{{Short description|Toxicity due to excessive consumption of opiates}} {{How-to|date=July 2025}} {{Redirect|Heroin overdose|other uses|heroin}} {{cs1 config|name-list-style=vanc}} {{Use dmy dates|date=September 2025}} {{Infobox medical condition (new) | name = Opioid overdose | synonyms = Narcotic overdose, opioid poisoning | image = NaloxoneKit.jpg | caption = A naloxone kit distributed in British Columbia, Canada | pronounce = | field = Toxicology, emergency medicine | symptoms = Respiratory depression, small pupils, unconsciousness | complications = Permanent brain damage, cardiac arrest | onset = | duration = | types = | causes = Opioids (morphine, codeine, heroin, fentanyl, tramadol, methadone, etc.) | risks = Opioid dependence, metabolic disorders, use of high doses of opioids, injection of opioids, use with antidepressants, alcohol, benzodiazepines, and cocaine.<ref name=WHO2014/><ref name=NIDA-deaths/> | diagnosis = Based on symptoms<ref name="NEJM20122"/> | differential = Low blood sugar, alcohol intoxication, head trauma, stroke<ref>{{cite book| vauthors = Adams JG |title=Emergency Medicine: Expert Consult -- Online|date=2008|publisher=Elsevier Health Sciences|isbn=978-1-4377-2129-4|page=PT4876|url=https://books.google.com/books?id=Q2Ag9OKC7awC&pg=PT4876 }}</ref> | prevention = Improved access to naloxone, treatment of opioid dependence | treatment = Supporting a person's breathing and naloxone | medication = | prognosis = | frequency = | deaths = over 110,000 (2017) | alt = }} <!-- Definition and symptoms -->
An '''opioid overdose''' is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, Oxycodone, and methadone.<ref name="NEJM20122">{{cite journal | vauthors = Boyer EW | title = Management of opioid analgesic overdose | journal = The New England Journal of Medicine | volume = 367 | issue = 2 | pages = 146–155 | date = July 2012 | pmid = 22784117 | pmc = 3739053 | doi = 10.1056/NEJMra1202561 }}</ref><ref>{{cite journal | vauthors = Rosenblum A, Marsch LA, Joseph H, Portenoy RK | title = Opioids and the treatment of chronic pain: controversies, current status, and future directions | journal = Experimental and Clinical Psychopharmacology | volume = 16 | issue = 5 | pages = 405–416 | date = October 2008 | pmid = 18837637 | pmc = 2711509 | doi = 10.1037/a0013628 }}</ref> This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing.<ref name="NEJM20122" /> Other symptoms include small pupils{{notetag|In the case of pethidine (brand name Demerol) in particular, extreme overdose may produce {{em|dilated}} pupils instead, due to this drug's tendency to produce non-opioid central nervous system toxicity and excitation at elevated doses.{{cn|date=April 2024}}}} and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors.<ref>{{cite book| vauthors = Malamed SF |title=Medical emergencies in the dental office|date=2007|publisher=Mosby|isbn=978-0-323-07594-7|edition=6th |location=St. Louis, Mo.|oclc=769189432}}</ref> Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.<ref name=":13" /><ref>{{cite journal| vauthors = Ritchie H, Roser M |date=16 March 2018|title=Opioids, cocaine, cannabis and illicit drugs|url=https://ourworldindata.org/illicit-drug-use|journal=Our World in Data}}</ref>
<!-- Cause and diagnosis --> Opioid overdoses are diagnosed based on symptoms and examination.<ref name="NEJM20122"/> Risk factors for opioid overdose include high levels of opioid dependence, use of opioids via injection, high-dose opioid usage, having a mental disorder or having a predisposition for one, and use of opioids in combination with other substances, such as alcohol, benzodiazepines, or cocaine.<ref name="WHO2014"/><ref>{{cite journal | vauthors = Park TW, Lin LA, Hosanagar A, Kogowski A, Paige K, Bohnert AS | title = Understanding Risk Factors for Opioid Overdose in Clinical Populations to Inform Treatment and Policy | journal = Journal of Addiction Medicine | volume = 10 | issue = 6 | pages = 369–381 | date = 2016 | pmid = 27525471 | doi = 10.1097/ADM.0000000000000245 | s2cid = 8871126 }}</ref><ref name=NIDA-deaths/> Dependence on prescription opioids can occur from their use to treat chronic pain in individuals.<ref name="WHO2014">{{cite web|title=Information sheet on opioid overdose|url=https://www.who.int/substance_abuse/information-sheet/en/|publisher=World Health Organization |date=November 2014 |archive-url=https://web.archive.org/web/20221006094443/https://www.who.int/news-room/fact-sheets/detail/opioid-overdose |archive-date=6 October 2022}}</ref> Additionally, if following a period of detoxification, which allows the tolerance level to fall, the risk of overdose upon return to use is high.<ref name="WHO2014" />
<!-- Treatment --> Initial treatment of an overdose involves supporting the person's breathing and providing oxygen to reduce the risk of hypoxia.<ref name=AHA2015Part12/> Naloxone is then recommended to those who cannot reverse the opioid's effects through breathing.<ref name=AHA2015Part12>{{cite journal | vauthors = de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt ÉW, Schexnayder SM, Samson RA | title = Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 132 | issue = 18 Suppl 2 | pages = S526–S542 | date = November 2015 | pmid = 26473000 | pmc = 6191296 | doi = 10.1161/cir.0000000000000266 }}</ref><ref name="NEJM20122"/> Giving naloxone via nasal administration or as an injection into a muscle has shown to be equally effective.<ref name="Chou2017">{{cite journal |vauthors=Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, Grusing S, Daya M |date=December 2017 |title=Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review |journal=Annals of Internal Medicine |volume=167 |issue=12 |pages=867–875 |doi=10.7326/M17-2224 |pmid=29181532 |doi-access=free}}</ref> Other efforts to prevent deaths from overdose include increasing access to naloxone and treatment for opioid dependence.<ref name=WHO2014/><ref>{{cite web|title=Opioid epidemic: 6 key steps that states should take now |publisher=American Medical Association|url=https://www.ama-assn.org/delivering-care/opioids/opioid-epidemic-6-key-steps-states-should-take-now|date=9 September 2019|access-date=14 October 2020}}</ref>
