What to Know About the Opioid Epidemic and Opioid Use Disorder

The nation is in the midst of an unprecedented opioid epidemic. According to data collected by the Centers for Disease Control and Prevention (CDC), more than 80,000 people died from opioid-related drug overdoses in 2021. That’s 220 people a day.

Opioids are a class of drugs that include prescription pain relievers such as oxycodone (Oxycontin), hydrocodone, codeine, and morphine (OMS); heroin; and synthetic opioids such as fentanyl (Actiq).

The crisis began in the 1990s, when pharmaceutical companies heavily marketed prescription opioids to doctors as an option to help patients reduce pain associated with things like surgery, chronic back pain, or dental pain. Pharmaceutical companies also reassured healthcare providers that patients would not become addicted to the pain relievers. This led to widespread use of highly addictive medications, and statistics show opioid overdoses began to increase.

The CDC reports the number of deaths from drug overdoses has grown more than six-fold since 1999. That’s largely been driven by opioid use. From 1999 to 2021, nearly 650,000 people died from opioid-related overdoses. Opioids accounted for three-quarters of all overdose deaths in 2021.

According to a paper published in the American Journal of Public Health, Purdue Pharma, the maker of Oxycontin, used aggressive approaches to market the drug to physicians, including a lucrative bonus system for sales representatives to increase their sales of Oxycontin.
Purdue Pharma targeted doctors who prescribed drugs at higher rates than others and drastically misrepresented Oxycontin’s risk of addiction, saying in brochures and audiotapes directed at physicians that the risk of addiction was extremely low. Doctors began prescribing opioids at greater rates, leading to an increase in the misuse of these highly addictive drugs.

Almost 280,000 Americans died from overdoses related to prescription opioids between 1999 and 2021, according to the CDC. And research shows that opioid use disorder can lead people to move on to stronger illicit drugs, like heroin.

As a result, opioid overdoses have skyrocketed in recent years. From 1999 to 2019, 247,000 Americans died from overdoses related to prescription opioids, according to the CDC.

Who Is Most at Risk of Opioid Use Disorder?

Opioid addiction can strike anyone, regardless of age, race, or socioeconomic background.

Still, certain populations are at a higher risk of opioid use disorder than others. These include people who:

Are of younger age, particularly teens and young adults in their early twenties
Have a personal or family history of substance abuse
Are living in stressful circumstances, such as being unemployed or living below the poverty line
Have had legal troubles in the past
Are in contact regularly with others who are addicted to drugs or are frequently exposed to environments where there’s drug use
Have a history of mental health issues, such as depression, anxiety, or post-traumatic stress disorder (PTSD)
Tend to engage in risky behavior
Use tobacco heavily

It’s important to be aware of the signs of an opioid addiction in order to recognize a problem in yourself or a loved one.

People who are addicted to drugs may:

Feel they need to use the drug regularly, daily, or even several times a day
Have intense urges for the drug that block out any other thoughts
Take the drug “just in case,” even when there is no medical need
Take larger amounts of the drug over a longer period of time than intended
Borrow the drug from others or “lose” it so that more prescriptions need to be written
Seek the prescription from multiple doctors in order to have a “backup” supply
Spend large quantities of money on the drug, even when they can’t afford it
Need more of the drug to get the same effect over time
Fail to meet work obligations
Cut back on social or recreational activities as a result of drug use
Experience a change in sleep patterns
Continue the drug use, despite it causing problems in life or physical or psychological harm
Do things to get the drug that they normally wouldn’t do, such as stealing
Drive or engage in other risky behaviors under the influence of the drug
Fail in attempts to stop using the drug

There are a number of different options available to treat opioid use disorder. The best strategy for most people, according to the American Society of Addiction Medicine (ASAM), is a combination of medication and counseling and behavioral therapies. This is known as medication-assisted treatment, or MAT.

Medication These include methadone (Dolophine) and buprenorphine (Subutex), two drugs that work by decreasing withdrawal symptoms and cravings. They act on the same targets in the brain as other opioids, but they do not make the person taking them feel high. Naltrexone (Vivitrol) is another option, which works differently from methadone and buprenorphine. It doesn’t help with withdrawal symptoms and cravings but rather takes away the high that you would normally get while on opioids.

There’s no set length of time for MAT, according to the ASAM. Individuals respond differently, but these medications can safely be taken for years.

The ASAM cites research that shows treating opioid use disorder with medication lowers the risk of overdose and death. But not everyone who could benefit from MAT has access to it. Use of these medications must be closely monitored, and only certain doctors can prescribe them. Some people also have the misconception that by taking these medications, they’re simply trading one addictive substance for another. According to the National Institute on Drug Abuse, that’s not the case.

Counseling Talking to qualified professionals about an addiction can be extremely beneficial in the treatment process. Counseling can include individual, group, and family counseling and often includes a combination of these plus medication. For more severe situations, residential/hospital-based treatment is advised.

Cognitive Behavioral Therapy Also known as CBT, cognitive behavioral therapy is an example of a form of individual talk therapy that helps patients recognize and stop negative patterns of thinking and behavior that can lead to the desire to use opioids.

Peer Support Groups For example, a community group that meets regularly, like a 12-step program such as Narcotics Anonymous or Medication-Assisted Recovery Anonymous. The SMART Recovery (Self-Management and Recovery Training) program also facilitates in-person and online group meetings.

