{{Short description|Deaths due to abuse of opioid drugs}} {{Globalize|1=article|2=North America|date=January 2026}} {{cs1 config|name-list-style=vanc}} {{Use American English|date = April 2019}} {{Use mdy dates|date = April 2019}}
The '''opioid epidemic''', also referred to as the '''opioid crisis''', is the rapid increase in the overuse, misuse or abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates or opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.[[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.]]
Opioids are a diverse class of moderate to strong painkillers, including oxycodone (commonly sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin, Norco), and fentanyl (Abstral, Actiq, Duragesic, Fentora), which is a very strong painkiller that is synthesized to resemble other opiates such as opium-derived morphine and heroin.<ref>{{Cite web|url=https://www.drugabuse.gov/drugs-abuse/opioids|title=Opioids|website=Drugs of Abuse|publisher=National Institute on Drug Abuse|access-date=July 29, 2019|archive-date=July 26, 2019|archive-url=https://web.archive.org/web/20190726161748/https://www.drugabuse.gov/drugs-abuse/opioids|url-status=live}}</ref> The potency and availability of these substances, despite the potential risk of addiction and overdose, have made them popular both as medical treatments and as recreational drugs. Due to the sedative effects of opioids on the respiratory center of the medulla oblongata, opioids in high doses present the potential for respiratory depression and may cause respiratory failure and death.<ref>{{cite web |date=4 August 2021 |title=Opioid overdose |url=https://www.who.int/news-room/fact-sheets/detail/opioid-overdose |url-status=live |archive-url=https://web.archive.org/web/20141201235302/https://www.who.int/substance_abuse/information-sheet/en/ |archive-date=December 1, 2014 |website=World Health Organization |publisher=}}</ref>
Opioids are highly effective for treating acute pain,<ref>{{cite journal |vauthors=Alexander GC, Kruszewski SP, Webster DW | title = Rethinking Opioid Prescribing to Protect Patient Safety and Public Health | journal = JAMA | volume = 308 | issue = 18 | pages = 1865–1866 | year = 2012 | pmid = 23150006 | doi = 10.1001/jama.2012.14282 }}</ref> but there is strong debate over whether they are suitable for treating chronic or high impact intractable pain,<ref name="Opioids for chronic noncancer pain">{{cite journal|last1=Franklin|first1=G. M.|title=Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology|journal=Neurology|date=29 September 2014|volume=83|issue=14|pages=1277–1284|doi=10.1212/WNL.0000000000000839|pmid=25267983|doi-access=free}}</ref> as the risks may outweigh the benefits.<ref name="Opioids for chronic noncancer pain"/>
== North America == === United States === {{main|Opioid epidemic in the United States}}{{See also|California opioid crisis}} From 1999 to 2021 it is estimated 645,000 Americans have died from opioid use.<ref>{{cite news |title=Understanding the Opioid Overdose Epidemic |url=https://www.cdc.gov/opioids/basics/epidemic.html |work=Centers for Disease Control and Prevention |date=August 8, 2023}}</ref> The number of overdose deaths involving opioids in 2021 was ten times what it was in 1999.<ref>{{Cite web |date=2023-08-08 |title=Data Overview {{!}} Opioids {{!}} CDC |url=https://www.cdc.gov/opioids/data/index.html |access-date=2023-11-12 |website=Cdc.gov }}</ref> What the U.S. Surgeon General dubbed "The Opioid Crisis" was theorized to have been caused by the over-prescription of opioids in the 1990s,<ref>{{cite book |editor1-last=Bonnie |editor1-first=Richard J. |editor2-last=Ford |editor2-first=Morgan A. |editor3-last=Phillips |editor3-first=Jonathan K. |title=Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use [PART II. Addressing the Opioid Epidemic]|date=2017 |publisher=The National Academies Press |isbn=978-0-309-45954-9 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK458661/ |chapter=4. Trends in Opioid Use, Harms, and Treatment |id=Responsible parties: National Academies of Sciences, Engineering and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse|access-date=January 10, 2022|archive-date=May 14, 2021 |archive-url=https://web.archive.org/web/20210514015544/https://www.ncbi.nlm.nih.gov/books/NBK458661/|url-status=live}}</ref> which led to the CDC ''Guideline for Prescribing Opioids for Chronic Pain'', 2016<ref>{{cite journal |title=CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 |journal=MMWR. Recommendations and Reports |doi=10.15585/mmwr.rr6501e1er |date=2016|last1=Dowell |first1=Deborah |last2=Haegerich |first2=Tamara M. |last3=Chou |first3=Roger |volume=65 |issue=1 |pages=1–49 |pmid=26987082 |doi-access=free |pmc=6390846 }}</ref> and the resulting impact on medical access to prescription opioids "outside of active cancer treatment, palliative and end of life." Opioids initiated for post-surgical pain management have long been debated as one of the causative factors in the opioid crisis, with misuse/abuse estimated at 4.3% of people continuing opioid use after trauma or surgery.<ref name="Mohamadi 1332–1340">{{cite journal | vauthors = Mohamadi A, Chan JJ, Lian J, Wright CL, Marin AM, Rodriguez EK, von Keudell A, Nazarian A | title = Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery: A Systematic Review and Meta-(Regression) Analysis | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 100 | issue = 15 | pages = 1332–1340 | date = August 2018 | pmid = 30063596 | doi = 10.2106/JBJS.17.01239 | s2cid = 51891341 }}{{subscription required}}</ref>
When people continue to use opioids beyond what a doctor prescribes, or when opioids are over-prescribed, whether to minimize pain or induce euphoric feelings, it can mark the beginning stages of an opiate addiction, with a tolerance developing and eventually leading to dependence, when a person relies on the drug to prevent withdrawal symptoms.<ref name=CNN>{{cite web|url=https://edition.cnn.com/2017/02/08/health/opioids-overdose-deaths-epidemic-explainer/ |title=Why opioid overdose deaths seem to happen in spurts |url-status=live |archive-url=https://web.archive.org/web/20170517103003/https://edition.cnn.com/2017/02/08/health/opioids-overdose-deaths-epidemic-explainer/ |archive-date=May 17, 2017 |work=CNN |last=Howard |first=Jacqueline |date=February 8, 2017}}</ref> Writers have pointed to a widespread desire among the public to find a pill for any problem, even if a better solution might be a lifestyle change, such as exercise, improved diet and stress reduction.<ref>{{cite web|url=https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/|title=Too many meds? America's love affair with prescription medication|date=August 3, 2017 |access-date=April 26, 2018|archive-date=April 25, 2018|archive-url=https://web.archive.org/web/20180425151502/https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/|url-status=live}}</ref><ref>{{cite web|url=https://curiousmatic.com/pills-for-everything-the-power-of-american-pharmacy/|title=Pills for everything: The power of American pharmacy|work=Curiousmatic |date=June 2, 2017 |access-date=April 26, 2018|archive-date=May 1, 2018|archive-url=https://web.archive.org/web/20180501095241/https://curiousmatic.com/pills-for-everything-the-power-of-american-pharmacy/|url-status=live}}</ref><ref>{{cite news|url=https://www.theguardian.com/commentisfree/2012/apr/09/america-prescription-drug-addiction|title=America's prescription drug addiction suggests a sick nation|access-date=April 26, 2018|newspaper=The Guardian|date=2012-04-09|last=Bekiempis|first=Victoria|archive-date=May 1, 2018|archive-url=https://web.archive.org/web/20180501160630/https://www.theguardian.com/commentisfree/2012/apr/09/america-prescription-drug-addiction|url-status=live}}</ref> Opioids are relatively inexpensive, and alternative interventions, such as physical therapy, may not be affordable.<ref>{{cite news |title=What are opioids and what are the risks? |url=https://www.bbc.co.uk/news/health-43462975 |access-date=27 February 2019 |publisher=BBC |date=19 March 2018 |archive-date=June 15, 2019 |archive-url=https://web.archive.org/web/20190615004612/https://www.bbc.co.uk/news/health-43462975 |url-status=live }}</ref>
[[File:US timeline. Opioid deaths.jpg|thumb|Opioids were involved in 80,411 overdose deaths in 2021, up from around 10,000 in 1999.<ref>{{cite news |title=Opioid Deaths Could Hit 165,000 Annually Without Intervention, Biden Official Warns |url=https://www.forbes.com/sites/mollybohannon/2023/06/07/opioid-deaths-could-hit-165000-annually-without-intervention-biden-official-warns/ |work=Forbes |date=June 7, 2023}}</ref>]] In 2017, around 100 million people or a third of the U.S. population was estimated to be affected by chronic pain at any given time.<ref>{{Cite journal |last1=Tompkins |first1=D. Andrew |last2=Hobelmann |first2=J. Greg |last3=Compton |first3=Peggy |date=April 2017 |title=Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma |journal=Drug and Alcohol Dependence |language=en |volume=173 |issue=Suppl 1 |pages=S11–S21 |doi=10.1016/j.drugalcdep.2016.12.002 |pmid=28363315 |pmc=5771233 |issn=0376-8716 }}</ref> This led to a push by drug companies and the federal government to expand the use of painkilling opioids.{{Citation needed|date=March 2024}} In the 1990's, initiatives like the Joint Commission began to push for more attentive physician response to patient pain, referring to pain as the fifth vital sign. This exacerbated the already increasing number of opioids being prescribed by doctors to patients.<ref>{{cite web | vauthors = Baker DW | date = 5 May 2017 | title = The Joint Commission's Pain Standards: Origin and Evolution | url = https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf | publisher = The Joint Commission | location = Oakbrook Terrace, IL | access-date = May 22, 2019 | archive-date = April 9, 2019 | archive-url = https://web.archive.org/web/20190409010427/https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf | url-status = live }}</ref>
Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year.<ref name="Economist">{{cite news |date=March 6, 2017 |title=America's opioid epidemic is worsening |url=https://www.economist.com/graphic-detail/2017/03/06/americas-opioid-epidemic-is-worsening |url-status=live |archive-url=https://web.archive.org/web/20230525111309/https://www.economist.com/graphic-detail/2017/03/06/americas-opioid-epidemic-is-worsening |archive-date=May 25, 2023 |newspaper=The Economist}}</ref> In 2016, more than 289 million prescriptions were written for opioid drugs.<ref name="SurgeonGeneral">{{cite web |date=2016 |title=Facing Addiction in America |url=https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf |archive-url=https://web.archive.org/web/20171019193303/https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf |archive-date=October 19, 2017 |publisher=U.S. Surgeon General |pages=1–14}}</ref>{{rp|43}} This was exacerbated by the aggressive and misleading marketing of drug makers, e.g. Purdue Pharma. Purdue trained its sales representatives to convey to doctors that the risk of addiction from OxyContin was "less than one percent."<ref>{{Cite news |title='SELL BABY SELL!': Inside the opioid industry's marketing machine |url=https://www.washingtonpost.com/graphics/2019/investigations/opioid-marketing/ |access-date=2024-06-16 |newspaper=Washington Post }}</ref>
Mirroring the growth of opioid pain relievers prescribed was an increase in the admissions for substance abuse treatments and opioid-related deaths. This illustrates how legitimate clinical prescriptions of pain relievers were diverted through an illegitimate market, leading to misuse, addiction, and death.<ref name="pmid23150006">{{cite journal | vauthors = Alexander GC, Kruszewski SP, Webster DW | title = Rethinking opioid prescribing to protect patient safety and public health | journal = JAMA | volume = 308 | issue = 18 | pages = 1865–6 | date = November 2012 | pmid = 23150006 | doi = 10.1001/jama.2012.14282 }}</ref> With the increase in volume, the potency of opioids also increased. By 2002, one in six drug users were being prescribed drugs more powerful than morphine. By 2012, the ratio had doubled to one in three.<ref name="Economist" /> The most commonly prescribed opioids have been oxycodone and hydrocodone.
