The United States is in the midst of an opioid epidemic, as close to 3 million people battled opioid addiction (to either heroin or prescription painkillers) in 2015, the American Society of Addiction Medicine (ASAM) publishes. Over 60 percent of the record-high overdose deaths in 2015 involved an opioid drug, and 91 people in the US die from an opioid overdose daily, the Centers for Disease Control and Prevention (CDC) reports. In 2015, roughly 300 million prescriptions were dispensed for narcotic pain medications around the world, and Americans consumed 80 percent of them, CNBC publishes.
Opioid abuse, addiction, and overdose are considered serious public health concerns in the United States. Below is a list of some of the most common prescription and illegal narcotics.
For years, opium was a drug derived from the crude botanical extract extruded from the opium poppy plant. With minimal processing, opium consisted of a mixture of naturally-occurring opiate alkaloids—substances that serve as the building blocks for the synthesis of many modern opioid drugs. Opium was sometimes distributed as a liquid or solid, but most commonly encountered as a brownish powder, according to the DEA. Opium may be smoked, taken in pill form, or injected when abused.
The opioid alkaloids contained in opium extracts (e.g., codeine, morphine, thebaine) are used to synthesize many prescription narcotics (like morphine, codeine, oxycodone, etc.). Heroin is also made from raw materials obtained from the opium poppy plant. Opium is not as common a drug of abuse in the United States as other opioids are, and outside of limited use as an anti-diarrheal agent, has no medical use in its traditional form.
In 2014, over 400,000 Americans abused heroin in the month leading up to the National Survey on Drug Use and Health (NSDUH). The CDC reports that heroin use is increasing across most demographics in the US in recent years.
As prescription opioids become costlier and less accessible, individuals may be opting for cheaper opiates like heroin. The CDC reports that three out of four people who initiate heroin use began by abusing a prescription opioid, close to half of those who use heroin are addicted to prescription opioids, and nine out of 10 also abuse another drug.
Overdose is a major risk of abuse. Heroin overdose deaths increased more than 20 percent from 2014 to 2015, and close to 13,000 people died as the result of a heroin overdose in 2015, the CDC publishes. A heroin overdose is indicated by dilated pupils, difficulties breathing, stupor, sluggish movements, mental confusion, clammy and cold skin, slow heart rate and blood pressure, a bluish tinge to the nails and lips, and a potential loss of consciousness. It should be considered a medical emergency.
Heroin is considered highly addictive. ASAM reports that more than 600,000 people battled heroin addiction in 2015. Heroin and other opioid drugs interact with dopamine levels in the brain, which is what causes the burst of pleasure associated with their use. Abuse of heroin can quickly lead to drug tolerance, dependence, and addiction.
One of the most popular and arguably one of the most controversial drugs in history, OxyContin is a time-release formulation of oxycodone that has made over $35 billion in sales for Purdue Pharma since it burst onto the market with aggressive marketing strategies in 1995, Forbes reports. Purdue has paid out millions for its alleged role in the opioid addiction epidemic currently sweeping across America.
OxyContin and other opiates containing oxycodone are effective painkillers for moderate to severe pain; however, they can quickly lead to drug tolerance and dependence with regular use or abuse. Oxycodone is generally dispensed in tablet form as immediate or extended-release options, and it may be combined with an over-the-counter analgesic, such as acetaminophen, in combination products.
Oxycodone is a Schedule II controlled substance, which means that it does have accepted medical use; however, it is also commonly abused for its mind-altering effects and can also lead to addiction. OxyContin (and other oxycodone products) contain a black-box warning regarding their high diversion, abuse, dependence, addiction, and overdose potential.
Oxycodone pills and tablets may be crushed up to bypass those with extended-release formulations and also to snort, smoke, or inject the resulting powder. This greatly increases the odds for overdose. Oxycodone is one of the most prescribed prescription pain relievers and also one of the most commonly involved drugs in prescription opioid overdose fatalities, the CDC reports.
