Opioid Overdose Symptoms, Risks, and Treatment
According to the Centers for Disease Control and Prevention (CDC), overdoses are the leading injury-related cause of death in the United States. In 2020, nearly 92,000 people died from drug overdoses, and 75% of these deaths involved a prescription or illicit opioid.1
If you or someone you love struggles with opioid misuse, it’s important to recognize the symptoms and signs of opioid overdose, understand opiate overdose treatment, and learn about the potential long-term effects of opioid overdose.
What Are Opioids?
Opioids are a class of drug that includes illegal substances like heroin, and legal painkillers—oxycodone (OxyContin), hydrocodone (Vicodin), fentanyl, codeine, and morphine, for instance—prescribed to treat pain.2 Doctors typically prescribe opioids to people suffering from moderate to severe pain, but certain opioids may also be used to treat coughing and diarrhea.3
The Drug Enforcement Administration (DEA) places different opioids in different drug schedules, depending on their potential for misuse and whether they have an accepted medical purpose. For example, heroin is a Schedule I substance, which means there is currently no accepted medical use in the United States and a high potential for misuse.4 Substances like oxycodone and fentanyl are classified as Schedule II substances. This means that they have a legitimate medical use but also have a potential for misuse, which may lead to severe physiological dependence.4
Some common opioid drugs include:2,4,5
- Fentanyl (Sublimaze and Duragesic).
- Hydrocodone or dihydrocodeinone (Vicodin, Norco, Zohydro).
- Hydromorphone (Dilaudid).
- Methadone (Dolophine).
- Meperidine (Demerol)
- Oxycodone (OxyContin, Percocet, and Percodan).
- Oxymorphone (Opana).
Opioid Overdose Symptoms
An opioid overdose is a life-threatening emergency and requires immediate action. Being able to quickly recognize the symptoms of an overdose on opioids can help save a person’s life, as the condition can be reversed.6
Causes and Risk Factors for Opioid Overdose
The causes of opioid overdose can be intentional, meaning the person purposely tried to inflict self-harm, or an overdose may be the result of an accidental, unintended consequence of using opioids, such as a therapeutic dosing error or failure to detect a drug interaction.8
The risks of opioid overdose can increase for different reasons, including:6,7,9-11
- Having a prescription for opioids or using illicit opioids places a person at increased risk of overdose and also developing an opioid use disorder.
- Returning to substance use after a period of sobriety, when an individual’s tolerance has decreased but they resume using at their previous dose.
- Using high doses of opioids
- Taking extended-release or long-acting opioid formulations.
- Having a severe medical or psychiatric problem, such as depression, HIV, or liver disease.
- Combining opioids with alcohol, sedative/hypnotic medications (such as zolpidem or eszopiclone), benzodiazepines (such as lorazepam or alprazolam), muscle relaxants (such as carisoprodol, chlorzoxazone, or methocarbamol), or antipsychotics (such as haloperidol, quetiapine, or risperidone).
- Being older (and therefore more sensitive to the effects of medications).
- Having respiratory conditions such as asthma or chronic obstructive pulmonary disease.
- Purchasing counterfeit prescription pills, which may be sold on the streets as opioids, such as oxycodone (Oxycontin or Percocet), hydrocodone (Vicodin), benzodiazepines like alprazolam (Xanax) or stimulants like amphetamines (Adderall), but are often laced with fentanyl.
- Using heroin, which may be laced with fentanyl.
- Using other illicit drugs, such as cocaine, methamphetamine, MDMA/molly, and counterfeit pills, all of which may be laced fentanyl.
People who use prescription or illicit opioids should understand that anybody who uses opioids is at an increased risk of overdose as well as an increased risk of opioid addiction and misuse.9 This is true even when opioids are prescribed and taken as directed.6
Opioid Overdose and Addiction Statistics
Opioid overdose is an epidemic in the United States.7 The CDC estimates that more than 1,000 emergency department visits every day are related to opioid misuse. Additionally, about 91 individuals die each day from an opioid overdose.7 Other opioid-related statistics include the following information:12-14
- As of 2021, more than 932,000 people died since 1999 from a drug overdose. Almost 75% of drug overdose deaths in 2020, were related to opioids.
- There were around 69,000 opioid-related deaths in 2020, and more than 82% of those involved synthetic opioids.
- The overall national opioid dispensing rate declined from 2012 to 2020. As of 2020, the dispensing rate fell to the lowest in 15 years, at an average rate of 43.3 prescriptions per 100 persons, although some counties had much higher rates.