The epidemic has been described as a "uniquely American problem".<ref name="review">{{cite journal | vauthors = Shipton EA, Shipton EE, Shipton AJ | title = A Review of the Opioid Epidemic: What Do We Do About It? | journal = Pain and Therapy | volume = 7 | issue = 1 | pages = 23–36 | date = June 2018 | pmid = 29623667 | pmc = 5993689 | doi = 10.1007/s40122-018-0096-7 }}</ref> The structure of the US healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies. According to Professor Judith Feinberg in 2017, "Most insurance, especially for poor people, won't pay for anything but a pill."<ref>{{cite news|url=https://www.bbc.com/news/world-us-canada-41701718|title=Why opioids are such an American problem|last=Amos|first=Owen|date=October 25, 2017|work=BBC News|access-date=December 29, 2017|archive-date=December 28, 2017|archive-url=https://web.archive.org/web/20171228185010/http://www.bbc.com/news/world-us-canada-41701718|url-status=live}}</ref> Prescription rates for opioids in the US are 40 percent higher than the rate in other developed countries, such as Germany or Canada.<ref>{{cite news|url=https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/|title=Analysis {{!}} Opioid abuse in the U.S. is so bad it's lowering life expectancy. Why hasn't the epidemic hit other countries?|last=Erickson|first=Amanda|date=December 28, 2017|newspaper=Washington Post|access-date=December 29, 2017|issn=0190-8286|archive-date=December 28, 2017|archive-url=https://web.archive.org/web/20171228121146/https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/|url-status=live|url-access=subscription}}</ref>
While the rates of opioid prescriptions increased between 2001 and 2010, the prescription of non-opioid pain relievers (aspirin, ibuprofen, etc.) decreased from 38% to 29% of ambulatory visits in the same time period,<ref name="pmid24025657">{{cite journal | vauthors = Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC | title = Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010 | journal = Medical Care | volume = 51 | issue = 10 | pages = 870–8 | date = October 2013 | pmid = 24025657 | pmc = 3845222 | doi = 10.1097/MLR.0b013e3182a95d86 }}</ref> and there has been no change in the amount of pain reported in the U.S.<ref name=WashPost>{{cite news|url=https://www.washingtonpost.com/news/in-theory/wp/2017/02/09/the-opioid-epidemic-could-turn-into-a-pandemic-if-were-not-careful/ |title=The opioid epidemic could turn into a pandemic if we're not careful |last=Gebelhoff |first=Robert |url-status=live |archive-url=https://web.archive.org/web/20200824011703/https://www.washingtonpost.com/news/in-theory/wp/2017/02/09/the-opioid-epidemic-could-turn-into-a-pandemic-if-were-not-careful/ |archive-date=August 24, 2020 |newspaper=Washington Post |date=February 9, 2017 |url-access=subscription}}</ref> This has led to differing medical opinions, with some noting that there is little evidence that opioids are effective for chronic pain not caused by cancer.<ref name=Prescriptions>{{cite web|url=https://www.nytimes.com/2017/07/06/health/opioid-painkillers-prescriptions-united-states.html |title=Opioid Prescriptions Fall After 2010 Peak, C.D.C. Report Finds |url-status=live |url-access=subscription |archive-url=https://web.archive.org/web/20190429063813/https://www.nytimes.com/2017/07/06/health/opioid-painkillers-prescriptions-united-states.html |archive-date=April 29, 2019 |work=The New York Times |last=Goodnough |first=Abby |date=July 6, 2017}}</ref> In the years preceding 2024, access to prescription opoids tightened somewhat as safety-related prescribing guidelines were enhanced.<ref>Nguyen, D., Javaheri, J., & Han, V. (2025). National Trends in Opioid Prescription Spending Among Medicaid and Medicare Part D Recipients. ''The Annals of Family Medicine, 23'' (Supplement 1), 7940. https://doi.org/10.1370/afm.23.s1.7940</ref>
[[File:Hydrocodone Opioid.jpg|thumb|Hydrocodone, one of the most popular opioids]] The opioid epidemic affects women and men differently.<ref name="US National Library of Medicine">{{cite journal |last1=Serdarevic |first1=Mirsada |title=Gender differences in prescription opioid use |journal=Current Opinion in Psychiatry |volume=30 |issue=4 |pages=238–246 |pmc=5675036 |year=2017 |pmid=28426545 |doi=10.1097/YCO.0000000000000337 }}</ref> For instance, women are more likely than men to report recent and non-recent prescription opioid use.<ref>{{Cite journal|last1=Serdarevic|first1=Mirsada|last2=Striley|first2=Catherine W|last3=Cottler|first3=Linda B|date=July 2017|title=Gender differences in prescription opioid use|journal=Current Opinion in Psychiatry|volume=30|issue=4|pages=238–246|doi=10.1097/YCO.0000000000000337|issn=0951-7367|pmc=5675036|pmid=28426545}}</ref> Women are also more likely to have chronic pain than men are.<ref name="Rehab Spot">{{cite web |title=Women and Opioids |url=https://www.rehabspot.com/opioids/who-addiction-affects/women/ |website=Rehab Spot |access-date=December 9, 2019 |archive-date=October 31, 2019 |archive-url=https://web.archive.org/web/20191031180634/https://www.rehabspot.com/opioids/who-addiction-affects/women/ |url-status=live }}</ref> In cases of domestic abuse and rape, women are prescribed pain medicine more than men.<ref name="Rehab Spot"/> During pregnancy, women may use prescription opioids to help with pregnancy pain, especially with post-pregnancy pain.<ref name="Rehab Spot"/> The number of women who died from opioid pain relievers increased 5 times from 1999 to 2010.{{citation needed|date=July 2023}} To help stop the spread of opioid abuse in women, it is advised that women are educated on the drugs that they are taking and the possible risk of addiction. Alternatives should always be used when possible in order to prevent addiction.<ref name="Rehab Spot"/>
Most research gone into understanding the epidemic is mostly focused on females, specifically anticipated mothers.<ref name=":02">{{Cite journal |last1=Silver |first1=Elisabeth R. |last2=Hur |first2=Chin |date=2020-02-01 |title=Gender differences in prescription opioid use and misuse: Implications for men's health and the opioid epidemic |url=https://www.sciencedirect.com/science/article/pii/S0091743519304293 |journal=Preventive Medicine |volume=131 |article-number=105946 |doi=10.1016/j.ypmed.2019.105946 |pmid=31816359 |s2cid=209164236 |issn=0091-7435|url-access=subscription }}</ref> Women are at the greatest risk for opioid addiction compared to men.<ref>{{Cite journal |last1=Serdarevic |first1=Mirsada |last2=Striley |first2=Catherine W |last3=Cottler |first3=Linda B |date=July 2017 |title=Gender differences in prescription opioid use |journal=Current Opinion in Psychiatry |volume=30 |issue=4 |pages=238–246 |doi=10.1097/YCO.0000000000000337 |issn=0951-7367 |pmc=5675036 |pmid=28426545}}</ref> Usually, opioid misuse in women stems from unused prescription drug hoarding, the dependence of the drugs and higher pain levels compared to men. Women are less likely to report opioid misuse in contrast to the male population.<ref name=":02"/> Analyzers of the epidemic stress that their main concern is the female victims, and studies tend to neglect the male population, when over 70% of prescription drug intake and overdose, happen to males.<ref name=":02" />
Adolescents can become easily addicted to opioids. Even before their teenage years, children go through the rapid growth of their reward center, the Mesolimbic pathway. The development of the Mesolimbic pathway allows children to be easily satisfied by small rewards to encourage learning, motivation, and acceptable behavior. This growth peaks in their adolescent years, and they start to feel a need for larger, more meaningful rewards, such as psychoactive substances which produce reward signals through direct receptor binding. Teens have an underdeveloped prefrontal cortex which governs impulse control and decision making. The combination of underdeveloped prefrontal cortex and a rundown reward system can lead to adolescents with addictive seeking behaviors and higher susceptibility to the neurological changes developed in substance use disorder (SUD).<ref>{{Cite journal|last=Levy|first=Sharon|date=February 2019|title=Youth and the Opioid Epidemic|journal=Pediatrics|volume=143|issue=2|article-number=e20182752|doi=10.1542/peds.2018-2752|pmid=30602544|issn=0031-4005|doi-access=free}}</ref> The Centers for Disease Control and Prevention estimates that In 2018, over 53 million people aged 12 years and older in the United States, reported the misuse of prescription drugs.
