Opioids

Opioids are a family of drugs that act on the body's opioid receptors. They include medicines prescribed for pain, such as oxycodone, hydrocodone, morphine, and fentanyl, and illegal drugs such as heroin and illicitly manufactured fentanyl.

Opioid use disorder (OUD) is a treatable medical condition in which opioid use becomes hard to control and continues despite harm. It is also one of the most dangerous substance use disorders, because of overdose. That is why this page starts with safety — and why the most effective treatments focus on keeping people alive while they recover.

This guide covers opioids as a group. Detailed guides for fentanyl, heroin, and prescription opioid painkillers follow below.

Opioid use disorder (OUD) covers problematic use of heroin, illicit fentanyl, and prescription opioids. Physical dependence on prescribed opioids taken as directed is not, by itself, a use disorder.

OUD is diagnosed by a clinician based on a pattern of problems such as using more than intended, being unable to cut down, intense craving, continuing despite harm, and giving up important activities.

• A starting point that varies. Some people first used opioids prescribed after an injury or surgery; others started with pills or heroin from friends or the street.
• Rapid tolerance. The body adapts quickly, so the same amount produces less effect and more is needed.
• Withdrawal as a driver. Once dependent, many people keep using mostly to avoid feeling sick.
• Pain, trauma, and mental health. Chronic pain, depression, anxiety, and trauma are common alongside OUD and can make each other worse.²
• Genetics and environment. Family history, stress, availability, and community conditions all shape risk.³

Opioids bind to opioid receptors in the brain, spinal cord, and gut. In the brain they reduce pain, produce calm and euphoria, and — critically — slow the brainstem areas that control breathing. That last effect is what makes overdose deadly.

With repeated use, the brain's reward, stress, and decision-making systems adapt. Over time, many people describe using not to feel high but to feel normal, as the stress systems that drive withdrawal become more active.⁴

• Withdrawal. Opioid withdrawal — aches, sweating, diarrhea, vomiting, anxiety, and sleeplessness — can be intensely unpleasant, and using again stops it within minutes.
• Craving and cues. Places, people, and stress can trigger strong cravings long after withdrawal ends.
• Untreated pain or distress. If pain, trauma, or depression are not addressed, the reasons for using remain.

• Taking prescribed opioids in larger amounts, more often, or for other reasons than prescribed
• Running out of prescriptions early, or seeing several prescribers
• Craving opioids or thinking about them constantly
• Withdrawal symptoms between doses
• Pinpoint pupils, nodding off, or slurred speech
• Pulling away from family and activities; new secrecy about money or time
• Using despite overdoses, health problems, or legal trouble

Overdose

The most urgent risk. The illicit drug supply in the U.S. is now dominated by fentanyl, which is far more potent than heroin and is often mixed into other drugs.⁵

Infections

Injecting can spread HIV and hepatitis C and cause skin and heart infections. Sterile supplies and testing reduce these risks.

Physical health

Constipation, hormone changes, sleep problems, and health conditions that go untreated.

Family and work

Financial strain, legal problems, broken trust, and fear among family members.

• Families often live with constant fear. That fear is understandable. It is also why naloxone in the home matters so much.
• Stigma blocks the best treatment. Some people are told medication "isn't real recovery." The evidence says otherwise: medications for OUD reduce overdose deaths and help people stay in treatment.⁶
• Return to use is common. It does not mean treatment failed or that recovery is impossible — but because of overdose risk, staying connected to care matters even more for OUD than for many other conditions.
• Legal and housing problems compound everything. Practical support often has to come alongside medical treatment.

For OUD, the first goal is staying alive. That means overdose safety today, and the fastest possible access to effective treatment.

• Get naloxone. In the U.S., naloxone nasal spray is approved for sale without a prescription.⁷
• Never use alone, and make sure someone nearby has naloxone and knows how to use it.
• Ask about medication for OUD — it can often be started quickly, sometimes in an emergency department or by telehealth.
• If you are not ready to stop, harm-reduction services can lower your risk and connect you to care when you are ready.

Three medications are FDA-approved to treat OUD: methadone, buprenorphine, and extended-release naltrexone. SAMHSA's clinical guidance describes them as effective treatments that reduce illicit opioid use, help people stay in treatment, and lower the risk of overdose death.⁶

Methadone

A long-acting opioid medication that prevents withdrawal and reduces craving. In the U.S. it is dispensed through certified opioid treatment programs.

Buprenorphine

A partial opioid agonist that reduces craving and withdrawal with a ceiling on some effects. It can be prescribed in offices and by telehealth, as a daily film or tablet or a monthly injection.

Extended-release naltrexone

A monthly injection that blocks opioid effects. People need to be fully withdrawn from opioids before starting it.

Medication works best combined with counseling, peer support, and help with practical needs — but the medication itself is not optional extra. Stopping medication too early is associated with return to use.⁶ How long to continue is a decision for the person and their clinician.

Make an overdose response plan before it is needed

Naloxone can reverse opioid overdose, but emergency medical care remains necessary. CDC guidance identifies inability to wake someone and slow or difficult breathing as warning signs. Make emergency contact promptly, give naloxone if available, follow the product instructions and emergency dispatcher guidance, and stay until responders arrive.⁸

For preparation, ask a pharmacist or clinician to show you how your particular naloxone product is used. Check where it is stored and its expiration date, and make sure someone close to you knows where to find it. Consider writing a simple household plan covering who will call for emergency help, who can bring the naloxone, and how responders will reach the person.

The emergency plan and the treatment plan serve different purposes. At a care appointment, ask how medication options fit your circumstances, how follow-up will work, and whom to contact if access is interrupted. Be open about other medications and substances so the clinician can consider interactions. These questions support a discussion; they do not tell you which medication or dose is appropriate.

1. If someone may be overdosing, call 911, give naloxone, and stay with them. Naloxone is safe to give if you are unsure.¹
2. Get naloxone from a pharmacy or local health department and keep it where people can find it.
3. Do not use alone. If you use, use less, go slowly, and have someone with naloxone nearby.
4. Call the SAMHSA National Helpline (1-800-662-4357) or search FindTreatment.gov (opens another website) for programs that offer medication for OUD.
5. If withdrawal is severe — especially vomiting or diarrhea that will not stop — seek medical care for dehydration.

• Keep naloxone in your home and car, learn how to use it, and tell others where it is.
• Learn the signs of overdose — they are listed at the top of this page.
• Express concern without threats or ultimatums you will not keep. Fear-based pressure tends to push people further away.
• Support medication treatment if it is offered. It is real treatment.
• Look after yourself: Nar-Anon, SMART Recovery Family & Friends, and family therapy can help.