Prescription Pain Medications (Opioids)

Opioids attach to specific proteins, called opioid receptors, on nerve cells in the brain, spinal cord, gut, and other organs. When these drugs attach to their receptors, they block pain messages sent from the body through the spinal cord to the brain. They can also reduce or stop other essential functions like breathing.

Opioid receptors are also located in the brain’s reward center, where they cause a large release of the neurotransmitter dopamine. This causes a strong feeling of relaxation and euphoria (extreme good feelings). Repeated surges of dopamine in the reward center from drug-taking can lead to addiction.

Learn more about how the brain works and what happens when a person misuses drugs. And, check out how the brain responds to natural rewards and to drugs.

Yes, you can overdose and die from prescription opioid misuse. In fact, taking just one large dose could cause the body to stop breathing.

Deaths from overdoses of prescription drugs have been increasing since the early 1990s, largely due to the increase in misuse of prescription opioid pain relievers. More than 17,000 people died from an overdose of a prescription pain medication in 2017. The risk of overdose and death increases if you combine opioids with alcohol or other medications that also slow breathing, such as benzodiazepines (e.g. Xanax). Among all age groups, males are more likely to overdose from prescription pain medicines than are females.¹ Learn more about drug overdoses in youth.

>National Overdose Deaths Involving Prescription Opioids—Number Among All Ages, 1999-2017. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving prescriptions opioids (including methadone) from 1999 to 2017. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. Since 2016, however, the number of deaths have remained stable. The bars are overlaid by lines showing the number of deaths involving prescription opioids in combination with other synthetic narcotics (mainly fentanyl) and without other synthetic narcotics from 1999 to 2017. The number of deaths involving prescription opioids in combination with synthetic narcotics has been increasing steadily since 2014 and shows that the increase in deaths involving prescription opioids is driven by the use of fentanyl (Source: CDC WONDER).

The risk of overdose and death increase if you combine opioids with alcohol or other medications that also slow breathing, such as Benzodiazepines (e.g. Xanax).

Signs of Overdose

Signs of a possible prescription opioid overdose are:

• slow breathing
• blue lips and fingernails
• cold damp skin
• shaking
• vomiting or gurgling noise

People who are showing symptoms of overdose need urgent medical help (call 911 immediately). A drug called naloxone can be given to reverse the effects of an opioid overdose and prevent death—but only if it is given in time.

Naloxone is available as an easy-to-use nasal spray or autoinjector. It is often carried by emergency first responders, including police officers and emergency medical services. In some states, doctors can now prescribe naloxone in advance to people who use prescription opioids or to their family members, so that in the event of an overdose, it can be given right away without waiting for emergency personnel (who may not arrive in time). Read more about how Naloxone Saves Lives.

Yes, prescription opioids can be addictive.  People who misuse prescription opioids are at greater risk of becoming addicted to opioids than people who take them as prescribed by a doctor.

Opioid withdrawal can cause:

• restlessness
• muscle and bone pain
• sleep problems
• diarrhea
• vomiting (throwing up)
• cold flashes with goosebumps (“cold turkey”)
• involuntary leg movements

Carefully following the doctor’s instructions for taking a medication can make it less likely that someone will develop dependence or addiction, because the medication is prescribed in amounts and forms that are considered appropriate for that person.

Doctors should always weigh the risks of opioid dependence and addiction against the benefits of the medication, and patients should communicate any issues or concerns to their doctor as soon as they arise. The earlier a problem is identified, the better the chances are for long term recovery. 

If you, or a friend, are in crisis and need to speak with someone now: 

• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by)

If you want to help a friend, you can:

• Share resources from this site, including this page.
• Point your friend to NIDA's Step by Step Guide for Teens and Young Adults. 
• Encourage your friend to speak with a trusted adult.

If a friend is using drugs, you might have to step away from the friendship for a while. It is important to protect your own mental health and not put yourself in situations where drugs are being used.

For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.