A 2020 review of the opioid epidemic in pediatrics stated that there were 4,094 opioid overdose deaths in people ages 14–24 in 2017.<ref name=":1">{{Cite journal|last1=Yaster|first1=Myron|last2=McNaull|first2=Peggy P.|last3=Davis|first3=Peter J.|date=June 2020|title=The opioid epidemic in pediatrics: a 2020 update|journal=Current Opinion in Anesthesiology|volume=33|issue=3|pages=327–334|doi=10.1097/ACO.0000000000000865|pmid=32371640|s2cid=218518917|issn=0952-7907}}</ref> Teens commonly use opioids as recreational drugs, instead of what they are supposed to be used for, pain management.<ref>{{Cite journal|last1=McCabe|first1=Sean Esteban|last2=West|first2=Brady T.|last3=Boyd|first3=Carol J.|date=May 2013|title=Medical use, medical misuse, and nonmedical use of prescription opioids: results from a longitudinal study|journal=Pain|volume=154|issue=5|pages=708–713|doi=10.1016/j.pain.2013.01.011|issn=1872-6623|pmc=3622844|pmid=23433943}}</ref> Centers for Disease Control and Prevention says that for every opioid death of a teen there are 119 emergency visits and 22 treatment admissions related to opioid abuse. Half a million teenagers in 2014 were reported as non medically prescribed opioid users and a third of those as having a substance use disorder (SUD).<ref name=":1"/>
Family is widely discussed as an influence for factors affecting adolescent opioid misuse behavior and in the treatment of adolescent opioid misuse.<ref>{{Cite journal|last1=Kaur|first1=Lovdeep|last2=Tadros|first2=Eman|last3=Patton|first3=Rikki|date=October 2019|title=The Role of Family in Youth Opioid Misuse: A Literature Review|url=http://journals.sagepub.com/doi/10.1177/1066480719868705|journal=The Family Journal|volume=27|issue=4|pages=429–442|doi=10.1177/1066480719868705|s2cid=202246255|issn=1066-4807|access-date=November 30, 2020|archive-date=January 30, 2022|archive-url=https://web.archive.org/web/20220130021024/https://journals.sagepub.com/doi/10.1177/1066480719868705|url-status=live|url-access=subscription}}</ref> Family involvement has been shown to be effective in decreasing substance use in adolescents by addressing family risk factors that may be contributing to an adolescent's substance use. Easy accessibility is a risk factor. The late 1990s, increases in opioid recommendations from pharmaceutical companies created an abundance of prescription painkillers in adult households. If family members are taking opioids for pains or have taken them in the past and did not dispose of them correctly or do not protect them properly, it can make it easy for adolescents to get their hands on them.<ref>{{Cite journal|last1=Yule|first1=Amy M.|last2=Lyons|first2=Rachael M.|last3=Wilens|first3=Timothy E.|date=2018-06-01|title=Opioid Use Disorders in Adolescents—Updates in Assessment and Management|url= |journal=Current Pediatrics Reports|volume=6|issue=2|pages=99–106|doi=10.1007/s40124-018-0161-z|issn=2167-4841|pmc=6422350|pmid=30895165}}</ref>
Proper disposal of these drugs is crucial to reducing adolescent misuse. A national insurance cohort reviewed almost 90,000 opioid prescribed patients, 13–21 years old, and found that 5% continued to fill their prescription 90 days or more after surgery. Medicine take-back programs are the most recommended and regulated disposal method by the United States Drug Enforcement Agency, although, it is not guaranteed that the prescribed patient will comply with this recommendation. There are eight different at-home drug disposal products on the market but none of them is federal agency approved or in the process of being evaluated. The main concern of proper opioid disposal is trash and sewage disposal that create pharmaceutical pollution and still grants access for adolescents with substance use disorders.<ref name=":1" />
Youth are at a heightened risk of developing opioid addictions, and treating youth opioid use disorder is more difficult than it is for older individuals. A systematic review of the epidemiological literature has found that adolescents and young adults consistently have shorter retention times in medication treatments for opioid use disorder than do older adults. This is why it is important for schools to implement effective strategies and programs to teach young children about the dangers and consequences of opioid misuse. Although the retention time of adolescents is much lower than adults, educating them from a younger age on opioid misuse should help keep children away from these drugs.
In 2018, there was a lack of appropriate treatments and treatment centers across the nation.<ref name="Rock Inst 2018">{{cite web |last1=Strach |first1=Patricia |last2=Zuber |first2=Katie |last3=Pérez-Chiqués |first3= Elizabeth |title=How a Rural Community Addresses the Opioid Crisis |url=https://rockinst.org/wp-content/uploads/2018/06/6-26-18-Stories-from-Sullivan-Web.pdf |website=Rockefeller Institute of Government|date=2018 |access-date=December 9, 2019 |archive-date=December 9, 2019 |archive-url=https://web.archive.org/web/20191209080141/https://rockinst.org/wp-content/uploads/2018/06/6-26-18-Stories-from-Sullivan-Web.pdf |url-status=live }}</ref> In 2018, big cities like New York City were lacking in treatment services and health offices as well as small rural areas.<ref name="Rock Inst 2018"/> Another reason the opioid epidemic is hard to combat is due to available housing being limited to recovering addicts.<ref name="Rock Inst 2018"/> Having limited housing makes it easy for recovering substance users to return to the environments and relationships that promoted drug misuse.<ref name="Rock Inst 2018"/>
Jobs for recovering addicts can be difficult to find. Individuals with substance use disorders that have criminal records have a more difficult time finding jobs once they leave recovery. Having to combat job insecurity can lead to stress, which can cause someone to relapse.<ref name="Rock Inst 2018"/> "Wraparound services", or programs that provide services for patients who have just come out of rehabilitation centers or programs,<ref name="Rock Inst 2018"/> are rare to non-existent, and are a contributing reason as to why the opioid epidemic has gone on for so long.
==== Public policy response ==== {{Further|Anti-fentanyl legislation in the United States|State government response to the opioid epidemic in the United States|United States sanctions against China}}
The 2019 lawsuit filed by the state of Oklahoma against Purdue Pharma was the first significant step in prompting public action toward ending the opioid epidemic.<ref name="PBS 2019">{{cite news |last1=Santhanam |first1=Laura |title=What Purdue Pharma's settlement with Oklahoma means for the opioid crisis|date=March 26, 2019|url=https://www.pbs.org/newshour/health/what-purdue-pharmas-settlement-with-oklahoma-means-for-the-opioid-crisis |work=PBS NewsHour |access-date=December 9, 2019 |archive-date=November 4, 2019 |archive-url=https://web.archive.org/web/20191104160631/https://www.pbs.org/newshour/health/what-purdue-pharmas-settlement-with-oklahoma-means-for-the-opioid-crisis |url-status=live }}</ref> The state of Oklahoma argued that Purdue Pharma helped start the opioid epidemic because of assertive marketing and deceptive claims on the dangers of addiction.<ref name="NPR"/> One of the marketing strategies was to redefine "substance use disorder" as "pseudo addiction".<ref name="PBS 2019"/>
In 2019, Purdue Pharma agreed to settle and pay 270 million dollars to the state of Oklahoma that would go towards addiction research and treatment.<ref name="NPR">{{cite web |last1=Bebinger |first1=Martha |title=Purdue Pharma Agrees To $270 Million Opioid Settlement With Oklahoma |url=https://www.npr.org/sections/health-shots/2019/03/26/706848006/purdue-pharma-agrees-to-270-million-opioid-settlement-with-oklahoma |website=NPR |date=March 26, 2019 |access-date=December 9, 2019 |archive-date=December 5, 2019 |archive-url=https://web.archive.org/web/20191205051559/https://www.npr.org/sections/health-shots/2019/03/26/706848006/purdue-pharma-agrees-to-270-million-opioid-settlement-with-oklahoma |url-status=live }}</ref> The settlement could indicate a win for other states that have taken legal action against similar opioid manufacturers.<ref name="PBS 2019"/> Specifically, states like California are raising similar claims that Purdue Pharma marketed the drug Oxycontin as a safe and effective treatment, which led to the opioid crisis leaving thousands dead in California from opioid overdoses.<ref name="LA Times">{{cite news |last1=MCGREEVY |first1=PATRICK |title=California joins opioid fight, sues Purdue Pharma over marketing of OxyContin |url=https://www.latimes.com/politics/la-pol-ca-oxycontin-maker-sued-by-california-20190603-story.html |newspaper=LA Times |access-date=December 9, 2019 |archive-date=March 21, 2020 |archive-url=https://web.archive.org/web/20200321031644/https://www.latimes.com/politics/la-pol-ca-oxycontin-maker-sued-by-california-20190603-story.html |url-status=live }}</ref>