<!-- Epidemiology --> Drug use contributes to 500,000 deaths worldwide, with opioid overdose resulting in approximately 115,000 of these deaths in 2018.<ref name="WHO2014"/> This is up from 18,000 deaths in 1990.<ref name="GBD2015De">{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR }}</ref><ref name="GDB2013">{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–171 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | collaboration = GBD 2013 Mortality Causes of Death Collaborators | author1 = GBD 2013 Mortality and Causes of Death Collaborators }}</ref> In 2018, approximately 269 million people had engaged in drug usage at least once, 58 million of which used opioids.<ref name="WHO2014"/> Drug use disorders have affected around 35.6 million people worldwide in 2018.<ref name="WHO2014"/> The WHO estimates that 70% of deaths due to drug use are in relation to opioids, with 30% being due to overdose.<ref name="WHO2014"/> It is believed that the opioid epidemic has partly been caused due to assurances that prescription opioids were safe, by the pharmaceutical industry in the 1990s.<ref name=NIH2017Cri>{{cite web|title=Opioid Overdose Crisis|url=https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis|website=National Institute on Drug Abuse|access-date=29 November 2017|date=1 June 2017}}</ref> This led to unwarranted trust and a subsequent heavy reliance on opioids.<ref name="NIH2017Cri" /> Though there are treatment interventions which can effectively reduce the risk of overdose in people with opioid dependence, less than 10% of affected individuals receive it.<ref name="WHO2014"/>
==Signs and symptoms== Opiate overdose symptoms and signs can be referred to as the "opioid toxidrome triad": decreased level of consciousness, pinpoint pupils, and respiratory depression. Other signs and symptoms include seizures and muscle spasms. Sometimes, an opiate overdose can lead to such a decreased level of consciousness that the person will not wake up.thumb|Pinpoint pupils, or miosis, caused by opioids
Because of their effect on the part of the brain that regulates breathing, opioids can cause very slow or stopped breathing during overdoses, leading to hypoxia<ref name=":3" /> or death if left untreated.<ref name="WHO2014" /> Hypoxia is typically caused by respiratory depression.<ref name=":5" /><ref name=":6">{{cite journal | vauthors = Imam MZ, Kuo A, Ghassabian S, Smith MT | title = Progress in understanding mechanisms of opioid-induced gastrointestinal adverse effects and respiratory depression | journal = Neuropharmacology | volume = 131 | pages = 238–255 | date = March 2018 | pmid = 29273520 | doi = 10.1016/j.neuropharm.2017.12.032 | s2cid = 3414348 }}</ref> The brain uses oxygen to regulate the homeostasis of the body. In animal studies, it was found that opioids act on specific regions of the central nervous system associated with respiratory regulation, including the medulla and pons.<ref name=":6" /> During cerebral hypoxia, the brain lacks sufficient oxygen supply.<ref name=":5" /> Prolonged lack of oxygenation from respiratory depression can lead to detrimental damage to the brain and spinal cord and can leave the person unable to walk or function normally, even if treatment with naloxone is given.<ref name=":5" />
Alcohol also causes respiratory depression and, therefore, when taken with opioids, can increase the risk of respiratory depression and death.<ref name=WHO2014/>
In young children, opioid overdose may not be apparent right away. This is due to absorption, distribution, and metabolism differences between young children and adults and the higher amount of opioid ingestion per kilogram of body weight.<ref name="NEJM20122"/>
==Causes== [[File:Fentanyl. 2 mg. A lethal dose in most people.jpg|thumb|upright=0.8|Fentanyl. 2 mg (white powder to the right) is a lethal dose in most people.<ref>[https://www.dea.gov/galleries/drug-images/fentanyl Fentanyl]. Image 4 of 17. US DEA (Drug Enforcement Administration). See [https://web.archive.org/web/20181008000027/https://www.dea.gov/galleries/drug-images/fentanyl archive] with caption: "photo illustration of 2 milligrams of fentanyl, a lethal dose in most people".</ref> US penny is 19 mm (0.75 in) wide.]] Risk factors for opioid overdose include opioid dependence, injecting opioids, using high doses of opioids, and use together with alcohol, benzodiazepines, or cocaine.<ref name=WHO2014/><ref name=NIDA-deaths/> The risk is particularly high following detoxification.<ref name=WHO2014/> Dependence on prescription opioids can occur from their use to treat chronic pain.<ref name=WHO2014/> In young children, an overdose is usually due to opioids that are intended for their parents, older siblings, or grandparents.<ref>{{cite journal | vauthors = Boyer EW, McCance-Katz EF, Marcus S | title = Methadone and buprenorphine toxicity in children | journal = The American Journal on Addictions | volume = 19 | issue = 1 | pages = 89–95 | date = January 2010 | pmid = 20132125 | doi = 10.1111/j.1521-0391.2009.00002.x }}</ref> In mothers who take codeine during breastfeeding, opioid overdoses have occurred in their baby.<ref name=Laz2015>{{cite journal | vauthors = Lazaryan M, Shasha-Zigelman C, Dagan Z, Berkovitch M | title = Codeine should not be prescribed for breastfeeding mothers or children under the age of 12 | journal = Acta Paediatrica | volume = 104 | issue = 6 | pages = 550–556 | date = June 2015 | pmid = 25809057 | doi = 10.1111/apa.13012 | s2cid = 34870882 }}</ref> Codeine is, therefore, not recommended for those who are breastfeeding.<ref name=Laz2015/>
=== Co-ingestion === Opioid overdoses are often associated with benzodiazepines, tranquilisers (e.g. xylazine) or alcohol use.<ref>{{cite web | vauthors = Barrie J | date = July 2005 |url=http://www.bestbets.org/bets/bet.php?id=1007 | work = BestBets | title = Concomitant use of benzodiazepines in opiate overdose and the association with a poorer outcome }}</ref><ref>{{cite web | vauthors = Barrie J | date = July 2005 |url=http://www.bestbets.org/bets/bet.php?id=1006 | work = BestBets | title = Concomitant use of alcohol in opiate overdose and the association with a poorer outcome }}</ref> Other central nervous system depressants, muscle relaxers, pain relievers, anti-convulsants, anxiolytics, treatment drugs of a psychoactive or epileptic variety or any other such drug with its active function meant to calm or mitigate neuronal signaling (barbiturates, etc.) can additionally cause a worsened condition with less likelihood of recovery cumulative to each added drug. This includes drugs less immediately classed to a slowing of the metabolism such as with GABAergic like GHB or glutamatergic antagonists like PCP or ketamine.
