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Manage Pain Safely. Manage Addiction.

Questions to Ask Yourself

Learn About Opioids

Ask Yourself These Questions

Are you currently taking prescription pain medications that were not given to you by a doctor?
Are you taking prescription pain medications in a way or a dose other than as directed by your doctor?
Have you used prescription pain medications to cope with stress, sadness or other difficult feelings?
Are you using more prescription pain medications than you want to?

If you or someone you know has a substance use disorder, also known as addiction, we can help.
Call anytime, toll-free.

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Additional Resources

Additional Resources

US Department of Health and Human Services
Opioids General Information Page

Spanish-Language Resources



Updated June 2019
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What is an "Opioid?"

Opioids are a class of drugs that interact with receptors on nerve cells in the body and brain. Opioids include pain relievers as well as illicit street drugs.


what are opioids?

When taken, it can make the user feel euphoric and pain-free. Therefore, opioids can become highly addictive drugs. Some opioids, such as heroin, are illegal. However, many opioids are legal and are prescribed by health care providers to treat pain; these include oxycodone (OxyContin®), hydrocodone (Vicodin®), hydrocodone-acetaminophen (Norco®), oxycodone-acetaminophen (Percocet®). codeine, and morphine, among others. Use of these prescription drugs for short durations, as prescribed by a doctor, is generally safe. However, misuse of prescription opioids can lead to addiction and even overdose or death. Misuse can include taking a drug that has been prescribed for someone else, taking a prescribed medicine differently than prescribed (for example, at a higher dose or for a longer period of time), or taking it to get high. SOURCE: https://www.hhs.gov/ash/oah/adolescent-development/substanceuse/drugs/opioids/index.html


Prescription pain medications that are Opioids include:
  • Oxycodone (OxyContin®, Percocet®)
  • Hydrocodone (Vicodin®, Norco®)
  • Codeine
  • Oxymorphone (Opana®)
  • Morphine (Kadian®, Avinza®)
  • Fentanyl

Other Opioids include:
  • Heroin
  • Synthetic "street"; Fentanyl

SOURCES
HHS Office of Adolescent Health: https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/opioids/index.html
National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/opioids#summary-of-the-issue


Updated June 2019
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What You Need To Know About Prescription Opioids

What You Need To Know About Prescription Opioids

Many people are prescribed medication when they have injured themselves or after a surgery. Frequently, these medications are prescription opioids. Prescription opioids can be very effective at reducing pain, and, for some people, improve their quality of life and ability to function.


What You Need To Know About Prescription Opioids
Some commonly prescribe prescription opioids are:
  • Oxycodone (OxyContin®, Percocet®)
  • Hydrocodone (Vicodin®, Norco®)
  • Codeine
  • Oxymorphone (Opana®)
  • Morphine (Kadian®, Avinza®)
  • Fentanyl (Actiq®, Duragesic®)

What Is Prescription Opioid Misuse?
Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by a doctor, but they can be misused. People misuse prescription opioids by:
  • Taking the medicine in a way or dose other than prescribed
  • Taking someone else's prescription medicine
  • Taking the medicine for the effect it causes-to get high or experience euphoria

What Are the Risks of Taking Prescription Opioids?
There may be serious risks associated with prescription opioids. Overuse or misuse of the drugs can result in addiction, overdose, and death. The use of prescription opioids can also have a number of side effects, even when taken as directed:
  • Tolerance
  • Physical dependence - meaning you have symptoms of withdrawal when the medication is stopped
  • Increased sensitivity to pain
  • Constipation
  • Nausea, vomiting, and dry mouth
  • Sleepiness and dizziness
  • Confusion
  • Depression
  • Low levels of testosterone that can result in lower sex drive, energy, and strength
  • Itching and sweating

What are the Symptoms of Tolerance, Dependence and Withdrawal?
Prescription opioids can be addictive, and people can develop tolerance and dependence when taking them. Tolerance for prescription opioids means that the user experiences the medication as less effective at reducing pain with continued use of the same amount. It also can mean that the user needs more or a higher dosage to achieve the desired effect of pain management or intoxication.