In 2007, OxyContin was reformulated to make it more abuse-deterrent. When crushed, the result is now a gooey substance that is more difficult to abuse. Even so, the drug can still be abused by swallowing and taking higher doses at one time. The Pharmaceutical Journal reports that while the reformulation of OxyContin did decrease abuse rates, individuals may be turning to the illicit drug heroin as a replacement.
In addition to being an effective painkiller, hydrocodone is also a cough suppressant (antitussive). Prescribed in tablets, capsules, and syrups, hydrocodone products may be swallowed, snorted, smoked, or injected. Nearly 3 percent of high school seniors reported misusing Vicodin (hydrocodone/acetaminophen) in 2015, MTF publishes.
The DEA warns that hydrocodone is one of the top drugs involved in prescription opioid overdose deaths, and it is considered highly addictive.
Morphine is a natural opiate derived directly from the opium poppy plant that is used as a narcotic analgesic for both acute and chronic pain management, and also to provide sedation before surgical procedures. Morphine is considered one of the most effective pain medications on the market, and it was traditionally only available in injectable forms, the DEA publishes.
Today, it comes in many forms, from oral solutions and tablets to suppositories and injection preparations. It is most often abused via injection by those dependent on opioids.
Morphine typically remains active in the bloodstream for 4-6 hours, and dependence can build up rapidly. The Global Information Network about Drugs (GINAD) reports that between 1990 and 2010, the US consumed over half of the world’s morphine, and an estimated 10 percent of Americans have abused an opioid drug (including morphine) at least one time in their lives. Many synthetic and semisynthetic narcotics are derived from morphine.
Another Schedule II narcotic opioid, hydromorphone is marketed in suppositories, tablets, vials, and injectable ampoules. The DEA reports that there were close to 4 million prescriptions dispensed for hydromorphone products in 2012.Hydromorphone is an opioid analgesic that is commonly diverted through “doctor shopping,” forged prescriptions, questionable prescribers, and pharmacy and nursing home theft to be smoked, snorted, swallowed, and injected. It is a semisynthetic opioid derived from morphine that is very potent, highly addictive, and has a high potential for overdose when abused. Almost 20,000 people received care in an emergency department (ED) for the misuse of hydromorphone in 2011, the Drug Abuse Warning Network (DAWN) publishes.
Fentanyl is prescribed to treat chronic and severe pain in those who are tolerant to opioids. The National Institute on Drug Abuse (NIDA) warns that fentanyl is a Schedule II drug that is 50-100 times more potent than morphine.
Overdose rates for synthetic opioids, including fentanyl and tramadol, increased more than 70 percent between 2014 and 2015, the CDC publishes. There were more than 2,000 fentanyl overdose deaths in 2015, the DEA reports, and numerous warnings regarding the danger of this drug have been published as a result.
The DEA publishes that 6.5 million prescriptions for fentanyl were dispensed in 2015. Fentanyl is available as lozenges, tablets, buccal tablets, nasal and sublingual spray, injectable formulations, and transdermal patches. It may be abused by freezing and cutting up the patches to suck or chew on them, or by scraping the gel off and injecting or ingesting the residue. Fentanyl may also be swallowed, snorted, smoked, or injected.
The drug creates an intense and rapid rush of euphoria, and its potency makes it extremely addictive. It can also be absorbed through the skin on contact and can be lethal in relatively small doses due to its high potency and level of effectiveness.
While codeine can be derived from the opium poppy plant, it is more often synthesized from morphine. In the United States, codeine is only available in generic form or in combination products, such as Tylenol with codeine (Tylenol1 through Tylenol4, with the higher number indicating a larger amount of codeine).
Around 10,000 people received ED care for misusing codeine in 2011, according to the DAWN report. It is generally thought to be less addictive and habit-forming than more potent narcotics; however, it still carries a risk for abuse, dependence, addiction, and overdose.
