecting the drugs, that puts you at risk for HIV. HIV can be passed along to your baby during pregnancy.

Prescription drug misuse

Misusing prescription drugs can also be harmful. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's medicines. The possible effects of misusing a medicine during pregnancy will depend on which medicine you are misusing.

Opioids

One type of drug that is a concern during pregnancy is opioids. Opioids include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Taking opioids during pregnancy can cause problems for you and your baby. The risks include birth defects, preterm birth, the loss of the baby, and neonatal abstinence syndrome (NAS). NAS causes withdrawal symptoms in newborn babies.

If you have pain and your health care provider suggests that you take prescription opioids during pregnancy, first discuss the risks and benefits with the provider. Then if you both decide that you need to take the opioids, you can work together to try to minimize the risks.

Cannabis (marijuana)

Cannabis (marijuana)

Getting help

If you are taking opioids or are addicted to drugs, don't stop taking them suddenly. That can be dangerous to you and the baby. Instead, contact your provider for help with getting off the drugs safely.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when opioids are misused. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

How do I know if I need to take opioid medicines?

First, you need to talk with your provider about whether you need to take opioids. You should discuss:

• Whether there are other medicines or therapies that might treat your pain
• The risks and benefits of taking opioids
• Your medical history and if you or anyone in your family has a history of substance misuse, a drug addiction, or alcohol use disorder (AUD)
• Any other medicines and supplements you are taking
• How much alcohol you drink
• If you are pregnant or planning to become pregnant

What do I need to know if I am going to take opioid medicines?

If you and your provider decide that you need to take opioids, make sure that you understand:

• How to take the medicine - how much and how often.
• How long you will need to take the medicine.
• What the possible side effects are.
• How you should stop the medicines when you no longer need them. If you have been taking opioids for a while, it can be dangerous to just stop suddenly. You may need to get off the medicines slowly.
• What the warning signs of addiction are, so you can watch for them. They include:
• Regularly taking more medicine than you are supposed to
• Taking someone else's opioids
• Taking the medicine to get high
• Mood swings, depression, and/or anxiety
• Needing too much or too little sleep
• Trouble making decisions
• Feeling high or sedated

If you have a high risk for an overdose, you will want to get naloxone from a pharmacy and carry it with with you wherever you go. Naloxone is a medicine that can reverse the effects of an opioid overdose.

How can I take my opioid medicine safely?

You should always be careful when taking any medicine, but you need to take extra care when taking opioids:

• Take your medicine exactly as prescribed - do not take extra doses.
• Check the instructions every time you take a dose.
• Do not break, chew, crush, or dissolve opioid pills.
• Opioids can cause drowsiness. Do not drive or use any machinery that may injure you, especially when you first start the medicine.
• Contact your provider if you have side effects.
• If you can, use the same pharmacy for all your medicines. The pharmacy's computer system will alert the pharmacist if you are taking two or more medicines that could cause a dangerous interaction.

How can I safely store and dispose opioid medicines?

It is important to store and dispose of opioid medicines properly:

• Store your opioids and other medicines in a safe place. If you have children at home, it's a good idea to store your medicines in a lockbox. Even one accidental dose of an opioid pain medicine meant for an adult can cause a fatal overdose in a child. Also, someone who lives with you or visits your house may look for and steal your opioid medicines to take or sell them.
• If you travel, carry the current bottle of opioids with you for safety. This will help you answer any questions about your medicine.
• Dispose of your unused medicine properly. If you have unused opioid medicines at the end of your treatment, you can get rid of them by:
• Finding a local drug take-back program
• Finding a pharmacy mail-back program
• In some cases, flushing them down the toilet - check the Food and Drug Administration (FDA) web site to find out which ones you can flush away
• Never sell or share your medicines. Your prescription is for you. Your health care provider considers many factors when prescribing opioids. What's safe for you might lead to an overdose for someone else.
• If someone steals your opioid medicines or prescription, report the theft to the police.