A physical dependence on prescription opioids means that the user feels withdrawal symptoms when they stop taking the drug. These symptoms include:
  • Nausea and vomiting
  • Anxiety
  • Insomnia
  • Hot and cold flashes
  • Perspiration
  • Muscle cramps
  • Watery discharge from eyes and nose
  • Diarrhea

Overdose
An opioid overdose can occur for a variety of reasons, including overusing or misusing prescribed medications, using someone else's prescribed opioid, or mixing a prescription opioid with alcohol or other drugs. Opioid overdose is life-threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.

Call 911 immediately if a person exhibits any of these symptoms:
  • Their face is extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

Naloxone is a medication that can reverse the life-threatening effects of an opioid overdose within minutes. Anyone who receives training can carry this medication and give it in the event of an overdose. Click here to learn more about naloxone and how you can potentially save someone's life in the event of an overdose. Transition to Other Drugs Prescription opioids are chemically similar to heroin. For some who become addicted to their prescription opioid and can no longer get it, heroin becomes an alternative. An estimated 4 to 6 percent who misuse prescription opioids transition to heroin. About 80 percent of people who use heroin first misused prescription opioids.

SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
The Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/opioids/prescribed.html
Substance Abuse and Mental health Services Administration: https://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose
Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310652/


Updated June 2019
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What are the Different Types of Opioids

What are the Different Types of Opioids

Opioids are a class of drugs that include powerful pain relievers that are available by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), as well as illegal drugs such as heroin. These drugs are chemically related and have similar effects on the brain and body.


Heroin

Heroin is an illegal opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.


What are the Different Types of Opioids

People inject, sniff, snort, or smoke heroin. Some people mix heroin with other drugs. It is highly addictive. People who regularly use heroin often develop tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.


A person can overdose on heroin. A heroin overdose occurs when a person uses enough of the drug to produce a life-threatening reaction or death.


Prescription Opioids

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor. However, because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor's prescription). Regular use - even as prescribed by a doctor - can lead to dependence and, when misused or overused, opioid pain relievers can lead to addiction, overdose, and death.


What are the Different Types of Opioids

Prescription opioid pain medicines such as oxycodone and hydrocodone have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use. Nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids first. Talk to your doctor if you currently have a prescription for opioids.


Fentanyl

Fentanyl is a powerful synthetic opioid that is up to 100 times more potent than morphine and 50 times more potent than heroin. It is both a prescribed drug, as well as a drug that is at times made and used illegally.


Prescription fentanyl is typically used to treat patients with severe pain, especially after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.


Fentanyl that is illegally manufactured is dangerous. It is made without the quality controls of pharmaceutical grade fentanyl and is a major contributor to recent increases in synthetic opioid overdose deaths. This illegally manufactured fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into counterfeit pills that look like other prescription opioids.


Importantly, some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine and MDMA. This is especially risky when people taking drugs don't realize that the drugs they are using might contain fentanyl and significantly increase their risk for overdose death.


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts


Updated June 2019
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Signs of Potential Overuse/Misuse

Common signs of opioid misuse, overuse or addiction include:
  • Regularly taking an opioid in a way not intended by the doctor who prescribed it, including taking more than the prescribed dose or taking the drug for the way it makes a person feel
  • Taking opioids "just in case," even when not in pain
  • Mood changes, including excessive swings from elation to hostility
  • Changes in sleep patterns
  • Borrowing medication from other people or "losing" medications so that more prescriptions must be written
  • Seeking the same prescription from multiple doctors in order to have a "backup" supply
  • Poor decision-making, including putting himself or herself and others in danger


SOURCES
National Institute on Drug Abuse: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-tell-if-a-loved-one-is-abusing-opioids/art-20386038


Updated June 2019
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Safe Pain Manangement

If you're one of millions of Americans with long-term pain, also called chronic pain, you know how debilitating and frustrating it can be. It can be harmful to your health and well-being. It can keep you from getting a good night's sleep, eating right, and exercising. It can affect your mood and work, and can keep you from spending time with your friends and family.

Every year, millions of prescriptions are written for pain medications - many of them are opioids that can lead to addiction. But there are many other treatments available for pain instead of opioids that may work better and have fewer associated risks.