==== Treatment within legal landscape ==== Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, otherwise known as the Controlled Substance Act, established five drug schedules to regulate and control their manufacture and distribution.<ref>{{Cite web|title=21 U.S.C. §§ 801— 904 - The Controlled Substance Act|url=https://www.govinfo.gov/content/pkg/USCODE-2014-title21/html/USCODE-2014-title21-chap13-subchapI.htm|url-status=live|access-date=2021-10-14|website=Govinfo.gov|archive-date=October 28, 2021|archive-url=https://web.archive.org/web/20211028175041/https://www.govinfo.gov/content/pkg/USCODE-2014-title21/html/USCODE-2014-title21-chap13-subchapI.htm}}</ref> In 2017, President Donald Trump officially declared the opioid crisis a "public health emergency."<ref>{{Cite web|date=2016-08-15|title=National Archives: Executive Order 12591--Facilitating access to science and technology|url=https://www.archives.gov/federal-register/codification/executive-order/12591.html|url-status=live|access-date=2021-10-14|website=National Archives|archive-date=October 28, 2021|archive-url=https://web.archive.org/web/20211028173111/https://www.archives.gov/federal-register/codification/executive-order/12591.html}}</ref> In 2018, the United States federal government enacted the SUPPORT Act which aims to help Americans gain access to opioid addiction treatment and help and reduce the amount of opioids prescribed.<ref>{{Cite web|date=2018-10-24|title=Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT for Patients and Communities Act, PL 115-271, October 24, 2018, 132 Stat 3894|url=https://www.congress.gov/bill/115th-congress/house-bill/6|url-status=live|access-date=2021-10-14|website=Congress.gov|archive-date=November 2, 2021|archive-url=https://web.archive.org/web/20211102144122/https://www.congress.gov/bill/115th-congress/house-bill/6}}</ref>
Other efforts include enacting legislation that provides funds from the Department of Health and Human Services to help support the creation and use of Syringe Services Programs.<ref>{{Cite web|date=2019-07-08|title=Center for Disease Control and Prevention: Federal Funding for Syringe Services Programs|url=https://www.cdc.gov/ssp/ssp-funding.html|url-status=live|access-date=2021-10-19|website=Cdc.gov|archive-date=November 5, 2021|archive-url=https://web.archive.org/web/20211105184034/https://www.cdc.gov/ssp/ssp-funding.html}}</ref> From 2019, legislatures have started to advocate for the implementation of supervised injection sites as another way to help the opioid crisis and reduce harm.<ref>{{cite journal|url=https://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=3737&context=bclr |first=Alex |last=Kreit |title=Safe Injection Sites and the Federal "Crack House" Statute |archive-url=https://web.archive.org/web/20200726013847/https://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=3737&context=bclr |archive-date=July 26, 2020 |journal=Boston College Law Review |volume=60 |issue=2 |date=February 25, 2019}}</ref> In 2021, the United States Court of Appeals for the Third Circuit held that supervised injection sites violate the Federal Crack House Statute.<ref>{{Cite web |url=https://www.safehousephilly.org/sites/default/files/attachments/2021-01/US%20v%20Safehouse%203d%20Circ%20Opinion.pdf |title=''United States v. Safehouse'', 985 F.3d 225 (3d Cir. 2021) |access-date=November 3, 2021 |archive-date=October 19, 2021 |archive-url=https://web.archive.org/web/20211019220828/https://www.safehousephilly.org/sites/default/files/attachments/2021-01/US%20v%20Safehouse%203d%20Circ%20Opinion.pdf |url-status=live }}</ref>
==== Safe injection sites ==== Safe injection sites, also known as supervised injection sites are designated facilities where individuals can use pre-obtained drugs under the supervision of trained medical staff. These sites are designed to reduce the health and societal impacts of drug use by providing a controlled, hygienic environment for drug consumption. The primary goal is to prevent overdose deaths through immediate medical intervention and to reduce the transmission of infectious diseases such as HIV and Hepatitis, by offering sterile injection equipment.<ref>{{Cite journal |last1=Kral |first1=Alex |last2=Davidson |first2=Peter |date=December 2017 |title=Addressing the Nation's Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S. |url=https://www.ajpmonline.org/article/S0749-3797(17)30316-1/pdf |journal=American Journal of Preventive Medicine |volume=53 |issue=6 |pages=919–922 |doi=10.1016/j.amepre.2017.06.010 |pmid=28801014|doi-access=free }}</ref> These sites often provide a range of services, including access to addiction treatment, healthcare, and social support systems, acting as critical points of contact for individuals who might otherwise be disconnected from the healthcare system.<ref name="Beletsky 553–554">{{Cite journal |last1=Beletsky |first1=Leo |last2=Baker |first2=Pieter |last3=Arredondo |first3=Jaime |last4=Emuka |first4=Ashley |last5=Goodman-Meza |first5=David |last6=Medina-Mora |first6=Maria Elena |last7=Werb |first7=Dan |last8=Davidson |first8=Peter |last9=Amon |first9=Joseph J |last10=Strathdee |first10=Steffanie |last11=Magis-Rodriguez |first11=Carlos |date=August 2018 |title=The global health and equity imperative for safe consumption facilities |journal=The Lancet |volume=392 |issue=10147 |pages=553–554 |doi=10.1016/s0140-6736(18)31469-7 |pmid=30152386 |issn=0140-6736}}</ref>
The concept of safe injection sites first emerged in Europe during the 1980s, with Switzerland opening the first such facility in 1986.<ref name="Beletsky 553–554"/> This initiative was driven by rising heroin use and its associated public health crises.<ref name="Beletsky 553–554"/> Over time, numerous studies have documented the benefits of these sites, including reductions in overdose deaths, lower rates of disease transmission, and improvements in public safety. These findings have contributed to the gradual adoption of safe injection sites in various countries.<ref name="Beletsky 553–554"/>
In the United States, the opioid crisis has reached unprecedented levels, prompting a growing interest in harm reduction strategies such as safe injection sites.<ref name="pbs.org">{{Cite web |date=2023-05-08 |title=Effectiveness of safe injection sites to be evaluated in government-backed study |url=https://www.pbs.org/newshour/health/effectiveness-of-safe-injection-sites-to-be-evaluated-in-government-backed-study |access-date=2024-08-02 |website=PBS News }}</ref> Despite facing significant legal and political challenges, several cities have taken steps toward implementing these facilities. The initiative has faced considerable opposition and legal hurdles, reflecting the contentious nature of the issue.<ref name="pbs.org"/>
In 2021, New York City became the first city in the US to open authorized overdose prevention centers. Other cities, including Seattle and Denver, have explored or implemented similar measures, reflecting a growing recognition of the need for innovative approaches to address the opioid crisis.<ref name="pbs.org"/> These initiatives often receive support from public health advocates and some local governments, who argue that safe injection sites are a pragmatic and humane response to a complex public health issue.<ref name="pbs.org"/>
In 2023, the U.S. government took a significant step towards evaluating the effectiveness of safe injection sites. It approved funding for a study with a $5 million grant from the National Institute on Drug Abuse to measure the impact of these sites on overdose prevention, health care costs, and community safety.<ref name="pbs.org"/> The study, conducted by New York University and Brown University, focused on two sites in New York City and one in Providence, Rhode Island. Researchers enrolled 1,000 adult drug users to assess the sites' effectiveness in reducing overdoses and estimating potential savings for the healthcare and criminal justice systems.<ref>{{Cite web |date=2023-05-08 |title=Effectiveness of safe injection sites to be evaluated in government-backed study |url=https://www.pbs.org/newshour/health/effectiveness-of-safe-injection-sites-to-be-evaluated-in-government-backed-study |access-date=2024-07-27 |website=PBS News }}</ref>
According to medical professionals, supervised injection sites are effective in reducing overdose deaths and the transmission of infectious diseases.<ref name="Finke 454–455">{{Cite journal |last1=Finke |first1=Jorge |last2=Chan |first2=Jie |date=May 2022 |title=The Case for Supervised Injection Sites in the United States |url=https://www.aafp.org/pubs/afp/issues/2022/0500/p454.html |journal=American Family Physician |volume=105 |issue=5 |pages=454–455 |pmid=35559640 |issn=1532-0650}}</ref> These sites have been legally operating in Europe, Canada, and Australia since 1986, and have been associated with significant public health benefits. For example, a 2022 study of a supervised injection site in Vancouver, Canada, found a 26% net reduction in overdose deaths in the area surrounding the site.<ref name="Finke 454–455"/> Despite these benefits, the U.S. Department of Health and Human Services has stopped short of supporting supervised injection sites, and legal challenges have hindered their implementation in many cities .