- Approximately 3.4% of people aged 12 and older (or 9.5 million people) misused opioids (heroin or prescription pain relievers) in 2020.
- In 2020, 0.8% of people aged 12 and older (or 2.3 million people) had a prescription pain reliever use disorder, 0.2% (or 691,000 people) had a heroin use disorder, and 1% (or 2.7 million people) had an opioid use disorder.
Opioid Overdose Treatment
Naloxone is a life-saving opioid overdose treatment medication that can rapidly reverse opioid overdose and restore an individual’s breathing.15 It is available in 2 FDA-approved forms—an injectable that is normally drawn from a vial and injected under the skin, and a prepackaged nasal spray that is pre-filled and sprayed into one nostril.15 Doctors can prescribe it, but the nasal spray is also available at pharmacies nationwide without a prescription.
Naloxone works for 30–90 minutes, but, many opioids stay active in a person’s body for longer than that and overdose symptoms may return once naloxone wears off, which is why it is important to receive immediate medical attention after receiving the medication.15 Anyone who receives naloxone should be supervised until emergency medical personnel arrive.15 In addition, people should continue to be monitored for 2 hours after the last dose of naloxone to ensure that they keep breathing.15
Individuals who visit the emergency department for an opioid overdose receive naloxone, constant monitoring, CPR (if necessary), and breathing assistance.7 Additionally, they may undergo laboratory tests, which may include a complete blood cell count, a comprehensive metabolic panel, a creatine kinase level, and an arterial blood gas determination.7 They may have electrocardiography (ECG), lung imaging tests, or an abdominal X-ray if deemed necessary.7
In the emergency department, most people who have overdosed on an opioid will be admitted for observation for at least 12–24 hours.7 Typically, they will also be referred for the appropriate addiction treatment to address the underlying issues and prevent relapse.7
Long-Term Effects of Opioid Overdose
Research indicates that 1 in 20 people who were treated in an emergency department for a nonfatal opioid overdose died within a year, and many within 2 days of being discharged. More than 66% of the deaths were due to another opioid overdose.17 Thus, individuals who suffer an opioid overdose are more likely to overdose on opioids again.1 This is why it is imperative to seek opioid addiction treatment after being treated for an opioid overdose.17
Individuals can suffer from different short- and long-term health consequences which are associated with an opioid overdose, such as acute lung injury, rhabdomyolysis (a breakdown of muscle tissue), seizures, or cardiac events.7
Those who receive naloxone sometimes are awakened from an overdose and then undergo immediate opioid withdrawal, which can cause symptoms such as body aches, diarrhea, tachycardia (rapid heartbeat), fever, runny nose, goosebumps, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, watery eyes, insomnia, opioid cravings, dilated pupils, and increased blood pressure.18
Additionally, people who survive an overdose may experience different emotional feelings, such as embarrassment, guilt, anger, and gratitude, as well as the physical and psychological discomforts associated with opioid withdrawal.18
Help is available, and you are not alone in your recovery efforts. Opioid rehab treatment can help you take back control of your life, reduce substance use, reduce the risk of experiencing health-related consequences, and prevent future overdoses.19
Treatment looks different for everyone, but may include:18,20
- Detoxification. Detox can help you safely and comfortably undergo withdrawal so you can become medically stable and ready for drug rehab treatment. It is often the first step in a comprehensive treatment plan for opioid use disorder.
- Inpatient/residential rehab. Inpatient or residential programs require you to live onsite and receive 24/7 monitoring and care. You’ll participate in different forms of education and therapy—individually and in groups—to address the underlying thoughts, emotions, and behaviors that led to opioid misuse in the first place; and learn coping strategies to help you stay sober and prevent relapse.
- Outpatient rehab. Outpatient services can take place in highly supportive settings that require daily attendance or less supportive settings that may only require attending sessions a few times per week. Similar to inpatient programs, you will also participate in different therapies and receive support and education.
Opioid addiction rehab usually involves a combination of medication for addiction treatment and behavioral therapies. You may receive medications like methadone, buprenorphine, or naltrexone to help cravings and prevent relapse.21 You will also participate in interventions and education that use different behavioral therapies, such as cognitive-behavioral therapy (CBT) or motivational enhancement therapies to address underlying issues that contribute to substance use and to help you learn coping and relapse prevention skills.21 Additionally, aftercare or ongoing care following treatment may include continuing counseling, therapy, medication, mutual-help groups, and more to help you maintain lasting recovery and stay substance free.