== Risk factors == End organ dysfunction (liver disease), which may lead to decreased drug clearance, is a risk factor for opioid overdose.<ref name="Babu 2019" /> Other risk factors for opioid overdose include sleep disordered breathing disorders such as sleep apnea, pulmonary diseases (such as asthma or chronic obstructive pulmonary disease) which may reduce ventilation and concomitant use of sedating medications such as benzodiazepines, gabapentinoids, muscle relaxants and other central nervous system depressants.<ref name="Babu 2019" /> Benzodiazepine use with opioids increases the risk of overdose death by four-fold, whereas concomitant use with gabapentintoids such as gabapentin or pregabalin increases the risk of overdose death by nearly two-fold.<ref name="Babu 2019" />
Higher doses of prescription opioids, as well as long-acting formulations, are associated with an increased risk of overdose.<ref name="Babu 2019" /> In those on long-term opioid treatment for chronic pain, daily morphine equivalents greater than 200 mg were associated with death from opioid related causes (including overdose) in 3.8% of men and 2.2% of women.<ref name="Babu 2019" /> Opioids are the most common cause for serious accidental poisonings of children in the UK.<ref>{{Cite journal |last1=King |first1=Charlotte |last2=Anderson |first2=Mark |last3=Agarwal |first3=Abhishek |last4=Fakis |first4=Apostolos |last5=Parry |first5=Christopher M |last6=Lynn |first6=Richard Michael |last7=Hawcutt |first7=Daniel B |last8=Starkey |first8=Elizabeth Sarah |date=12 February 2025 |title=Severe accidental poisonings in children: a British Paediatric Surveillance Unit nationwide prospective study |url=https://adc.bmj.com/lookup/doi/10.1136/archdischild-2024-328196 |journal=Archives of Disease in Childhood |volume=110 |issue=8 |language=en |pages=archdischild–2024–328196 |doi=10.1136/archdischild-2024-328196 |pmid=39939143 |issn=0003-9888|url-access=subscription }}</ref>
=== Metabolic disorders === Opioids are primarily metabolized in the liver, before being excreted through urine. Opioids are metabolized by phase 1 and/or phase 2 metabolism, which can lead to the activation or inhibition of these drugs.<ref name=":7">{{cite journal | vauthors = Smith HS | title = Opioid metabolism | journal = Mayo Clinic Proceedings | volume = 84 | issue = 7 | pages = 613–624 | date = July 2009 | pmid = 19567715 | pmc = 2704133 | doi = 10.1016/S0025-6196(11)60750-7 }}</ref><ref name="NEJM20122"/> Phase 1 metabolism is the CYP pathway which consists of different cytochrome P450s – a set of enzymes that catalyze hydrolysis, reduction, and oxidation reactions – to create an active metabolite.<ref name=":8">{{cite web|title=Drug Metabolism - Clinical Pharmacology|url=https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-metabolism|access-date=13 November 2020|website=Merck Manuals Professional Edition|language=en-US}}</ref> In contrast, Phase 2 metabolism causes the opioids to undergo conjugation, with little to no interaction with the CYP pathway.<ref name=":8" /> The opioids undergo phase 1 and phase 2 metabolism until they are hydrophilic enough to be renally excreted.<ref name=":7" />
Various factors play a role in how an opioid is metabolized. In phase 1 metabolism, the CYP family has several polymorphisms, which can account for the difference in therapeutic responses within each individual.<ref name=":9">{{cite journal | vauthors = Preissner SC, Hoffmann MF, Preissner R, Dunkel M, Gewiess A, Preissner S | title = Polymorphic cytochrome P450 enzymes (CYPs) and their role in personalized therapy | journal = PLOS ONE | volume = 8 | issue = 12 | article-number = e82562 | date = 10 December 2013 | pmid = 24340040 | pmc = 3858335 | doi = 10.1371/journal.pone.0082562 | doi-access = free | bibcode = 2013PLoSO...882562P }}</ref> This diversification leads to opioids being modified at varying rates, which can cause the drug to remain in the bloodstream for either a longer or shorter period.<ref name=":9" /> Therefore, these polymorphisms control opioid tolerance and facilitate overdose.