The Dangers of Taking Prescription Opioids Recreationally

It's dangerous to take prescription pain medications recreationally or for reasons other than managing pain as directed.

It can lead to addiction and unintentional overdose. Taking opioids with alcohol or sedatives increases the risk of overdose. Misuse of prescription opioids is also a risk factor for transitioning to heroin use.

Talk to your doctor about trying these non-opioid alternatives for pain relief.

Non-Opioid Medication Options

Medication Examples Indications
Over-the-Counter
(OTC)
Acetaminophen Acetaminophen (Tylenol®) Osteoarthritis, chronic lower back pain, migraine
Non-Steroidal
AntiInflammatory Drugs
Ibuprofen (Motrin®, Advil®, Aleve®),
Celecoxib (Celebrex®)
Acute and chronic low back pain,
osteoarthritis
Topical Agents Capsaicin Neuropathic pain, osteoarthritis,
musculoskeletal pain
Requires a
Prescription
Tricyclic Anti-Depressants Amitryptyline (Elavil®, Endep®),
Nortriptyline (Pamelor®)
Diabetic neuropathy, post-herpetic neuralgia, fibromyalgia, migraine
Anticonvulsants Pregabilin, Gabapentin, Carbamazepine Diabetic neuropathy, postherpetic neuralgia, fibromyalgia
Topical Agents Lidocaine, Topical Non-Steroidal Anti-Inflammatory Drugs Neuropathic pain, osteoarthritis, musculoskeletal pain
Interventional Approaches Epidural or Joint Injections Glucocorticoid injections Osteoarthritis, Rheumatoid arthritis, rotator cuff disease

Non-Pharmacological Treatment Options

Treatment Indications
Physical/Exercise Therapy Lower back pain, fibromyalgia, osteoarthritis
Cognitive Behavioral Therapy (CBT) Chronic pain, disability, mood
Acupuncture Chronic pain, fibromyalgia
Therapeutic massage Chronic pain, fibromyalgia

Each of these treatment options may have risks. Talk to your doctor about what the potential risks could be.

For more information on safe opioid prescribing, review Safe Med LA's Safe Opioid Prescribing Recommendations (endorsed by the California Society of Addiction Medicine).


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/misuse-prescription-drugs/what-classes-prescription-drugs-are-commonly-misused
Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/training/nonopioid/508c/index.html
Choosing Wisely: http://www.choosingwisely.org/wp-content/uploads/2018/02/Medicines-To-Relieve-Chronic-Pain-ASA.pdf


Updated June 2019
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Safe Disposal of Prescription Drugs

Safe Disposal of Prescription Drugs

Why should you take back your unused medications?
  • Safe drug disposal reduces drug abuse. Many people who abuse opioids, including teenagers, get opioids from a friend or relative, often without their knowledge. Safe drug disposal often gets unused opioids out of the home and curbs the risk that it will be misused or diverted.
  • Safe drug disposal reduces accidental poisoning. Unwanted opioids left in your home endanger your children, adolescents, and senior who may have access to them.
  • Safe drug disposal protects the environment and keeps medications from entering streams, rivers, and the water supply.
Find locations in LA County where you can dispose of your unused medications here.

More information is available at: SafeMedLA.org
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Questions to Ask Your Doctor about Prescription Opioids

Questions to Ask Your Doctor about Prescription Opioids

Making decisions about treating pain is difficult. If you are considering starting or questioning whether to continue taking prescription opioids, talk to your doctor about side effects, risks, and addiction - and make sure that you watch for them too.

Here are a few questions that can help you and your doctor make the best choice for you:

Questions to Ask Your Doctor about Prescription Opioids
  • Why do I need this medication - is it right for me?
  • How long should I take this medication?
  • Are there non-opioid alternatives that could help with pain relief while I recover?
  • How can I reduce the risk of potential side effects from this medication?
  • What if I have a history of addiction with tobacco, alcohol or drugs?
  • What if there is a history of addiction in my family?
  • Could this treatment interact with my other medications?
  • Can I share this medication with someone else? Why not?
  • How should I store my opioid medication to prevent other people from taking it?
  • What should I do with unused opioid medicine?
  • Can I have a prescription for naloxone?