Family Therapy This includes partners or spouses and other family members who are close to the patient. It can help to repair and improve family relationships, which often can contribute to addiction issues.

Residential and Hospital-Based Treatments Residential programs combine housing and treatment services. Inpatient hospital-based programs combine healthcare and addiction treatment services for people with medical problems, and some offer intensive outpatient treatment to help less severe issues or to help transition out of inpatient care. All these types of treatments are very structured and usually include several different kinds of counseling and behavioral therapies. They also often include medicines and medical care to transition off of the prescription or illicit opiate substance.

Learn More About Treatment Options for Opioid Use Disorder

One element of the public health response to the opioid crisis is known as harm reduction. This means preventing overdoses and improving the quality of life for people with opioid use disorder, even if they aren’t able to stop using drugs. The Substance Abuse and Mental Health Services Administration supports many programs that are administered at the local level. Strategies include:

Clean needle programs to stop the spread of infectious diseases like HIV and hepatitis.
Outreach campaigns to connect people with treatment and social services.
Education about and distribution of naloxone for reversing an overdose.
Programs to provide fentanyl testing strips so drug users can check for contamination.

In 2022, the CDC recorded over 103,000 drug overdose deaths, the highest amount in any 12-month period. One 2020 report found that deaths tied to the use of opioids had increased by 38.4 percent compared with the previous year.

The COVID-19 lockdown interrupted many people’s treatment regimens, while social isolation and financial insecurity may have worsened addiction. Being alone in one’s home, with little to do but worry about what’s going on in the world, caused many to relapse.

Addiction facilities were not prepared to cope with the challenges of social distancing, either. According to one study published in 2020, only 27 percent of U.S. addiction facilities had telehealth options at the start of the pandemic.

But the federal government took steps to expand telehealth options for treating opioid use disorder during the pandemic by relaxing policies limiting remote appointments and prescriptions, as well as take-home medications. A study published in 2022 found positive results. More Medicare recipients were able to use telehealth for opioid use disorder during the pandemic than before it began, and those who did were more likely to stay in treatment and less likely to overdose.

In an effort to combat the opioid epidemic, many in the scientific community are looking at ways to prevent addiction before it takes hold.

Doctors play an important role in helping curb the opioid epidemic by practicing safer and more responsible prescribing of opioids and screening patients for opioid misuse at routine medical visits.

The majority of states have implemented prescription drug monitoring programs, which are electronic databases that track controlled substance prescriptions. These programs can help identify patients who may be misusing prescription opioids and those at risk for an overdose. Doctors can then use this information to assess patients’ history of controlled substance use before prescribing medication.

Patients can also play a role in preventing addiction: Patients should never share their prescription drugs, nor should they stop or change a drug regimen without discussing it with their doctors first.

Patients should also be careful to discard medication responsibly, as research shows that most people get the opioids they use for free from friends or family.

The U.S. Department of Justice’s Drug Enforcement Administration (DEA) holds National Prescription Drug Take Back Day twice a year to provide the public with a safe way to discard opioids. If you miss those days, the DEA also offers year-round locations where controlled substances can be thrown away.

Finally, researchers are looking at novel strategies to prevent opioid abuse and overdose, including opioid-blocking vaccines and gaining Food and Drug Administration (FDA) approval for opioid alternatives.

Learn More About How to Prevent Opioid Abuse

Cognitive behavioral therapy (CBT) is a form of psychotherapy aimed at increasing mindful awareness, changing destructive thought patterns, and helping patients bring a rational frame of mind to life’s challenges.

It’s most often used to treat mood disorders, like anxiety or depression. But some researchers believe it can also play a role in alleviating chronic pain without the sometimes detrimental effects of opioids.

Experts say patients’ thoughts and beliefs play a pivotal role in how they experience their pain and how that pain affects their lives. Patients might, for example, avoid activities they enjoyed because they worry about aggravating their pains. Adults with chronic pain are often prescribed opioids to manage their pain, but CBT can give patients strategies they can use to disrupt some of chronic pain’s psychological complications.

But doctors emphasize CBT does not cure the underlying pathology for pain, and it may not be effective for everyone.

There is mounting evidence that trauma (for example, physical, psychological, sexual), especially in childhood, and the resulting PTSD can contribute to someone developing addiction issues later in life, such as opiate and other substance abuses; and that therapies like CBT and other trauma-informed approaches can potentially address some of the root drivers of the addiction state.

Learn More About CBT

ASAM’s Pocket Guideline and Patient Guide

The American Society of Addiction Medicine publishes a guide for people with opioid use disorder, plus their families and friends. It explains the assessment process and available treatments, including medications. The organization also has links to find a provider and support groups on its website.

SAMHSA Opioid Treatment Program Directory

The Substance Abuse and Mental Health Services Administration has a number of resources on its website, including a database of treatment programs.

SAMHSA Buprenorphine Practitioner Locator

You can also search for a doctor in your area who prescribes buprenorphine through this tool on the SAMHSA website.

Never Use Alone

This nonprofit hotline and online chat service allows someone using drugs alone to connect with a volunteer. That person is trained to listen for signs of an overdose and can alert first responders.

Menu