A dose of lethal fentanyl as compared to a penny

Opioids

Prescription painkillers, heroin, and fentanyl can be dangerous and potentially addictive

Overview

Opioids are a class of substances that reduce pain, including physical pain, psychological pain, and emotional pain. An individual can develop a physiological dependence to opioids, experience opioid withdrawal symptoms between doses or use, and ultimately, develop opioid use disorder.

Opioids can be naturally occurring (derived from the poppy plant), semi-synthetic (made in a lab but similar in structure to naturally-occurring opioids), or synthetic (made in a lab and not similar in structure to naturally occurring opioids).  Opioids attach to opioid receptors in the brain to reduce pain but cause additional effects like drowsiness. Currently, the most commonly used opioids are: prescription opioids, heroin, and illicitly manufactured fentanyl and its analogues. 

Harm reduction strategies are essential in keeping people alive and decreasing potential harms for people who are using opioids. Syringe services programs, overdose prevention and intervention, including naloxone and fentanyl test strip distribution, and medication for opioid use disorder (MOUD) help address the immediate health and safety needs of people who use heroin and other opioids.

What you can do:
  • Talk to young people about the dangers of opioids
  • Learn to recognize the signs of opioid use, opioid use disorder, and overdose
  • Ask your health care provider about non-prescription alternatives to opioid medications
  • Store prescription opioids and all medications safely and securely
  • Keep track of medications and safely dispose of unused or expired medications at approved drop-off sites
  • Get overdose prevention training so you know how to administer naloxone to reverse an opioid overdose
  • Keep naloxone readily available

Signs of Opioid Use

Physical Signs
  • Loss of appetite 
  • Weight loss 
  • Intense flu-like symptoms (nausea, vomiting, sweating, shaky hands, enlarged pupils) are associated with opioid withdrawal
  • Wearing long-sleeves or other clothing that covers the arms could indicate injection drug use
  • Small (pinpoint) pupils are associated with opioid use or intoxication
  • Decreased respiratory rate is associated with opioid use or intoxication
  • Drowsiness or non-responsiveness is associated with opioid use or intoxication  
     
Behavioral Signs
  • Change in attitude
  • Avoiding contact with family and/or friends 
  • Change in friends, hobbies, and/or activities
  • Drop in grades or performance at work 
  • Isolation and changes in behavior 
  • Moodiness, irritability, nervousness/anxiety, giddiness 
  • Illicit behaviors 
     
Environmental Warning Signs
  • Missing medications 
  • Burnt or missing spoons and/or bottle caps 
  • Syringes 
  • Small bags with powder residue 
  • Missing shoelaces and/or belts 

Opioid Medications

Prescription opioid medication can be prescribed by a healthcare professional to treat or manage moderate to severe pain resulting from a medical condition, surgery, or injury.  Individuals prescribed opioids may not perceive any risk associated with their use because they were prescribed to them by a healthcare professional.  However, when misused, prescription opioids may result in overdose and death, opioid use disorder, and/or other serious medical or mental health effects.

Some individuals who use prescription opioids may progress to using illicit opioids like heroin or fentanyl or engage in other potentially risky behaviors like mixing opioids with alcohol and other substances.  

Common prescription opioids include oxycodone (OxyContin, Percocet), hydrocodone (Norco, Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), codeine, morphine (Oramorph, MS Contin), and fentanyl (Duragesic). 

Signs of Misuse:
  • Using prescription opioids in larger amounts or more frequently than prescribed.
  • Using prescription opioids for reasons other than prescribed.
  • Running out of medications early and/or frequently reporting lost medication supplies.
  • Using prescription opioids for longer than prescribed or recommended.
  • Using prescription opioids in ways other than how they are prescribed, such as: sniffing, smoking, vaping, injecting or skin popping.
  • Mixing prescription opioids with other sedating substances such as alcohol or benzodiazepines or stimulants such cocaine or methamphetamine. 
  • Using prescription opioids that were not prescribed for you, i.e., taking medications from someone else like a friend or family member, or purchasing them on the street. 

Heroin

Heroin is an illicitly manufactured opioid. The chemical structure of heroin is similar to some prescription opioids, and it produces similar effects. 

Heroin is typically a white or brown powder or sticky black substance. It can be injected with a syringe (intravenously) but may also be sniffed, smoked, vaped, or skin popped (injected superficially into the skin). The route by which heroin is used determines how quickly the effects are felt.  

Injection use increases the risk of infection such as skin and soft tissue infections, endocarditis (infection within the heart), HIV, hepatitis C (HCV), and hepatitis B (HBV). Overdose with heroin can occur regardless of the method of use. Overdose is more likely when tolerance is low, such as after a period of not using, or when using heroin with additional sedating substances such as alcohol and benzodiazepines.  

Effects and Potential Side Effects of Heroin Use:
  • Euphoria 
  • Nausea, vomiting, drowsiness 
  • Clouded mental function 
  • Slowed breathing and heart function 
  • Unresponsiveness, loss of consciousness 
  • Death by overdose

Harm reduction strategies are crucial to decreasing the potential harms for people who are using opioids. Syringe services programs, overdose prevention and intervention, including naloxone and fentanyl test strip distribution, and medication for opioid use disorder help keep people alive and meet their immediate health/safety needs.

Illicit Fentanyl

Illicitly manufactured fentanyl and its analogues are markedly more potent than opioid medications or heroin. Just three milligrams of fentanyl can be fatal, compared to 30 milligrams of heroin.  Fentanyl increasingly can be found across the United States. It is added commonly to other substances or replaces other substances entirely. Often this is done without the street dealers’ or end users’ knowledge.

Substances containing fentanyl or its analogues - even in very small amounts - substantially increase the risk of overdose and death.

Illicitly manufactured fentanyl can be: 
  • A liquid, or a white or brown powder
  • Pressed into a pill, often mislabeled as an actual medication such as OxyContin or Xanax
  • Mixed in with other illicit substances, including heroin, methamphetamine, and cocaine. 

 

A dose of lethal fentanyl as compared to a penny
Image above shows the dose of lethal fentanyl as compared to a penny. Image courtesy of the New York State Police Crime Laboratory.

Medication for Opioid Use Disorder (MOUD)

OASAS has worked to increase access to medication for opioid use disorder (MOUD). Medication options for the treatment of opioid use disorder are FDA-approved and safe to use, including for pregnant or breastfeeding persons. These medications include methadone, buprenorphine, and long-acting injectable naltrexone.

Treatment for substance use disorder should be person-centered, individualized, non-judgmental, and trauma-informed.

If you or someone you love is living with an opioid use disorder or any other substance use disorder and looking for assistance and linkage to supports, call the OASAS HOPEline.