Download these questions in your language below:
SOURCES
Food and Drug Administration - https://www.fda.gov/consumers/consumer-updates/what-ask-your-doctor-taking-opioids


Updated June 2019
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Preventing Overdose

Preventing Overdose

Naloxone

Ask your doctor about naloxone - a safe medication that can quickly stop an opioid overdose. It can be injected into the muscle or sprayed into the nose to rapidly block the effects of the opioid on the body.

Naloxone is a medicine that can treat an opioid overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of heroin and other opioid drugs. Sometimes more than one dose may be needed to help a person start breathing again, which is why it's important to get the person to an emergency department or a doctor to receive additional support if needed.

Naloxone is available as an injectable (needle) solution, a handheld auto-injector (EVZIO®), and a nasal spray (NARCAN® Nasal Spray). You don't have to be a health care professional to give naloxone. Friends, family, and others in the community who receive the right training can use it to save someone who is overdosing.

The rising number of opioid overdose deaths has led to an increase in public health efforts to make naloxone available to at-risk persons and their families, as well as first responders and others in the community. California allows pharmacists to dispense naloxone without a prescription from a person's personal doctor.

For additional information and training on how to use naloxone in response to an opioid overdose, click here.


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/heroin
Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-Card-a.pdf


Updated June 2019
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Information for Parents and Young People about Prescription Pain Medication

Information for Parents and Young People about Prescription Pain Medication

All adolescents are at risk for misusing opioids. There are a number of concrete ways that parents, family members, and other concerned adults can help prevent opioid misuse among adolescents. The fact that the adolescent brain is still growing means that teens are vulnerable to addiction, but the adolescent brain also is ripe for learning healthy habits and behavior.

To help prevent opioid misuse, those who care about and for adolescents should:

  • Treat pain cautiously. If a pain reliever is prescribed to a young person, ask the provider if it is an opioid. If it is a prescription opioid, talk to your doctor about whether to consider alternatives to opioids. For more questions for your doctor, click here.
  • Signs of Opioid Misuse
    • Fatigue
    • Fading in and out of consciousness
    • Slowed breathing
    • Constricted pupils
    • Flushed skin
    • Dry mouth
    • Itching
    • Nausea
    • Vomiting
  • Store prescriptions medications safely (in a locked cabinet or box) and dispose of them when they are expired or no longer needed.
  • Talk with teens in your life about pain treatment and management. Regardless of drug use history, reach out to youth. Building strong relationships with adolescents is the first step to connecting with youth on drug prevention.
  • If you suspect a young person is using opioids, express concern and encourage them to talk openly about the issue. Make sure that adolescents who are struggling with opioid misuse get appropriate treatment and support.


SOURCES
National Institute on Drug Abuse: https://drugfree.org/drug/prescription-pain-relievers-opioids/
HHS Office of Adolescent Health: https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/opioids/index.html


Updated June 2019
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Opioids in LA County

Opioids in LA County

Key Los Angeles County Statistics

  • Accidental opioid-related poisoning deaths (2017): 488
  • Prescription opioid overdose emergency department visits (2017): 547
  • Prescription opioid overdose hospitalizations (2017): 445
  • Opioid prescriptions (2017): 3.8 million

Rate of opioid overdose deaths per 100,000 population by opioid type, LAC, 1999-2017
Opioids in LA County Source: CDC Wonder


Opioid-Related Deaths
Opioids in LA County Source: CDPH Vital Statistics


Misuse/Abuse of Rx Opioids (pain medication) in the Past Year by Age, 2012-2014
Opioids in LA County Source: SAMHSA



Opioids in LA County Source: SAMHSA

Opioids in LA County Source: SAMHSA

More Information and statistics are available here and here.

Updated June 2019
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What is Medication for Addiction Treatment?

Medication for Addiction Treatment(MAT)

There is more than one path to recovery. MAT is a proven treatment for opioid use disorders that uses medications such as methadone or buprenorphine to treat addiction to both illegal opioids and prescription opioids. MAT works by both relieving cravings for opioids and staving off withdrawal symptoms so that people can focus on their recovery.