=== Mental health === Evidence suggests that mental health can be a significant facilitator for opioid use disorder.<ref name=":10">{{cite journal | vauthors = Grattan A, Sullivan MD, Saunders KW, Campbell CI, Von Korff MR | title = Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse | journal = Annals of Family Medicine | volume = 10 | issue = 4 | pages = 304–311 | date = 2012 | pmid = 22778118 | pmc = 3392289 | doi = 10.1370/afm.1371 }}</ref> Given that opioids are prescribed for pain management, mental health disorders, such as depression, have been shown to increase use of opioids when treating conditions associated with chronic pain.<ref name=":10" /> Evidence has shown that individuals with mood and anxiety disorders have an increased likelihood of being prescribed opioids and continuing usage for lengthy periods of time, consequently increasing likelihood for dependence.<ref name=":11">{{cite journal | vauthors = Davis MA, Lin LA, Liu H, Sites BD | title = Prescription Opioid Use among Adults with Mental Health Disorders in the United States | journal = Journal of the American Board of Family Medicine | volume = 30 | issue = 4 | pages = 407–417 | date = 1 July 2017 | pmid = 28720623 | doi = 10.3122/jabfm.2017.04.170112 | s2cid = 23057867 | doi-access = free }}</ref> As such, affected individuals have almost double the risk of using opioids for pain relief in the long-term.<ref name=":11" /> Additionally, mental health challenges associated with trauma, economic depression, social environments conducive to substance use and risk-taking behaviours have been shown to increase opioid misuse.<ref>{{cite journal | vauthors = Webster LR | title = Risk Factors for Opioid-Use Disorder and Overdose | language = en-US | journal = Anesthesia and Analgesia | volume = 125 | issue = 5 | pages = 1741–1748 | date = November 2017 | pmid = 29049118 | doi = 10.1213/ANE.0000000000002496 | doi-access = free }}</ref> Furthermore, mental health challenges associated with cardiovascular disease, sleep disorders, and HIV can cause opioid dependence and subsequent overdose.<ref name=":12">{{cite journal | vauthors = Chiappini S, Guirguis A, John A, Corkery JM, Schifano F | title = COVID-19: The Hidden Impact on Mental Health and Drug Addiction | journal = Frontiers in Psychiatry | volume = 11 | article-number = 767 | date = 29 July 2020 | pmid = 32848937 | pmc = 7403495 | doi = 10.3389/fpsyt.2020.00767 | doi-access = free }}</ref> Notably, cyclic behaviours can be observed between mental illness and opioid use disorder where individuals with mental health diagnoses engage in opioid use which further perpetuates mental health challenges and increased drug usage.<ref name=":12" />
==Mechanism== [[File:Mu-opioid receptor (GPCR).png|thumb|Mu opioid receptor (a GPCR)]] Opioids bind with neural opioid receptors to provoke analgesic, sedative, and euphoric effects.<ref name=":3">{{cite journal | vauthors = Wang S | title = Historical Review: Opiate Addiction and Opioid Receptors | journal = Cell Transplantation | volume = 28 | issue = 3 | pages = 233–238 | date = March 2019 | pmid = 30419763 | pmc = 6425114 | doi = 10.1177/0963689718811060 }}</ref> Opioids function by stimulating specific G-protein coupled receptors distributed throughout the body—including the brain, skin and spinal cord.<ref name=":3" /> Three of the major opioid receptors include mu, kappa, delta, and nociception, each playing a role in eliciting the effects associated with opioids.<ref name=":4">{{cite journal | vauthors = Corder G, Castro DC, Bruchas MR, Scherrer G | title = Endogenous and Exogenous Opioids in Pain | journal = Annual Review of Neuroscience | volume = 41 | pages = 453–473 | date = July 2018 | pmid = 29852083 | pmc = 6428583 | doi = 10.1146/annurev-neuro-080317-061522 }}</ref> An opioid overdose results from over-activation of these receptors, which can cause permanent brain damage from cerebral hypoxia or neurotoxicity.<ref name="NIH2017Her">{{cite web|date=July 2017|title=Heroin|url=https://www.drugabuse.gov/publications/drugfacts/heroin|access-date=29 November 2017|website=National Institute on Drug Abuse}}</ref><ref name=":13">{{cite journal | vauthors = Cunha-Oliveira T, Rego AC, Oliveira CR | title = Cellular and molecular mechanisms involved in the neurotoxicity of opioid and psychostimulant drugs | journal = Brain Research Reviews | volume = 58 | issue = 1 | pages = 192–208 | date = June 2008 | pmid = 18440072 | doi = 10.1016/j.brainresrev.2008.03.002 | hdl-access = free | s2cid = 17447665 | hdl = 10316/4676 }}</ref>
Mu receptors have an analgesic effect on the brain, and are found in various parts of the nervous system including the cerebral cortex and thalamus.<ref name=":3" /> They can be found in the nucleus accumbens, the pleasure centre of the brain, as well as the amygdala.<ref name=":3" /> Kappa receptors, in the hypothalamus, produce a similar analgesic effect. They bind with dynorphins to stimulate anti-reward effects (dysphoria) and other negative effects of withdrawal. While mu receptors are the source of addiction, kappa receptors contribute to continued use. They generate dysphoria in response to increasing stress levels via corticotropin-releasing factor (CRF).<ref name=":3" /> This increases erratic shifts in mood during the withdrawal period and can prompt relapse.<ref name=":3" /> Delta receptors, found in the basal ganglia of the limbic system, have been shown to reduce anxiety by binding with enkephalins, although this requires further research.<ref name=":3" /> The most recent addition to these receptors are nociception opioid receptors. Although they have been determined to be receptors to certain ligands from opioids, their role is not yet fully understood.<ref>{{cite journal | vauthors = Al-Hasani R, Bruchas MR | title = Molecular mechanisms of opioid receptor-dependent signaling and behavior | journal = Anesthesiology | volume = 115 | issue = 6 | pages = 1363–1381 | date = December 2011 | pmid = 22020140 | pmc = 3698859 | doi = 10.1097/ALN.0b013e318238bba6 }}</ref>
When opioids are ingested, the ligand binds to these constitutively active receptors to reduce neural activity.<ref name=":4" /> This is accomplished by inhibiting adenylyl cyclase and cyclic AMP, which are necessary for communication within the central nervous system.<ref name=":4" /> There is research indicating that opioids reduce pain by disrupting ion channels and vesicle fusion.<ref name=":4" />
Prolonged exposure to opioids can cause these receptors to become internalized, leading to increased tolerance and increased opioid use.<ref name=":5">{{cite journal | vauthors = Kiyatkin EA | title = Respiratory depression and brain hypoxia induced by opioid drugs: Morphine, oxycodone, heroin, and fentanyl | journal = Neuropharmacology | volume = 151 | pages = 219–226 | date = June 2019 | pmid = 30735692 | pmc = 6500744 | doi = 10.1016/j.neuropharm.2019.02.008 }}</ref>