In 2024, the city of Providence, Rhode Island, approved the state's first safe injection site. This site, set to operate openly, became the only such facility in the U.S. outside of New York City.<ref name="Betts">{{Cite news |last=Betts |first=Anna |date=2024-02-04 |title=Providence Officials Approve Overdose Prevention Center |url=https://www.nytimes.com/2024/02/04/us/ri-opiod-safe-injection-site.html |access-date=2024-08-02 |work=The New York Times |issn=0362-4331}}</ref> The approval came more than two years after Rhode Island authorized overdose prevention centers, highlighting the state's commitment to innovative harm reduction strategies.<ref name="Betts"/> The Providence Center, run by the nonprofit Project Weber/RENEW and VICTA, aims to provide comprehensive services, including drug-related resources, case management, and housing support.<ref name="Betts"/> This initiative reflects a broader trend of states and cities exploring the potential of safe injection sites to address the opioid crisis, despite facing resistance and legal challenges.<ref>{{Cite news |last=Betts |first=Anna |date=2024-02-04 |title=Providence Officials Approve Overdose Prevention Center |url=https://www.nytimes.com/2024/02/04/us/ri-opiod-safe-injection-site.html |access-date=2024-07-27 |work=The New York Times |issn=0362-4331}}</ref>
Despite the documented benefits and support from certain quarters, the establishment of safe injection sites in the US remains highly controversial. Opponents argue that these sites may enable drug use and attract crime, while proponents contend that the evidence from other countries demonstrates significant public health benefits.<ref name="Betts"/>
=== Canada === [[File:Naloxone kit.jpg|thumb|upright=0.75|A Naloxone injection kit at a train station in Calgary, Canada]] In 1993, an investigation by the chief coroner in British Columbia identified an "inordinately high number" of drug-related deaths, of which there were 330. In 2016, there were 2,861 opioid related deaths in Canada. In 2017, there were 1,473 deaths in British Columbia and 3,996 deaths in Canada as a whole.<ref>{{cite journal |last1=Fischer |first1=Benedict |display-authors=etal |title=The opioid death crisis in Canada: crucial lessons for public health |journal=Lancet |date=1 February 2019 |volume=4 |issue=2 |pages=e81–e82 |pmid=30579840 |doi=10.1016/S2468-2667(18)30232-9 |doi-access=free }}</ref> Between 2016 and 2022 Canada saw a two and a half fold increase in the per capita rate of opioid related deaths, reaching 20.3 per 100,000 population per year, with 1,904 deaths reported in the first 3 months of 2023 alone.<ref>{{Cite web |title=Opioid- and stimulant-related harms — Canada.ca |url=https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/ |access-date=2023-11-12 |website=health-infobase.canada.ca |date=December 11, 2019 }}</ref>
In 2015, Canada was identified as the second-highest per-capita user of prescription opioids, behind the United States.<ref>{{Cite journal|last=Dyer|first=Owen|date=2015-09-03|title=Canada's prescription opioid epidemic grows despite tamperproof pills|url=https://www.bmj.com/content/351/bmj.h4725|journal=BMJ|volume=351|article-number=h4725|doi=10.1136/bmj.h4725|issn=1756-1833|pmid=26338104|s2cid=1364660|access-date=March 30, 2019|archive-date=March 30, 2019|archive-url=https://web.archive.org/web/20190330111541/https://www.bmj.com/content/351/bmj.h4725|url-status=live|url-access=subscription}}</ref> In Alberta, emergency department visits as a result of opiate overdose, attributable to both prescription and illicit opioids, specifically fentanyl and fentanyl analogues, rose 1,000% in the previous five years. The Canadian Institute for Health Information found that while a third of overdoses were intentional overall, among those ages 15–24 nearly half were intentional.<ref name="globalnews.ca">{{cite web|url=https://globalnews.ca/news/3743705/canadas-opioid-crisis-is-burdening-the-health-care-system-report-warns/|title=Canada's opioid crisis is burdening the health care system, report warns|website=Globalnews.ca|access-date=November 10, 2017|date=2017-09-14|archive-date=November 10, 2017|archive-url=https://web.archive.org/web/20171110010342/https://globalnews.ca/news/3743705/canadas-opioid-crisis-is-burdening-the-health-care-system-report-warns/|url-status=live}}</ref> In 2017, there were 3,987 opioid-related deaths in Canada, 92% of these deaths being unintentional. The number of deaths involving fentanyl or fentanyl analogues increased by 17% compared to 2016.<ref>{{Cite web|url=https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-june-2018.html|title=National report: Apparent opioid-related deaths in Canada|last1=Canada|first1=Public Health Agency of|date=19 June 2018|website=aem|access-date=2018-11-20|archive-date=March 27, 2019|archive-url=https://web.archive.org/web/20190327101132/https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-june-2018.html|url-status=live}}</ref>
Between April and December 2020, there was an 89% increase in opioid related deaths in comparison to 2019.<ref>{{Cite web|title=Opioid- and Stimulant-related Harms in Canada|url=https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/|access-date=2021-09-19|website=health-infobase.canada.ca|date=December 11, 2019 |archive-date=September 22, 2021|archive-url=https://web.archive.org/web/20210922234953/https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants|url-status=live}}</ref> Saskatoon, Saskatchewan experienced a record month in opioid overdoses in May 2020 caused, authorities explained, by a combination of ever-amplifying toxic drugs and the COVID-19 pandemic's quarantine keeping individuals from family and needed mental health services. Over 28,800 Emergency Medical Services (EMS) responded to possible opioid related health crises between January and December 2020 after the COVID-19 pandemic began.<ref>{{Cite web|title=Opioid- and Stimulant-related Harms in Canada|url=https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/|access-date=2021-10-17|website=health-infobase.canada.ca|date=December 11, 2019 |archive-date=September 22, 2021|archive-url=https://web.archive.org/web/20210922234953/https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants|url-status=live}}</ref> In May 2020, Medavie Health Services provided over 250 ambulance services for overdoses, administering the opioid antagonist nasal spray Narcan (naloxone) in record numbers.
North America's first safe injection site, Insite, opened in the Downtown Eastside (DTES) neighborhood of Vancouver in 2003. Safe injection sites are legally sanctioned, medically supervised facilities in which individuals are able to consume illicit recreational drugs, as part of a harm reduction approach towards drug problems, which includes information about drugs and basic health care, counseling, sterile injection equipment, treatment referrals, and access to medical staff, for instance in the event of an overdose. In 2017, Health Canada licensed 16 safe injection sites nationally.<ref>{{cite news|url=https://www.bbc.com/news/world-us-canada-40828608|title=The city where addicts are allowed to inject|first=Robin|last=Levinson-King|date=August 7, 2017|access-date=November 10, 2017|newspaper=BBC News|archive-date=November 9, 2017|archive-url=https://web.archive.org/web/20171109044330/http://www.bbc.com/news/world-us-canada-40828608|url-status=live}}</ref> In Canada, about half of overdoses resulting in hospitalization were accidental, while a third were deliberate overdoses.<ref name="globalnews.ca"/>
In 2012, OxyContin was removed from the Canadian drug formulary,<ref>{{cite journal | vauthors = Morin KA, Eibl JK, Franklyn AM, Marsh DC | title = The opioid crisis: past, present and future policy climate in Ontario, Canada | journal = Substance Abuse Treatment, Prevention, and Policy | volume = 12 | issue = 1 | article-number = 45 | date = November 2017 | pmid = 29096653 | pmc = 5667516 | doi = 10.1186/s13011-017-0130-5 | doi-access = free }}g</ref> and medical opioid prescription was reduced. This led to an increase in the illicit supply of stronger and more dangerous opioids such as fentanyl and carfentanil. In 2018, there were around one million users at risk from these toxic opioid products. In 2012 in Vancouver, Jane Buxton of the British Columbia Centre for Disease Control joined the Take-home naloxone program to provide at risk individuals medication that quickly reverses the effects of an overdose from opioids.<ref>{{cite news |title=Distribution of take-home opioid antagonist kits during a synthetic opioid epidemic in British Columbia, Canada: a modelling study |url=https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30044-6/fulltext |access-date=30 August 2019 |publisher=Lancet |date=17 April 2018 |archive-date=January 30, 2022 |archive-url=https://web.archive.org/web/20220130021026/https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2818%2930044-6/fulltext |url-status=live }}</ref>
==Outside North America == {{Main|List of countries by prevalence of opiates use}}
In 2023, opioid seizures by authorities in Africa accounted for half of the global seizures of opioids, particularly tramadol.<ref>{{cite news |last1=Sharkah |first1=Madlyn |title=Tackling Substance Abuse: WHO Supports Efforts to Combat the Kush Epidemic in Sierra Leone |url=https://www.afro.who.int/countries/sierra-leone/news/tackling-substance-abuse-who-supports-efforts-combat-kush-epidemic-sierra-leone |access-date=24 April 2025 |agency=World Health Organisation |date=19 April 2024}}</ref> In the 2010s, opioids became a serious problem outside the U.S., mostly among young adults.<ref name=Martins>{{cite journal | vauthors = Martins SS, Ghandour LA | title = Nonmedical use of prescription drugs in adolescents and young adults: not just a Western phenomenon | journal = World Psychiatry | volume = 16 | issue = 1 | pages = 102–104 | date = February 2017 | pmid = 28127929 | pmc = 5269500 | doi = 10.1002/wps.20350 }}</ref> According to an epidemiologist at Columbia University: "Once pharmaceuticals start targeting other countries and make people feel like opioids are safe, we might see a spike [in opioid abuse]. It worked here. Why wouldn't it work elsewhere?"<ref name=WashPost/>
Many deaths worldwide from opioids and prescription drugs are from sexually transmitted infections passed through shared needles.<ref>{{Cite journal|last1=Cepeda|first1=Javier A.|last2=Beletsky|first2=Leo|last3=Sawyer|first3=Anne|last4=Serio-Chapman|first4=Chris|last5=Smelyanskaya|first5=Marina|last6=Han|first6=Jennifer|last7=Robinowitz|first7=Natanya|last8=Sherman|first8=Susan G.|date=2017-02-01|title=Occupational Safety in the Age of the Opioid Crisis: Needle Stick Injury among Baltimore Police|journal=Journal of Urban Health|volume=94|issue=1|pages=100–103|doi=10.1007/s11524-016-0115-0|issn=1468-2869|pmc=5359173|pmid=28105586}}</ref> This has led to a global initiative of needle exchange programs<ref>{{Cite web |url=http://www.gmhc.org/files/editor/file/gmhc_intl_seps.pdf |title=programs |access-date=March 30, 2019 |archive-date=October 20, 2019 |archive-url=https://web.archive.org/web/20191020195153/http://www.gmhc.org/files/editor/file/gmhc_intl_seps.pdf |url-status=live }}</ref> and research into the varying needle types carrying STIs. Some worry that the epidemic could become a worldwide pandemic if not curtailed.<ref name=WashPost/> In 2017, prescription drug abuse among teenagers in Canada, Australia, and Europe was comparable to U.S. teenagers.<ref name=WashPost/>
In 2017, in Lebanon and Saudi Arabia, and in parts of China, surveys found that one in ten students had used prescription painkillers for non-medical purposes. Similar high rates of non-medical use were found among the young throughout Europe, including Spain and the United Kingdom.<ref name=WashPost/> In 2017, 1,049 people had a death related to opioids in Spain.<ref>{{cite news |last1=Güell |first1=Oriol |title=Las sobredosis de opioides causan más de 1.000 muertes al año en España |url=https://elpais.com/sociedad/2019/10/20/actualidad/1571601031_438955.html |work=El País |date=20 October 2019 |language=es |access-date=September 6, 2021 |archive-date=September 6, 2021 |archive-url=https://web.archive.org/web/20210906205502/https://elpais.com/sociedad/2019/10/20/actualidad/1571601031_438955.html |url-status=live }}</ref>
While strong opiates are heavily regulated within the European Union, there is a "hidden addiction" with codeine. Codeine, though a mild painkiller, is converted into morphine in the liver.<ref name=":0">{{Cite web|url=https://horizon-magazine.eu/article/europes-silent-opioid-epidemic.html|title=Europe's silent opioid epidemic|website=Horizon: the EU Research & Innovation magazine|access-date=2019-05-06|archive-date=May 6, 2019|archive-url=https://web.archive.org/web/20190506200343/https://horizon-magazine.eu/article/europes-silent-opioid-epidemic.html|url-status=live}}</ref> "It's a hidden addiction,' said Dr Michael Bergin of Waterford Institute of Technology, Ireland. 'Codeine abuse affects people with diverse profiles, from children to older people across all social classes."<ref name=":0" />
=== Asia ===
==== Myanmar ==== In May 2020, Myanmar and the U.N. Office of Drugs and Crime (UNODC) announced that, over the previous three months, police had confiscated illicit drugs with a street value estimated at hundreds of millions of dollars. Most was methamphetamine. They also seized 3,750 liters (990 US gallons) of the potent opiate liquid methylfentanyl.<ref>{{Cite web|title=Drug bust in Myanmar nets haul likely worth hundreds of millions of dollars|url=https://www.cnn.com/2020/05/18/asia/myanmar-drug-bust-intl-hnk/index.html|last=Berlinger|first=Joshua|date=18 May 2020|website=CNN|access-date=2020-05-18|archive-date=May 18, 2020|archive-url=https://web.archive.org/web/20200518172840/https://www.cnn.com/2020/05/18/asia/myanmar-drug-bust-intl-hnk/index.html|url-status=live}}</ref>
==== Iran ==== {{Main|Opium in Iran}}
In 2022, Iran had the highest rate of nonmedical opium use in the world.<ref>{{cite journal |last1=Farhoudian |first1=Ali |last2=Radfar |first2=Seyed |title=How Substance Use Treatment Services in Iran Survived Despite a Dual Catastrophic Situation |journal=American Journal of Public Health |date=March 29, 2022 |volume=112 |issue=S2 |pages=S133–S135 |doi=10.2105/AJPH.2022.306794 |pmid=35349327 |pmc=8965175 }}</ref> Proximity to opiates produced in Afghanistan and Pakistan make Iranian society vulnerable to opiate addiction<ref name="Christian Oliver">{{Cite news | last= Oliver | first= Christian | url= http://www.opioids.com/opium/iran.html | title= Iran Opium Addicts Find Supplies Despite Earthquake | publisher= Reuters | date= 3 January 2004 | access-date= 18 August 2010}}</ref> in the past, however since the Taliban since coming into power in Afghanistan has cracked down on opium poppy cultivation and opioid use, potentially lowering the risk of the neighbouring countries sourcing a supply.