Talk to your doctor about whether MAT is right for you.

For more information on MAT, click here.


Updated June 2019
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Heroin

What is Heroin?

Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin. People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, a practice called speedballing.

Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.


What You Need To Know About Prescription Opioids

The Dangers of Heroin
Heroin is addictive and there is a high risk of overdose and death from using it. Heroin also often contains additives, such as sugar, starch, or powdered milk, that can clog blood vessels leading to the lungs, liver, kidneys, or brain and cause permanent damage. In addition, sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV and hepatitis (see "Injection Drug Use, HIV, and Hepatitis").

Risk of Overdose
A person can easily overdose on fentanyl. An overdose occurs when a drug produces serious adverse effects and life-threatening symptoms. Death from an opioid overdose happens when the drug depresses the parts of the brain that control breathing. Signs and symptoms when people overdose on opioids include

  • Their face becomes extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

Risk of Addiction
Heroin is highly addictive. People who regularly use heroin often develop tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.

Those who are addicted to heroin and stop using the drug abruptly may have severe withdrawal. Withdrawal symptoms - which can begin as early as a few hours after the drug was last taken - include:

  • Restlessness
  • Severe muscle and bone pain
  • Sleep problems
  • Diarrhea and vomiting
  • Cold flashes with goose bumps ("cold turkey")
  • Uncontrollable leg movements ("kicking the habit")
  • Severe heroin cravings

Researchers are studying the long-term effects of opioid addiction on the brain. Studies have shown some loss of the brain's white matter associated with heroin use, which may affect decision-making, behavior control, and responses to stressful situations.


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/finder/t/160/DrugFacts
Substance Abuse and Mental Health Service Administration: https://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose


Updated June 2019
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Help for Addiction

Help for Addiction

If you or someone you know has a substance use disorder, also known as addiction, we can help.


Call anytime, toll-free.

Substance Abuse Service Helpline Logo


For more information, see our brochure (PDF): English | Spanish



No Cost, No Fee Treatment for Substance Use Disorders
People who have a Substance Use Disorders (also known as addiction) may be eligible to receive no cost treatment for opioid or other drug addiction. For more information or to see if you are eligible, call the number above or click here.



Updated June 2019
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Glossary

Glossary

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with addiction have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.

Dependence develops when the neurons in the body adapt to the repeated exposure of the substance and only function normally in the presence of the substance. When the substance is withdrawn, several physiologic reactions occur. These can be mild (e.g., for caffeine) or even life threatening (e.g., for alcohol). This is known as the withdrawal syndrome.

Drug misuse is improper or unhealthy use of a drug. These include the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other than prescribed or using someone else's prescription.

Opioid Use Disorder, sometimes referred to as "opioid abuse or dependence" or "opioid addiction," is a problematic pattern of opioid use that causes significant impairment or distress.

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent.

Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

Naloxone is a short-acting medication that reverses the life-threatening effects of an opioid overdose.

Medication-assisted treatment (MAT) is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. There are four major dimensions that support recovery:

  • Health - overcoming or managing one's disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
  • Home - having a stable and safe place to live.
  • Purpose - conducting meaningful daily activities and having the independence, income, and resources to participate in society.
  • Community - having relationships and social networks that provide support, friendship, love, and hope


SOURCES
American Psychiatric Association: https://www.psychiatry.org/patients-families/addiction/what-is-addiction
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/8-definition-dependence
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/fentanyl
National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/opioids
National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/heroin
Substance Abuse and Mental health Services Administration: https://www.samhsa.gov/find-help/recovery
Substance Abuse and Mental health Services Administration: https://www.samhsa.gov/medication-assisted-treatment/treatment


Updated June 2019
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For Caregivers, Friends and Family

For Caregivers, Friends and Family

If you are providing care for a patient or a family member who is taking a prescription opioids for pain, it is important that you are aware of the potential risks associated with their medication. These include the potential risk of dependency, addiction, overdose, and death, as well as how to prevent overdose.