==Prevention== Opioid overdoses can often be prevented.<ref name=Bow2013>{{cite journal | vauthors = Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD | title = Reducing the health consequences of opioid addiction in primary care | journal = The American Journal of Medicine | volume = 126 | issue = 7 | pages = 565–571 | date = July 2013 | pmid = 23664112 | doi = 10.1016/j.amjmed.2012.11.031 }}In press</ref><ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864">{{cite journal | vauthors = Beletsky L, Rich JD, Walley AY | title = Prevention of fatal opioid overdose | journal = JAMA | volume = 308 | issue = 18 | pages = 1863–1864 | date = November 2012 | pmid = 23150005 | pmc = 3551246 | doi = 10.1001/jama.2012.14205 }}</ref> Clear protocols for staff at emergency departments and urgent care centers can reduce opioid prescriptions for individuals presenting in these settings who engage in drug seeking behaviors or who have a history of a substance use disorder.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url= https://innovations.ahrq.gov/profiles/emergency-department-and-urgent-care-clinicians-use-protocol-reduce-opioid-prescriptions |title=Emergency Department and Urgent Care Clinicians Use Protocol To Reduce Opioid Prescriptions for Patients Suspected of Abusing Controlled Substances |date=12 March 2014 | access-date=14 March 2014}}</ref> Drug seeking behaviors include but are not limited to obsessiveness or impatience when it comes to attaining medications, seeking multiple pain adjunct medications, and inconsistent physiological presentation.<ref>{{cite journal | vauthors = Pretorius RW, Zurick GM | title = A systematic approach to identifying drug-seeking patients | journal = Family Practice Management | volume = 15 | issue = 4 | pages = A3–A5 | date = April 2008 | pmid = 18444310 }}</ref> A prescription monitoring program may help determine if an individual is receiving a high doses of opioids or combinations of medications such as benzodiazepines and opioids that put them at high risk.<ref name=":1" /> Limited amount of evidence suggests opioid therapy with extended-release or long-acting formulations may increase the risk of an unintentional overdose compared to shorter-acting agents.<ref>{{cite journal | vauthors = Miller M, Barber CW, Leatherman S, Fonda J, Hermos JA, Cho K, Gagnon DR | title = Prescription opioid duration of action and the risk of unintentional overdose among patients receiving opioid therapy | journal = JAMA Internal Medicine | volume = 175 | issue = 4 | pages = 608–615 | date = April 2015 | pmid = 25686208 | doi = 10.1001/jamainternmed.2014.8071 | doi-access = }}</ref> Routinely screening using tools such as the CAGE-AID and the Drug Abuse Screening Test (DAST-10) in adults and the CRAFFT in those aged 14–18 years is recommended.<ref name=Bow2013/> The revised risk index for overdose or severe opioid induced respiratory depression (RIOSORD) is a validated screening tool that may be used to estimate the risk of overdose in people using opioids, or the rapid opioid dependence screen may be used as a more rapid and succinct method to screen for opioid use disorder.<ref name="Babu 2019">{{cite journal |last1=Babu |first1=Kavita M. |last2=Brent |first2=Jeffrey |last3=Juurlink |first3=David N. |title=Prevention of Opioid Overdose |journal=New England Journal of Medicine |date=6 June 2019 |volume=380 |issue=23 |pages=2246–2255 |doi=10.1056/NEJMra1807054|pmid=31167053 }}</ref> Other "drug seeking" behaviors and physical indications of drug use should be used as clues to perform formal screenings.<ref name=Bow2013/>
There are several medication-assisted treatments available for people with opioid use disorder or opioid dependence who are at higher risk for opioid overdose.<ref name="WHO2014"/><ref name=":2">{{cite web|url=https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf|title=ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use|access-date=1 November 2018|archive-date=7 April 2019|archive-url=https://web.archive.org/web/20190407162936/https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf}}</ref> The selection of treatment depends on various factors, such as a person's preference, accessibility, and history of treatment.<ref name=":2" /> Examples of medication-assisted treatments are buprenorphine (with or without naloxone), naltrexone, and methadone.<ref>{{cite news|url=https://www.ajmc.com/journals/supplement/2018/combating-opioid-epidemic/current-and-emerging-options-to-combat-the-opioid-epidemic?p=3|title=Current and Emerging Options to Combat the Opioid Epidemic|work=AJMC|access-date=1 November 2018}}</ref><ref>{{cite journal | vauthors = Mattick RP, Breen C, Kimber J, Davoli M | title = Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence | journal = The Cochrane Database of Systematic Reviews | issue = 2 | article-number = CD002207 | date = February 2014 | volume = 2014 | pmid = 24500948 | doi = 10.1002/14651858.CD002207.pub4 | s2cid = 207854926 | pmc = 10617756 }}</ref> Methadone and buprenorphine are associated with reduced mortality in those with opioid use disorder as well as higher drug treatment program retention, lower illicit drug use, and decreased overdose deaths.<ref name="Babu 2019" /> The mortality benefit of long-term naltrexone use in those with opioid use disorder is less well-established.<ref name="Babu 2019" /> After a non-fatal opioid overdose, subsequent methadone or buprenorphine initiation and use reduce the risk of overdose death by 59% and 38%, respectively. Initiating buprenorphine in the emergency department is associated with lower mortality and increased adherence to opioid use disorder treatment programs.<ref name="Babu 2019" /> Peer support groups have tentative evidence of benefit.<ref>{{cite journal | vauthors = Tracy K, Wallace SP | title = Benefits of peer support groups in the treatment of addiction | journal = Substance Abuse and Rehabilitation | volume = 7 | pages = 143–154 | date = September 2016 | pmid = 27729825 | pmc = 5047716 | doi = 10.2147/SAR.S81535 | doi-access = free }}</ref> There is also some evidence indicating benefits in community-based overdose education and naloxone distribution programs.<ref>{{cite journal | vauthors = Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA | title = A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming Into Clinical Practice | journal = Substance Abuse | volume = 36 | issue = 2 | pages = 240–253 | date = 16 March 2015 | pmid = 25774771 | pmc = 4470731 | doi = 10.1080/08897077.2015.1010032 | bibcode = 2015JPkR...36..240M }}</ref> Buprenorphine and methadone can help decrease drug cravings.