=== Oceania ===
==== Australia ==== In Australia, approximately 60% of drug related deaths are attributed to opioids; a vast majority of which are legal pharmaceuticals such as oxycodone (commonly as Targin ER or Endone) and codeine (Panadeine, Nurofen Plus) rather than illicit heroin or fentanyl. Monash University has claimed that opioids are over-prescribed in Australia, and cited a clinical trial which found that patients with chronic low-back pain or that of the neck experienced a minimal or no difference between oxycodone and placebo in terms of pain management.<ref>{{Cite web |title=The key to solving Australia's opioid problem |url=https://www.monash.edu/news/articles/the-key-to-solving-australias-opioid-problem3 |archive-url=http://web.archive.org/web/20250725201101/https://www.monash.edu/news/articles/the-key-to-solving-australias-opioid-problem3 |archive-date=2025-07-25 |access-date=2026-02-03 |website=Monash University |language=en}}</ref>
Daily in Australia, hospitals receive approximately 150 patients who are experiencing opioid-related health issues, with 3 dying. In 2016-17, 15.4 million prescriptions of opioids were given to 3.1 million Australians; an increase in prescriptions, but generally for lower oral morphine equivalent than in prior years.<ref>{{Cite web |title=Opioid harm in Australia: and comparisons between Australia and Canada, Summary |url=https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary |archive-url=http://web.archive.org/web/20240927230547/https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary |archive-date=2024-09-27 |access-date=2026-02-03 |website=Australian Institute of Health and Welfare |language=en}}</ref>
Possession of illicit opioids such as heroin and fentanyl, as well as diverted pharmaceutical opioids, is decriminalized in the Australian Capital Territory. Supervised injection sites, pill testing, and opioid-assisted therapy for opioid use disorder are available in varying parts of the country.<ref>{{Cite web |last=Hitchins |first=Carley |date=2025-04-16 |title=The ACT drug decriminalisation laws: here’s what it means |url=https://codalaw.com.au/the-act-drug-decriminalisation-laws-heres-what-it-means/ |access-date=2026-02-03 |website=CODA Criminal Law |language=en-AU}}</ref><ref>{{Cite web|url=https://www.monash.edu/medicine/news/latest/2021-articles/medically-supervised-injecting-rooms-and-the-politics-of-illicit-drug-policy|title=Medically supervised injecting rooms and the politics of illicit drug policy|date=September 3, 2021|website=Monash.edu|access-date=May 29, 2026}}</ref>
===Europe=== In 2017, in Europe, prescription opioids accounted for three‐quarter of overdose deaths, which represented 3.5% of total deaths among 15-39-year-olds.<ref name=Martins/> While deaths from overdoses related to illicit fentanyl and oxycodone are relatively rare in the UK and Europe, fatal outcomes from opioid intoxications have seen a moderate increase since 2015. In continental Europe, the rise of deaths as a result of opioid/opiate use had been partly due to chronic illnesses of addicts 40 years and older, but some of the recent deaths were experienced by younger users experimenting with 'designer drugs'. Generally speaking, the use of fentanyl by addicts in Europe has been rare as of 2022, but at the same time general deaths from opioid use have increased by 177% since 2019. As in other parts of the Western world, the COVID-19 pandemic has brought a reduced availability of therapies for addicts, but at the same time increased the availability of synthetic opioids on the black market.<ref>[https://www.statista.com/statistics/470910/death-by-fentanyl-drug-poisoning-in-england-and-wales/ "Number of deaths from drug poisoning by fentanyl in England and Wales from 1999 to 2021"] ''statista.com''. Accessed 15 Feb 2023.</ref><ref>[https://www.waz.de/politik/landespolitik/drogen-krise-in-nrw-experten-sehen-viele-ursachen-id237581321.html "Drogen Krise in NRW: Experten sehen viele Ursachen (in German)".] ''waz.de''. Accessed 15 Feb 2023.</ref><ref>[https://ethz.ch/de/news-und-veranstaltungen/eth-news/news/2022/06/opioide-auch-in-der-schweiz-auf-dem-vormarsch.html "Opioid-Vergiftungen nehmen stark zu"] ''ethz.ch.'' Accessed 15 Feb 2023.</ref>
====United Kingdom==== From January to August 2017, there were 60 fatal overdoses of fentanyl in the UK.<ref>{{cite news|url=https://www.bbc.com/news/uk-england-40793887|title=Warnings after drug kills 'at least 60'|date=August 1, 2017|access-date=November 10, 2017|newspaper=BBC News|archive-date=November 9, 2017|archive-url=https://web.archive.org/web/20171109131340/http://www.bbc.com/news/uk-england-40793887|url-status=live}}</ref> In England, opioid prescribing in general practice mirrors general geographical health inequalities.<ref>{{cite news |title=Opioid prescribing highest in more deprived regions of England, study shows |url=https://www.pharmaceutical-journal.com/20206014.article |access-date=27 February 2019 |publisher=Pharmaceutical Journal |date=16 January 2019 |archive-date=March 30, 2019 |archive-url=https://web.archive.org/web/20190330112002/https://www.pharmaceutical-journal.com/20206014.article |url-status=live }}</ref> In July 2019, two Surrey GPs working for a Farnham-based online pharmacy were suspended by the General Medical Council for prescribing opioids online without appropriate safeguards.<ref>{{cite news |title=Surrey GPs suspended for prescribing opioids online without appropriate safeguards |url=https://www.getsurrey.co.uk/news/surrey-news/surrey-gps-suspended-prescribing-opioids-16662569 |access-date=30 August 2019 |publisher=Surrey Live |date=1 August 2019 |archive-date=August 30, 2019 |archive-url=https://web.archive.org/web/20190830075930/https://www.getsurrey.co.uk/news/surrey-news/surrey-gps-suspended-prescribing-opioids-16662569 |url-status=live }}</ref> Public Health England reported in September 2019 that half the patients using strong painkillers, antidepressants and sleeping tablets had been on them for more than a year, which was generally longer than was "clinically" appropriate and where the risks could outweigh the benefits. They found that problems in the UK were less than in most comparable countries,<ref>{{cite news |title=Too many hooked on prescription drugs - health chiefs |url=https://www.bbc.co.uk/news/health-49639914 |access-date=10 September 2019 |publisher=BBC |date=10 September 2019 |archive-date=September 10, 2019 |archive-url=https://web.archive.org/web/20190910094839/https://www.bbc.co.uk/news/health-49639914 |url-status=live }}</ref> but there were 4,359 deaths related to drug poisoning, largely opioids, in England and Wales in 2018 – the highest number recorded since 1993.<ref>{{cite news |title=Drug-related deaths in England and Wales reach record levels, says ONS |url=https://www.pharmaceutical-journal.com/20206962.article |access-date=1 October 2019 |publisher=Pharmaceutical Journal |date=16 August 2019 |archive-date=October 1, 2019 |archive-url=https://web.archive.org/web/20191001124539/https://www.pharmaceutical-journal.com/20206962.article |url-status=live }}</ref>
Public Health England reported in September 2019 that 11.5 million adults in England had been prescribed benzodiazepines, Z-drugs, gabapentinoids, opioids, or antidepressants in the year ending March 2018. Half of these had been prescribed for at least a year.<ref>PHE, 'Dependence and withdrawal associated with some prescribed medicines An evidence review' (2019) 12, "The totals for each medicine were: antidepressants 7.3 million people (17% of the adult population) opioid pain medicines 5.6 million (13%) gabapentinoids 1.5 million (3%) benzodiazepines 1.4 million (3%) z-drugs 1.0 million (2%)</ref> About 540,000 had been prescribed opioids continuously for three years or more. Prescribing of opioids and Z-drugs had decreased, but antidepressants and gabapentinoids had increased, gabapentinoids by 19% between 2015 and 2018 to around 1.5 million.<ref>{{cite news |title=More than 500,000 patients in England were prescribed an opioid for over three years, PHE finds |url=https://www.pharmaceutical-journal.com/20207042.article |access-date=3 November 2019 |publisher=Pharmaceutical Journal |date=10 September 2019 |archive-date=November 3, 2019 |archive-url=https://web.archive.org/web/20191103104819/https://www.pharmaceutical-journal.com/20207042.article |url-status=live }}</ref>
It was reported that in 2021/2022, 1.80 million patients were prescribed dependency-forming medicines in the most deprived areas in England, 1.66 times more than the number prescribed these medicines in the least deprived areas. This pattern had been consistent since 2015/2016.<ref>{{cite news |title=Patients in most deprived areas are 50% more likely to be prescribed dependency-forming drugs, finds NHS report |url=https://pharmaceutical-journal.com/article/news/patients-in-most-deprived-areas-50-more-likely-to-be-prescribed-dependency-forming-drugs-nhs-report-finds |access-date=28 October 2022 |publisher=Pharmaceutical Journal |date=8 September 2022}}</ref>
====France==== A study of prescription opioid use in France over 2004-2017 <ref>{{cite journal | vauthors = Chena C, Kabore JL, Delorme J, Pereira B, Mulliez A, Zenut M, Delage N, Ardid D, Eschalier A, Authier N | title = Prescription opioid analgesic use in France: Trends and impact on morbidity–mortality | journal = European Journal of Pain | volume = 23 | issue = 1 | pages = 124–134 | date = January 2019 | pmid = 30051548 | doi = 10.1002/ejp.1291 | url = https://www.ofma.fr/wp-content/uploads/2018/09/Chenaf_et_al-2018-European_Journal_of_Pain-vf.pdf | access-date = July 12, 2024 }}</ref> found that the use of strong prescription opioids more than doubled over the period. There was a large increase in the use of oxycodone for chronic non-cancer pain, by nearly 20-fold. Prescription opioid-related hospitalizations increased from 15 to 40 per 1,000,000 population (+167%, 2000–2017). Heroin and methadone hospitalisations were much lower, increasing from 2.6 to 6.9 per 100,000, with all of the increase due to methadone use rather than heroin. Opioid-related deaths, including drugs of abuse, rose from 1.3 to 3.2 per 1,000,000 population (+146%, 2000–2015).