When talking to your patient or family member's doctor about prescription pain medications, ask the following questions:

For Caregivers, Friends and Family
  • Why do they need this medication?
  • Is this medication addictive?
  • What are the benefits?
  • What are the risks?
  • What are the side effects?
  • What is the safest way to manage their pain?
  • Are there non-opioid options I can use?
  • How does this medication interact with other drugs they are taking?
  • How long should they take this drug?
  • What is the risk of overdose?
  • Do they need a prescription for naloxone?

What do I need to know about dependency and addiction?
It may not be easy to tell if someone is becoming addicted to prescription opioids. Perhaps you've noticed changes in your patient's or loved one's moods or behavior that don't add up. Even if you can't point to anything specific, addressing your concerns could save their life

Taking opioids as prescribed reduces the likelihood someone will become addicted. However, not taking prescription opioids as prescribed or for an extended period of time increases the risk of misuse, addiction, overdose, and death. Studies suggest that up to one-third of people who take opioids for chronic pain misuse them, and more than 10 percent become addicted over time.

Your patient or loved one is also at increased risk of addiction if he or she obtains opioids without a prescription, and using opioids illegally increases the risk of drug-related death. Drugs that pass hands illegally, such as fentanyl may be laced with life-threatening contaminants or much more powerful opioids. And people who use opioids illegally often turn to heroin, which is a cheaper alternative to prescription opioids that has similar effects.

Signs of misuse, dependency and addiction
People who are addicted to opioids may still hold down jobs and other responsibilities, maintaining the appearance of stability at work and home. Over time, however, the addiction is likely to lead to serious problems. When a person is addicted to a drug, he or she will continue to use the drug even when it makes his or her life worse.

Common signs of opioid addiction include:

  • Regularly taking an opioid in a way not intended by the doctor who prescribed it, including taking more than the prescribed dose or taking the drug for the way it makes a person feel
  • Taking opioids "just in case," even when not in pain
  • Mood changes, including excessive swings from elation to hostility
  • Changes in sleep patterns
  • Borrowing medication from other people or "losing" medications so that more prescriptions must be written
  • Seeking the same prescription from multiple doctors, in order to have a "backup" supply
  • Poor decision-making, including putting himself or herself and others in danger

If someone you love is addicted to opioids, you're also likely to experience changes in your thoughts and behaviors. You may find yourself:

  • Worrying about your loved one's drug use, ranging from persistent anxiety to fullblown fear that your loved one is going to die
  • Lying or making excuses for your loved one's behavior
  • Withdrawing from your loved one to avoid mood swings and confrontations
  • Thinking about or acting on the urge to call the police when your loved one uses drugs or uses illegal means to obtain them

It's common - and entirely human - to avoid addressing your concerns for fear your relationship or family will fall apart. Some addiction experts now recommend that doctors interview family members and caregivers as part of routine follow-up care for a person taking opioid medications. But don't wait to be asked before you voice your concerns. If you think your loved one may be addicted to opioids, talk with his or her doctor right away.


SOURCE: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-tell-if-a-loved-one-is-abusing-opioids/art-20386038

Preventing Overdose
Death from an opioid overdose happens when too much of the drug overwhelms the brain and interrupts the body's natural drive to breathe. Signs and symptoms when people overdose on opioids includes:

  • Their face becomes extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

It may be hard to tell if a person is high or experiencing an overdose. If you aren't sure, it's best to treat it like an overdose - you could save a life.

  • Call 911 immediately
  • Give naloxone, if available
  • Give rescue breathes, as needed, until person starts breathing or help arrives
  • If person is still not breathing after 2 - 3 minutes of rescue breathing, give another naloxone dose, if available
  • Once the patient wakes up, try to keep the person awake and breathing
  • Lay the person on their side to prevent choking
  • Stay with him or her until emergency workers arrive


Naloxone
Ask your doctor about naloxone - a safe medication that can quickly stop an opioid overdose. It can be sprayed into the nose or injected into the muscle to treat an opioid overdose when given right away.

Naloxone is a medicine that works by rapidly binding to opioid receptors and blocking the effects of heroin and other opioid drugs. Sometimes more than one dose may be needed to help a person start breathing again, which is why it's important to call an ambulance and get the person to an emergency department as soon as possible.