<ref name=":2" /> Combining pharmacologic treatments with behavioral therapy, such as support or recovery groups, can increase the likelihood of overcoming addiction and reduce the risk of an opioid overdose. thumb|President Trump with families of overdose victims after signing the HALT Fentanyl Act, 16 July 2025 Individuals diagnosed with opioid dependence should be prescribed naloxone to prevent overdose. They should be directed to one of the treatment options available, such as needle exchange programs and treatment centers.<ref name=Bow2013 /><ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864" /> A naloxone prescription is also recommended when risk factors for opioid overdose are present, such as a history of overdose, substance use disorder, or higher doses of opioids.<ref name=":1">{{cite journal | vauthors = Dowell D, Haegerich TM, Chou R | title = CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016 | journal = JAMA | volume = 315 | issue = 15 | pages = 1624–1645 | date = April 2016 | pmid = 26977696 | pmc = 6390846 | doi = 10.1001/jama.2016.1464 }}</ref> With the CDC recommending naloxone be provided to all people on long term opioids who have risk factors for overdose, including a history of a substance use disorder, daily morphine equivalents greater than 50 mg or concurrent benzodiazepine use.<ref name="Babu 2019" /> Brief motivational interviewing can also be performed and has been shown to improve people's motivation to change their behavior.<ref name=Bow2013 /><ref>{{cite journal | vauthors = Zahradnik A, Otto C, Crackau B, Löhrmann I, Bischof G, John U, Rumpf HJ | title = Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients | journal = Addiction | volume = 104 | issue = 1 | pages = 109–117 | date = January 2009 | pmid = 19133895 | doi = 10.1111/j.1360-0443.2008.02421.x }}</ref> Despite these opportunities, the dissemination of prevention interventions in the US has been hampered by the lack of coordination and sluggish federal government response.<ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864" />
Unused or old opioids should not be stored in the home as there is a risk of people using the drugs for non-medical purposes. Among adolescents and young-adults, non-medical use of prescription opioids is associated with a subsequent 13-fold increased risk of heroin use later in life.<ref name="Babu 2019" /> Opioids that are no longer being used may be taken to drug take back programs at local pharmacies, healthcare facilities or law enforcement agencies for safe disposal. The United States Food and Drug Administration also has a "flush list"; a list of medications that may be safely disposed of by flushing down the toilet.<ref name="FDA">{{cite web |title=Drug Disposal: FDA's Flush List for Certain Medicines |url=https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines |archive-url=https://web.archive.org/web/20201021034725/https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines |archive-date=21 October 2020 |website=FDA |access-date=31 May 2024 |language=en |date=1 October 2020 }}</ref>
In the United States, 49 states and the District of Columbia have expanded naloxone access at a pharmacy level via standing order, protocol order, naloxone-specific collaborative practice agreement, or pharmacist prescriptive authority.<ref>{{cite web|url=http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139|title=PDAPS - Naloxone Overdose Prevention Laws|website=pdaps.org|access-date=23 October 2019}}</ref>
==Treatments== If someone is suspected to have overdosed on opioids, call for medical attention, administer naloxone, and provide basic life support as soon as possible.<ref name=":0">{{cite web |date=19 July 2021 |title=Responding to a suspected opioid overdose {{!}} NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/topics/opioids/response.html |access-date=4 November 2022 |website=www.cdc.gov |language=en-us}}</ref>
[[File:Mendocino Pride 2023 - Sarah Stierch - 12.jpg|thumb|Free Narcan and test strips at a community event in Hopland, California]] === Naloxone === {{Main|Naloxone}}
Naloxone works by temporarily blocking the effects of opioids, including respiratory depression and sedation.<ref name=":0" /><ref name="NEJM20122"/> Naloxone is safe and side effects are rare, generally limited to allergic reactions.<ref>{{cite web |date=11 January 2022 |title=Naloxone DrugFacts |url=https://nida.nih.gov/publications/drugfacts/naloxone |archive-url=https://web.archive.org/web/20220127063621/https://nida.nih.gov/publications/drugfacts/naloxone |archive-date=27 January 2022 |access-date=17 November 2022 |website=National Institute on Drug Abuse |language=en}}</ref> It should be given if there is any suspicion of an opioid overdose. Naloxone is available to the public in the United States in two routes of administration: intranasal and intramuscular/subcutaneous. Intranasal forms include Narcan, approved in 2015, and Kloxxado, approved in 2021.<ref name=":15" /> Formulations that are injectable into the intramuscular or subcutaneous spaces include Evzio, approved in 2014, and Zimhi, approved in 2021.<ref name=":22" /><ref name=":32" /> The doses are approved for both children and adults and may be repeated every 2–3 minutes.<ref name=":15">{{cite journal | vauthors = | title = Higher-Dose Naloxone Nasal Spray (Kloxxado) for Opioid Overdose | journal = JAMA | volume = 326 | issue = 18 | pages = 1853–1854 | date = November 2021 | pmid = 34751711 | doi = 10.1001/jama.2021.15948 | s2cid = 243863732 }}</ref><ref name=":22">{{cite web |date=October 2016 |title=EVZIO® (naloxone hydrochloride injection) Auto-Injector for intramuscular or subcutaneous use |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/209862lbl.pdf |website=FDA.gov |archive-url=https://web.archive.org/web/20221116170243/https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/209862lbl.pdf |archive-date=16 November 2022 }}</ref><ref name=":32">{{cite web |date=October 2021 |title=ZIMHI (naloxone hydrochloride injection) for intramuscular or subcutaneous use |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/212854s000lbl.pdf |url-status=live |website=FDA.gov |archive-url=https://web.archive.org/web/20221115144030/http://www.accessdata.fda.gov/drugsatfda_docs/label/2021/212854s000lbl.pdf |archive-date=15 November 2022 }}</ref> Synthetic opioids like fentanyl and carfentanil are much more potent than prescription opioids and heroin.<ref>{{cite journal | vauthors = Armenian P, Vo KT, Barr-Walker J, Lynch KL | title = Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review | journal = Neuropharmacology | volume = 134 | issue = Pt A | pages = 121–132 | date = May 2018 | pmid = 29042317 | doi = 10.1016/j.neuropharm.2017.10.016 | s2cid = 21404877 | url = https://escholarship.org/uc/item/8xh0s7nf }}</ref> There is some debate about whether increased doses of naloxone are required to reverse overdose from synthetic opioids; however, this concern has prompted FDA approval of higher dose naloxone formulations such as Kloxxado and Zimhi.