===Africa=== ====West Africa==== {{Further|Opioid addiction in West Africa}}
There were 4 million people misusing opioids in Nigeria in 2025, driven by unlicensed, highly addictive opioids illegally exported from India.<ref name=2025BBCWestAfrica/> A 2024 BBC investigation exposed Aveo Pharmaceuticals, a Mumbai-based company, as a key supplier of Tafrodol and similar pills, which contain tapentadol, a potent opioid, and carisoprodol, a highly addictive muscle relaxant banned in Europe. This combination has led to severe addiction, overdoses, and painful withdrawal symptoms.<ref name=2025BBCWestAfrica>{{cite news |last1=Wong |first1=Vicky |title=India bans two opioids behind crisis in West Africa |url=https://www.bbc.com/news/articles/cdx2vwg8gq1o |access-date=23 April 2025 |publisher=BBC |date=23 February 2025}}</ref>
The rise of these opioids followed tramadol restrictions in Nigeria and India, creating a demand for new alternatives. These combination pills are now cheap and widely available on the streets of Ghana, Nigeria, and Ivory Coast, devastating the lives of millions of young people and prompting local leaders to form vigilante groups to seize and destroy the drugs.<ref>{{cite news|url=https://www.bbc.com/news/articles/cwyew21yyjzo|title=Exposing an Indian pharma firm fuelling West Africa's opioid crisis|date=February 21, 2025|access-date=February 21, 2025|newspaper=BBC News}}</ref>
==Accessibility of prescribed opioids==
The worry surrounding the potential of a worldwide pandemic has affected opioid accessibility in countries around the world. Approximately 25.5 million people per year, including 2.5 million children, die without pain relief worldwide, with many of these cases occurring in low and middle-income countries. The current disparity in accessibility to pain relief in various countries is significant. The U.S. produces or imports 30 times as much pain relief medication as it needs, while low-income countries such as Nigeria receive less than 0.2% of what they need. 90% of all the morphine in the world is used by the world's richest 10%.<ref>{{cite journal | vauthors = Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, Arreola-Ornelas H, Gómez-Dantés O, Rodriguez NM, Alleyne GA, Connor SR, Hunter DJ, Lohman D, Radbruch L, Del Rocío Sáenz Madrigal M, Atun R, Foley KM, Frenk J, Jamison DT, Rajagopal MR | title = Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report | journal = Lancet | volume = 391 | issue = 10128 | pages = 1391–1454 | date = April 2018 | pmid = 29032993 | doi = 10.1016/S0140-6736(17)32513-8 | s2cid = 3866872 | url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32513-8/fulltext | access-date = March 30, 2019 | archive-date = April 29, 2019 | archive-url = https://web.archive.org/web/20190429025237/https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32513-8/fulltext | url-status = live | url-access = subscription }}</ref>
America's opioid epidemic has resulted in an "opiophobia" that is stirring conversations among some Western legislators and philanthropists about adopting a "war on drugs rhetoric" to oppose the idea of increasing opioid accessibility in other countries, in fear of starting similar opioid epidemics abroad.<ref>{{cite news|url=https://www.nytimes.com/2017/12/04/health/opioids-africa-pain.html |title='Opiophobia' Has Left Africa in Agony |first=Donald G. |last=McNeil |date=December 4, 2017 |work=The New York Times |access-date=April 27, 2018 |issn=0362-4331 |archive-date=June 16, 2022 |archive-url=https://web.archive.org/web/20220616145537/https://www.nytimes.com/2017/12/04/health/opioids-africa-pain.html |url-status=live |url-access=subscription |location=Kampala, Uganda}}</ref> The International Narcotics Control Board (INCB), a monitoring agency established by the U.N. to prevent addiction and ensure appropriate opioid availability for medical use, has written model laws limiting opioid accessibility that it encourages countries to enact. Many of these laws more significantly impact low-income countries; for instance, one model law ruled that only doctors could supply opioids, which limited opioid accessibility in poorer countries that had a scarce number of doctors.<ref>{{cite web|url=https://www.huffingtonpost.com/the-conversation-us/the-other-opioid-crisis_b_9548050.html|title=The Other Opioid Crisis – People in Poor Countries Can't Get the Pain Medication They Need|author=The Conversation US|date=March 25, 2016|website=Huffington Post|access-date=April 27, 2018|archive-date=June 7, 2017|archive-url=https://web.archive.org/web/20170607125405/http://www.huffingtonpost.com/the-conversation-us/the-other-opioid-crisis_b_9548050.html|url-status=live}}</ref>
In 2018, deputy head of China's National Narcotics Commission Liu Yuejin criticized the U.S. market's role in driving opioid demand.<ref>{{cite news|url=https://www.reuters.com/article/us-china-drugs-usa/china-says-united-states-domestic-opioid-market-the-crux-of-crisis-idUSKBN1JL0D2|title=China says United States domestic opioid market the crux of crisis|author=<!--Not stated-->|date=June 25, 2018|access-date=June 28, 2018|newspaper=Reuters|archive-date=June 29, 2018|archive-url=https://web.archive.org/web/20180629000442/https://www.reuters.com/article/us-china-drugs-usa/china-says-united-states-domestic-opioid-market-the-crux-of-crisis-idUSKBN1JL0D2|url-status=live}}</ref>
In 2016, it was reported that while Mexican cartels are the main source of heroin smuggled into the U.S., Chinese suppliers provide both raw fentanyl and the machinery necessary for its production.<ref name=STAT>{{cite web|url=https://www.statnews.com/2016/04/05/fentanyl-traced-to-china/ |title='Truly terrifying': Chinese suppliers flood US and Canada with deadly fentanyl |url-status=live |archive-url=https://web.archive.org/web/20180201033518/https://www.statnews.com/2016/04/05/fentanyl-traced-to-china/ |archive-date=February 1, 2018 |work=STAT |date=April 5, 2016 |last=Armstrong |first=David}}</ref> In 2016 in British Columbia, police discovered a lab making 100,000 fentanyl pills each month, which they were shipping to Calgary, Alberta. 90 people in Calgary overdosed on the drug in 2015.<ref name=STAT/> In 2016 in Southern California, a home-operated drug lab with six pill presses was uncovered by federal agents. Each machine was capable of producing thousands of pills an hour.<ref name=STAT/>
In 2018, a woman died in London after getting a prescription for tramadol from an online doctor based in Prague who had not considered her medical history. Regulators in the UK admitted that there was nothing they could do to stop this from happening again.<ref>{{cite news |title=Steve Field: Digital GPs overseas remain a danger |url=https://www.hsj.co.uk/policy-and-regulation/steve-field-digital-gps-overseas-remain-a-danger/7024551.article |access-date=15 April 2019 |publisher=Health Service Journal |date=8 March 2019}}</ref> A reporter from The Times was able to buy opioids from five online pharmacies in September 2019 without any contact with their GP by filling in an online questionnaire and sending a photocopy of their passport.<ref>{{cite news |title=RPS calls for investigation after online pharmacies prescribed opioids to undercover reporter |url=https://www.pharmaceutical-journal.com/20207125.article |access-date=20 November 2019 |publisher=Pharmaceutical Journal |date=1 October 2019 }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>
== Alternative for opioids == Alternative drug options for opioids include over the counter pain medication such as Ibuprofen, Tylenol (acetaminophen/paracetamol), and Aspirin or steroid options.<ref name="American Society of Anesthesiologists">{{cite web |title=Non-Opioid Treatment |url=https://www.asahq.org/whensecondscount/pain-management/non-opioid-treatment/ |website=American Society of Anesthesiologists |access-date=December 9, 2019 |archive-date=November 23, 2019 |archive-url=https://web.archive.org/web/20191123165310/https://www.asahq.org/whensecondscount/pain-management/non-opioid-treatment/ |url-status=live }}</ref><ref>{{cite web|title=Medications: opioids vs non-opioids|publisher=UC Davis Health|url=https://health.ucdavis.edu/livinghealthy/topic/pain-management/medications-opioids-vs-non-opioids.html|access-date=8 October 2020|archive-date=October 18, 2020|archive-url=https://web.archive.org/web/20201018191308/https://health.ucdavis.edu/livinghealthy/topic/pain-management/medications-opioids-vs-non-opioids.html|url-status=live}}</ref> A German study comparing legal opioid use between different countries concluded that a high consumption of oxycodone could be attributed to the non-availability of the drug metamizole, a non-opioid pain reliever which is heavily used in some countries such as Germany and Austria, but which is banned in others such as the US and Canada.<ref>{{cite journal | vauthors = Preissner S, Siramshetty VB, Dunkel M, Steinborn P, Luft FC, Preissner R | title = Pain-Prescription Differences - An Analysis of 500,000 Discharge Summaries | journal = Current Drug Research Reviews | year = 2019 | volume = 11 | issue = 1 | pages = 58–66 | pmid = 30207223 | doi = 10.2174/1874473711666180911091846 | s2cid = 52192130 }}</ref>
Along with drug alternatives, many other alternatives can provide relief through physical activities. Physical therapy, acupuncture, injections/nerve blocks, massages, and relaxation techniques are physical activities that have been found to help with chronic pain.<ref name="American Society of Anesthesiologists" /> New pain management drugs like cannabis and cannabinoids have also been found to help treat symptoms of pain.<ref name="American Society of Anesthesiologists" /> Many treatments like cancer treatments are using these drugs to help manage pain.<ref name="American Society of Anesthesiologists" />
An alternative for opioid addiction are opioid receptor agonists or full opioid receptor agonist drugs like methadone, which is also a analgesic and can be used in the treatment of pain in opioid tolerant patients as an extremely safe treatment of choice in hospital settings. Methadone is an opioid, and treatment of pain (over NSAIDs for example) in this form does include opioids; it is, however, an alternative to opioid addiction as a somewhat effective method of eventually reducing opioid use. On the other hand (of methadone, and in opioid addiction treatment), buprenorphine (commonly known as subutex, suboxone) is an easier opioid to taper from, is an alternate opioid with a lower potential for abuse, comes with many contraindications and restrictions.