Naloxone is available as a nasal spray, an injectable (needle) solution, and a handheld autoinjector. You don't have to be a health care professional to give naloxone. Friends, family, and others in the community can use it to save someone who is overdosing.

The rising number of opioid overdose deaths has led to an increase in public health efforts to make naloxone available to at-risk persons and their families, as well as first responders and others in the community. California allows pharmacists to dispense naloxone without a doctor's prescription.


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/heroin
Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-Card-a.pdf
Substance Abuse and Mental Health Service Administration: https://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose


Updated June 2019
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Fentanyl

Fentanyl

What is Fentanyl?

Fentanyl is a powerful synthetic opioid that is up to 100 times more potent than morphine and 50 times more potent than heroin. It is both a prescribed drug, as well as a drug that is at times made and used illegally.

Fentanyl Like morphine, prescription fentanyl is typically used to treat patients with severe pain, especially after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person's skin, or as lozenges that are sucked like cough drops.

Fentanyl that is illegally manufactured is dangerous. It is made without the quality controls of pharmaceutical grade fentanyl and is a major contributor to recent increases in synthetic opioid overdose deaths. This illegally manufactured fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into counterfeit pills that look like other prescription opioids.

Importantly, fentanyl is also being mixed with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is especially risky when people taking drugs don't realize that the drugs they are using might contain fentanyl and significantly increase their risk for overdose death.

Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59 percent of opioid-related deaths involved fentanyl, compared to 14.3 percent in 2010.


Risk of Addiction
Fentanyl is addictive because of its potency. A person taking prescription fentanyl as instructed by a doctor can still experience dependence, which is characterized by withdrawal symptoms when the drug is stopped. A person can be dependent on a substance without being addicted, but dependence can sometimes lead to addiction.

People addicted to fentanyl who stop using it can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms can be extremely uncomfortable and are the reason many people find it so difficult to stop taking fentanyl.

These symptoms include:

  • Muscle and bone pain
  • Sleep problems
  • Diarrhea and vomiting
  • Cold flashes with goose bumps
  • Uncontrollable leg movements
  • Severe cravings


SOURCES
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/finder/t/160/DrugFacts
Substance Abuse and Mental Health Service Administration: https://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose


Updated June 2019
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Additional Resources

Additional Resources

The Centers for Disease Control and Prevention
Opioid Basics
Understanding the Epidemic
Overdose Prevention
Information for Patients
Information for Providers
Nonopioid Treatments for Chronic Pain
Publications

The National Institute on Drug Abuse
General Page on Opioids
The NIH HEAL Initiative
Fentanyl
Heroin
Naloxone
Opioid Facts for Teens
For Providers: Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants

Substance Abuse and Mental Health Services Administration
Opioid Treatment Program Directory
Are You Taking Medicine for Opioid Use Disorder and Are Pregnant or Thinking about Having a Baby?
Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants
Medication-Assisted Treatment (MAT)
Opioid Overdose Prevention Toolkit
Opioids Publications
Rx Pain Medications: Know the Options, Get the Facts

The Food and Drug Administration
Opioid Medications
Disposal of Unused Medicines: What You Should Know
Information about Medication-Assisted Treatment (MAT)
Naloxone

The Surgeon General
Facing Addiction in America: The Surgeon General's Spotlight on Opioids
Naloxone Advisory
Preventing Misuse Postcard

MedlinePlus
Opioid Abuse and Addiction

US Department of Health and Human Services
Opioids General Information Page

The White House
Confronting the Opioid Crises in the United States

California Department of Public Health
California Opioid Overdose Surveillance Dashboard
California's Approach to the Opioid Epidemic

Safe Med LA

Spanish-Language Resources

The National Institute on Drug Abuse
Los opioides
El uso indebido de los medicamentos recetados
¿Qué es el fentanilo?
La heroína
Los opioides: Información para adolescents

Substance Abuse and Mental Health Services Administration
Publicaciones en Español
Prevención de la Sobredosis de Opioides MANUAL DE INSTRUCCIÓN


Updated June 2019
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