<ref name=":15" /><ref>{{cite journal |vauthors=Moss RB, Carlo DJ |date=February 2019 |title=Higher doses of naloxone are needed in the synthetic opioid era |journal=Substance Abuse Treatment, Prevention, and Policy |volume=14 |issue=1 |article-number=6 |doi=10.1186/s13011-019-0195-4 |pmc=6379922 |pmid=30777088 |doi-access=free }}</ref> The effects of naloxone last for approximately 30-90 minutes, at which point opioids present in the body may begin to take effect again depending on the specific opioids duration of action. Therefore, transport to a hospital is indicated after naloxone administration, and the medication may need to be re-administered.<ref name="Babu 2019" /> {| class="wikitable" |+ Naloxone Formulations for Public Use in the US !Brand name !Route of Administration !Dose !Additional Considerations |- |Narcan<ref>{{cite web |date=November 2015 |title=NARCAN® (naloxone hydrochloride) nasal spray |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/208411lbl.pdf |archive-url=https://web.archive.org/web/20151123222838/http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/208411lbl.pdf |archive-date=23 November 2015 |website=FDA.gov}}</ref> |Intranasal |4 mg | |- |Kloxxado<ref>{{cite web |date=April 2021 |title=KLOXXADO (naloxone hydrochloride) nasal spray |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/212045s000lbl.pdf |archive-url=https://web.archive.org/web/20210430211341/https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/212045s000lbl.pdf |archive-date=30 April 2021 |website=FDA.gov}}</ref> |Intranasal |8 mg | |- |Evzio<ref name=":22" /> |Intramuscular/subcutaneous auto-injector |2 mg | |- |Zimhi<ref name=":32" /> |Intramuscular/subcutaneous prefilled syringe |5 mg |For individuals 12 years of age or older |}
==== Access to Naloxone ==== {{globalize|section|US|date=February 2024}} Opioid overdose should be reversed as soon as possible. To shorten the time between overdose and naloxone administration, multiple programs have been enacted to improve naloxone access for drug users, caregivers, and first responders.<ref name=":42">{{cite web |date=29 May 2019 |title=Expanding Access to Naloxone: A Review of Distribution Strategies |url=https://ldi.upenn.edu/our-work/research-updates/expanding-access-to-naloxone-a-review-of-distribution-strategies/ |access-date=4 November 2022 |website=Penn LDI |language=en-US}}</ref> In the US, these efforts include FDA approval of intranasal and injectable naloxone over the counter, professional organizations recommending physicians to co-prescribe naloxone when opioids are used for pain management, free community overdose education and naloxone distribution (OEND) programs, and efforts to train non-medical first responders such as firefighters and police to use naloxone. These actions have reduced opioid-related deaths at the state and national levels and are cost-effective.<ref name=":42" /><ref>{{cite web |date=30 March 2017 |title=Naloxone for Opioid Overdose: Life-Saving Science |url=https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science |archive-url=https://web.archive.org/web/20220130192314/https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science |archive-date=30 January 2022 |access-date=4 November 2022 |website=National Institute on Drug Abuse |language=en}}</ref>
In the UK, naloxone is a prescription-only medicine, but drug treatment services can supply it without a prescription. In an emergency, anyone can use it as a life-saving measure.<ref>{{cite web |url=https://www.gov.uk/government/publications/widening-the-availability-of-naloxone/widening-the-availability-of-naloxone|title= Widening the availability of naloxone|author=<!--Not stated--> |date=18 February 2019 |website=GOV.UK |publisher= |access-date= 8 February 2024}}</ref>
In August 2024, a new device was developed by researchers at MIT and Brigham and Women's Hospital that can be implanted under the skin, which rapidly releases naloxone when an overdose is detected.<ref>{{Cite web |date=14 August 2024 |title=An implantable sensor could reverse opioid overdoses |url=https://news.mit.edu/2024/implantable-sensor-could-reverse-opioid-overdoses-0814 |access-date=16 August 2024 |website=MIT News {{!}} Massachusetts Institute of Technology |language=en}}</ref>
=== Basic Life Support === Opioid overdose leads to death when people stop breathing.<ref>{{cite journal | vauthors = Boom M, Niesters M, Sarton E, Aarts L, Smith TW, Dahan A | title = Non-analgesic effects of opioids: opioid-induced respiratory depression | journal = Current Pharmaceutical Design | year = 2012 | volume = 18 | issue = 37 | pages = 5994–6004 | pmid = 22747535 | doi = 10.2174/138161212803582469 | s2cid = 6751315 }}</ref> Bystanders trained in first aid can evaluate people who have overdosed and provide basic life support including rescue breathing via bag valve mask or mouth to mouth. If the person who has overdosed does not have a pulse, rescuers should begin CPR.<ref name=":0" />
=== Other Treatments === Another medication that can be used to treat opioid overdoses is Nalmefene, which is an opioid derivative structurally similar to Naltrexone. It works similarly to Naloxone but has a longer half-life.<ref>{{cite journal | vauthors = Wang DS, Sternbach G, Varon J | title = Nalmefene: a long-acting opioid antagonist. Clinical applications in emergency medicine | journal = The Journal of Emergency Medicine | volume = 16 | issue = 3 | pages = 471–475 | date = May 1998 | pmid = 9610980 | doi = 10.1016/s0736-4679(98)00019-5 | doi-access = free }}</ref> It is approved for intravenous, intramuscular, and subcutaneous administration by prescription only, unlike the over the counter formulations of naloxone.<ref>{{cite web |title=Revex (nalmefene hydrochloride injection) |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020459s006lbl.pdf |website=FDA.gov}}</ref>
==Epidemiology== {{globalize|date=October 2018}} {{See also|Opioid epidemic}} [[File:2 milligrams of fentanyl on pencil tip. A lethal dose for most people. US Drug Enforcement Administration.jpg|thumb|upright=1.0|A two milligram dose of fentanyl powder (on pencil tip) is a lethal amount for most people.<ref name=onepill>{{cite web |title=One Pill Can Kill |url=https://www.dea.gov/onepill |access-date=15 November 2023 |website=US Drug Enforcement Administration |archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115200822/https://www.dea.gov/onepill |url-status=live}}</ref>]] In 2016, the World Health Organization estimated that 34 million people used opioids and 19 million used opiates.<ref name="WHO2014"/> Of these, about 27 million people had opioid dependence, with the majority—but a decreasing number—using illicit heroin.<ref name="WHO2014"/> In 2015, 118,000 people died from opioid use disorders, causing almost one-third of all drug-related deaths.<ref name="WHO2014"/>