Methadone is one of the longer acting opioid agonists, staying active in the bloodstream for close to a full day, meaning that it can be prescribed in lower doses less often in order to keep opioid withdrawal symptoms at bay. Methadone is still an opioid agonist drug though; therefore, it does have the potential to be abused and also to create dependence and lead to addiction. More than 66,000 people were treated in EDs for the misuse of methadone in 2011, per the DAWN report. It is also one of the most common drugs found in prescription opioid overdose fatalities.
Even when taking Demerol as directed and with a necessary prescription, a person can become dependent on it and suffer withdrawal symptoms when the drug wears off. When this happens, it can become difficult to stop taking Demerol, which may lead to abuse and compulsive drug use, or addiction.
Meperidine is prescribed as a tablet or syrup, the National Library of Medicine (NLM) publishes. It should not be stopped suddenly; rather, it will need to be slowly tapered off to allow it to safely process out of the body.
After OxyContin was reformulated, it may have opened the door to the abuse of Opana, Reuters publishes. Opana could be crushed and then snorted or injected for an intense high as the extended-release formulation is bypassed. In 2012, Opana was reformulated to deter abuse. While the new coating did drop nasal abuse rates, per Reuters, it is still possible to crush and inject the drug, which occurs frequently. Oxymorphone can easily lead to dependence, and it is extremely addictive.
Tramadol has generally been considered to have a low abuse and dependence potential, the Primary Care Companion to the Journal of Clinical Psychiatry reports; however, the DEA classified tramadol as a controlled substance in 2014, as over 3 million Americans were reported to have abused it in their lifetime by the year 2012. Tramadol is most often abused by people who are opioid-dependent already, healthcare providers, and chronic pain sufferers. While it may be less addictive than other opioid narcotic drugs, it does still have a risk for dependence and addiction, especially when abused.
Carfentanil is a powerful opioid narcotic that is used as an elephant tranquilizer. It is 50 times more potent than heroin, 100 times more potent than fentanyl, and 10,000 times more potent than morphine, the DEA warns as it issued an alert to the public and police as to carfentanil’s rising presence as a drug of abuse in 2016.
The drug is made to resemble powdered heroin or cocaine, but it is much more dangerous, often lethal in very small doses of two milligrams or less. It may be being added to heroin, used to “cut” or stretch the drug, or passed off as a different drug. In addition to having a very high potential for fatal overdose, it is also highly addictive.
Buprenorphine with the brand names of Subutex, Buprenex, Butrans, and Probuphine and Buprenorphine/Naloxone combinations Suboxone, Zubsolv, and Bunavail.
Buprenorphine is a partial opioid agonist drug that is FDA-approved to treat opioid dependence, both on its own and in combination buprenorphine/naloxone formulations. It is a long-acting opioid.
In 2012, more than 9 million prescriptions were dispensed in the United States for buprenorphine, the DEA publishes. It may still be abused and has a potential for dependence.
The introduction of naloxone in combination products acts as an abuse-deterrent, as naloxone is an antagonist drug. When buprenorphine combination products are altered and then injected to be abused, effects of the opioid agonist are blocked, and withdrawal symptoms can be precipitated. The DAWN report publishes that over 20,000 people received ED treatment for buprenorphine abuse in 2011.
Narcotic drugs can be incredibly dangerous and have a high risk for potentially life-threatening overdose. Over 33,000 people died of an opioid overdose in the United States in 2015, the CDC publishes. Opioid dependence and addiction are further possible side effects of opioid abuse.
Early intervention is key, as overdose is preventable, and opioid addiction is highly treatable. There are several things to watch out for when abuse of a narcotic is suspected, such as:
Narcotic drug abuse and addiction are treatable with behavioral therapies, counseling services, medications, detox services, and supportive care. There are many different forms of treatment available to choose from; the key is to reach out for help as soon as possible.