=== United States === {{Further|US drug overdose death rates and totals over time}} Of the 70,200 overdose deaths in the US in 2017, opioids were involved in 47,600, with three male deaths for each female death.<ref name="NIDA-deaths">{{cite web |date=20 January 2022 |title=Overdose Death Rates |url=https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates |archive-url=https://web.archive.org/web/20221005054752/https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates |archive-date=5 October 2022 |publisher=National Institute on Drug Abuse}}</ref> This is an increase from 2016 where over 64,000 died from drug overdose, and opioids were involved in over 42,000.<ref name=CDC-counts>{{cite web|url=https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf|title=Provisional Counts of Drug Overdose Deaths, as of 8/6/2017|last=National Center for Health Statistics|author-link=National Center for Health Statistics|date=<!-- not specified -->|publisher=Centers for Disease Control and Prevention|location=United States}} Source lists US totals for 2015 and 2016 and statistics by state.</ref> In 2017, the five states with the highest rates of death due to drug overdose were West Virginia (57.8 per 100,000), Ohio (46.3 per 100,000), Pennsylvania (44.3 per 100,000), Kentucky (37.2 per 100,000), and New Hampshire (37.0 per 100,000).<ref name=CDC-map>[https://www.cdc.gov/drugoverdose/data/statedeaths.html Drug Overdose Deaths]. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Click on a map year. The data table is below the map. Number of deaths for each state, and the age-adjusted death rates for each state. Also, place the cursor on the map states to get data.</ref>
Concerning the 2017 data in the charts below, deaths from the various drugs add up to more than 70,200 because multiple substances are involved in many of the deaths.<ref name=NIDA-deaths/> According to the National Safety Council, the lifetime odds of dying from an overdose in the United States is 1 in 96.<ref>{{cite web |title=Odds of Dying |url=https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/ |website=Injury Facts |access-date=31 January 2019}}</ref>
In 2023, the most opioid overdose deaths were among Whites (47,754), followed by Blacks (16,481), Latinos (11,310), Native Americans (1,170), and Asians (695).<ref>{{cite news |title=Opioid Overdose Deaths by Race/Ethnicity |url=https://www.kff.org/mental-health/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D |work=Kaiser Family Foundation |date=2023}}</ref>
[[File:Drug overdose death rates per 100,000 by state. US map.svg|350px|thumb|Drug overdose deaths in the US per 100,000 people by state.<ref name=NCHS-map>[https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm Drug Overdose Mortality by State]. Pick the year from the menu below the map. From National Center for Health Statistics for the Centers for Disease Control and Prevention. The numbers are in the data table below the map and by running your cursor over the map at the source. The CSV data link is below the table.</ref><ref name=CDC-map/>]]
<gallery mode="packed" style="text-align:left" heights="180px" caption="Charts of deaths involving specific opioids and classes of opioids"> File:US timeline. Opioid deaths.jpg|US yearly deaths from all opioid drugs. Included in this number are opioid analgesics, along with heroin and illicit synthetic opioids.<ref name=NIDA-deaths/> File:US timeline. Deaths involving other synthetic opioids, predominately Fentanyl.jpg|US yearly deaths involving other synthetic opioids, predominately Fentanyl.<ref name=NIDA-deaths/> File:US timeline. Prescription opioid pain reliever deaths.jpg|US yearly deaths involving prescription opioids. Non-methadone synthetics is a category dominated by illegally acquired fentanyl, and has been excluded.<ref name=NIDA-deaths/> File:Timeline of US overdose deaths involving heroin, by other opioid involvement.jpg|US yearly overdose deaths involving heroin.<ref name=NIDA-deaths/> </gallery>
== Awareness == The Substance Abuse and Mental Health Services Administration hosts an annual health observance known as National Prevention Week. Every third week of May, they encourage communities across the country to unite to share stories about positive mental and behavioral health and the importance of implementing prevention methods.<ref>{{cite web|url=https://www.samhsa.gov/prevention-week/about|title=About National Prevention Week| vauthors = Heslin C |date=8 November 2013|website=www.samhsa.gov|access-date=1 November 2018}}</ref> They also sponsor Recovery Month every September. Recovery Month aims to raise awareness about mental and substance use disorders and to honor individuals who recover, promoting the positive message that prevention works and that treatment is effective.<ref>{{cite web|url=https://www.recoverymonth.gov/|title=Home {{!}} RecoveryMonth.gov|website=www.recoverymonth.gov|language=en|access-date=20 November 2018|archive-date=30 November 2018|archive-url=https://web.archive.org/web/20181130023527/https://www.recoverymonth.gov/}}</ref>
International Overdose Awareness Day is on 31 August to remember those who have died from an overdose, to decrease the stigma of drug-related deaths, and to promote the prevention of overdose.<ref>{{cite journal | vauthors = | title = International Overdose Awareness Day - August 31, 2019 | language = en-us | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 34 | page = 737 | date = August 2019 | pmid = 31466079 | pmc = 6715257 | doi = 10.15585/mmwr.mm6834a1 }}</ref>
== See also == *Harm reduction *List of deaths from drug overdose and intoxication *Responsible drug use
== Notes == {{Notefoot}}
== References == {{Reflist}}
== External links == * [https://www.who.int/news-room/fact-sheets/detail/opioid-overdose WHO fact sheet on opioid overdose] * {{cite book |url=http://apps.who.int/iris/bitstream/10665/137462/1/9789241548816_eng.pdf?ua=1 |title=Community management of opioid overdose |date=2014 |publisher=World Health Organization |isbn=978-92-4-154881-6 |archive-url=https://web.archive.org/web/20220901070459/http://apps.who.int/iris/bitstream/handle/10665/137462/9789241548816_eng.pdf?sequence=1 |archive-date=1 September 2022}}
{{Medical resources | DiseasesDB = | ICD10 = {{ICD10|F|11||f|10}}.0, {{ICD10|T|40|0|t|36}}-{{ICD10|T|40|2|t|36}} | ICD9 = {{ICD9|305.5}}, {{ICD9|965.0}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = emerg | eMedicineTopic = 330 | MeshID = }} {{Psychoactive substance use}} {{Poisoning and toxicity}} {{Opioidergics}}
Category:Poisoning by drugs, medicaments and biological substances Category:Drug overdose Category:Opioids Category:Medical emergencies Category:Wikipedia medicine articles ready to translate Category:Causes of death