== Signs of addiction ==
People that are addicted to opioids can have many changes in behavior. Some of the common signs or symptoms of addiction include spending more time alone, losing interest in activities, quickly changing moods, sleeping at odd hours, getting in trouble with the law, and financial hardships.<ref name="American Society of Anesthesiologists1">{{cite web |title=Opioid Abuse |url=https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/opioid-abuse/ |website=American Society of Anesthesiologists |access-date=December 9, 2019 |archive-date=December 15, 2019 |archive-url=https://web.archive.org/web/20191215174401/https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/opioid-abuse/ |url-status=live }}</ref> People that notice any of these behaviors in a peer or in oneself, are usually advised to consult a physician.<ref name="American Society of Anesthesiologists1" />
==Treatment and prevention of addiction== Opioid use disorder can be treated in a number of different ways: Medication assisted treatment pathways offer methadone, Suboxone (Buprenorphine/naloxone) and Vivitrol (naltrexone), though naltrexone has poor treatment outcomes due to low patient retention.<ref>{{cite web |url= https://www.lecturio.com/concepts/opioid-use-disorder/ |title= Opioid Use Disorder |website= The Lecturio Medical Concept Library |access-date= 2021-06-25 |archive-date= June 25, 2021 |archive-url= https://web.archive.org/web/20210625141533/https://www.lecturio.com/concepts/opioid-use-disorder/ |url-status= live }}</ref> According to the 2017 Surgeon General's report, medication (buprenorphine/methadone) assisted therapies (MAT's) remain the gold standard in evidence-based care for opiate addiction, with the highest reduction in morbidity, mortality, and general negative outcomes achieved through long term opioid replacement therapy.<ref>{{Cite journal |last=Murthy |first=Vivek H. |date=2017-01-10 |title=Surgeon General's Report on Alcohol, Drugs, and Health |journal=JAMA |volume=317 |issue=2 |pages=133–134 |doi=10.1001/jama.2016.18215 |issn=1538-3598 |pmid=27854372}}</ref> The report makes recommendations concerning expanding access to MAT in order to combat the opioid epidemic. Social stigma regarding medication-assisted treatment in nations like the USA have been a major barrier in implementing evidence based treatments for opiate addiction.<ref>{{Cite web |last=Lopez |first=German |date=2017-07-20 |title=There's a highly successful treatment for opioid addiction. But stigma is holding it back. |url=https://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexone |access-date=2023-11-12 |website=Vox }}</ref>
Cognitive behavioral therapies and counseling are proven effective (though less efficacious on their own than medication assisted therapies) as well as digital care programs to increase abstinence rates.<ref>{{Cite web|last=Association for Behavioral and Cognitive Therapies|title=Opioid Use Disorder Fact Sheet|url=http://www.abct.org/Information/?m=mInformation&fa=fs_OPIOIDS#:~:text=CBT%20is%20effective%20on%20its,block%20the%20effects%20of%20opioids.|access-date=June 8, 2020|website=Association for Behavioral and Cognitive Therapies|archive-date=June 3, 2020|archive-url=https://web.archive.org/web/20200603121038/http://www.abct.org/Information/?m=mInformation&fa=fs_OPIOIDS#:~:text=CBT%20is%20effective%20on%20its,block%20the%20effects%20of%20opioids.|url-status=live}}</ref><ref>{{Cite web|last=Ryan|first=Shawn|title=Improving Inner-city Substance Use Outcomes with Technology|url=https://static1.squarespace.com/static/5bfc6a4db98a78e1c648c1bd/t/5e37a2db12092f158789ef49/1580704479790/2020-01-25+DynamiCare_Brightview+White+Paper.pdf|access-date=June 8, 2020|website=Ohio Opioid Technology Challenge|archive-date=June 8, 2020|archive-url=https://web.archive.org/web/20200608152352/https://static1.squarespace.com/static/5bfc6a4db98a78e1c648c1bd/t/5e37a2db12092f158789ef49/1580704479790/2020-01-25+DynamiCare_Brightview+White+Paper.pdf|url-status=live}}</ref>
An emerging area in opioid risk prevention is the use of genetic tests intended to inform prescribing decisions. In 2024, the U.S. Food and Drug Administration (FDA) authorized AvertD, a genetic test designed to identify elevated risk of Opioid use disorder in opioid-naïve adults being considered for short-term opioid prescriptions.<ref>{{cite web |title=FDA authorizes first genetic test to identify elevated risk of opioid use disorder |url=https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-genetic-test-identify-elevated-risk-opioid-use-disorder |website=U.S. Food and Drug Administration |date=2024 |access-date=2026-03-10}}</ref> The test analyzes a panel of genetic variants associated with addiction risk to generate a probabilistic risk classification intended to support clinical decision-making rather than provide a diagnosis.<ref>{{cite news |last=Ovalle |first=David |title=FDA approves first genetic test for opioid addiction risk |url=https://www.washingtonpost.com/health/2024/12/19/fda-genetic-test-opioid-addiction-risk-avertd/ |work=The Washington Post |date=2024 |access-date=2026-03-10}}</ref>
Researchers and clinicians have debated the potential role of genetic risk prediction in addiction medicine. Some argue that such tools could help physicians better assess risks when prescribing opioids, particularly in contexts such as post-surgical pain management. Others have raised concerns about the current predictive accuracy of genetic risk scores, the possibility of unequal performance across ancestry groups, and the risk that genetic risk classification could contribute to undertreatment of pain or reinforce stigma surrounding substance use disorders.<ref>{{cite journal |last=Hatoum |first=Alexander S. |title=Concerns about genetic risk testing for opioid use disorder |journal=The Lancet Psychiatry |year=2025 |volume=12 |issue=2 |pages=94–95 |doi=10.1016/S2215-0366(24)00382-9}}</ref>
===Anti-opioid advertisements=== {{See also|D.A.R.E}} A number of methods for the prevention of opioid addiction have been used and suggested. One method is the creation of anti-opioid advertisements. In the 1990s, advertisements depicting drug-seeking people purposefully slamming their arms into doors and crashing their cars, were unsuccessfully targeted at teens.<ref name= Rosenberg>{{cite web|last=Rosenberg |first=Tina |url=https://www.nytimes.com/2020/01/28/opinion/opioid-drug-prevention-ads.html |title=Weaponizing Truth Against Opioids |url-status=live |url-access=subscription |archive-url=https://web.archive.org/web/20200620185747/https://www.nytimes.com/2020/01/28/opinion/opioid-drug-prevention-ads.html |archive-date=June 20, 2020 |work=The New York Times |date=January 28, 2020 |access-date=June 20, 2020}}</ref> These ads were unsuccessful because they emphasized the risk of danger, pain, and death caused by opioids.<ref name=Rosenberg/> While this tactic would make adults acknowledge the risks and stop using opioids, for many teenagers, the perceived danger adds to the appeal, as smoking becomes a form of rebellion against authoritative adults.<ref name=Rosenberg/>
When ads were created that instead channeled teenage rebellion toward resisting the tobacco industry's manipulative tactics, the numbers of teens smoking went down.<ref name=Rosenberg/> The makers of these ads feel that since the internet allows teenagers to view gruesome things anyway, it is perfectly acceptable to subject them to images of self-mutilation in order to protect their lives.<ref name=Littlefield>{{cite web|last=Lifflefield |first=Susan-Elizabeth |url=https://www.cbsnews.com/minnesota/news/anti-opioid-ads-aim-to-prevent-addiction/ |title=Anti-Opioid Ads Aim To Prevent Addiction |url-status=live |archive-url=https://web.archive.org/web/20231017072627/https://www.cbsnews.com/minnesota/news/anti-opioid-ads-aim-to-prevent-addiction/ |archive-date=October 17, 2023 |website=CBS News (WCCO) |location=Minneapolis, MN |date=June 5, 2019 |access-date=June 20, 2020}}</ref> It is felt that thirty seconds of gruesomeness is a small price to pay for sparing a lifetime (however short) of opioid abuse and its accompanying poverty and crime.<ref name=Littlefield/>
These advertisements, which started in the 1980s, are continuing to play on television today, utilizing donated advertisement time. The goals of the most recent advertisements are to show teenagers that addiction can begin after only five days, and that feeding this addiction can consume a person's entire life.<ref>{{cite web|url=https://www.cbsnews.com/news/white-house-launches-new-anti-opioid-ad-campaign-aimed-at-youth/ |title=White House launches new anti-opioid campaign aimed at youth |url-status=live |archive-url=https://web.archive.org/web/20200621161133/https://www.cbsnews.com/news/white-house-launches-new-anti-opioid-ad-campaign-aimed-at-youth/ |archive-date=June 21, 2020 |website=CBS News |date=June 7, 2019 |access-date=June 20, 2020}}</ref>
==References== {{reflist}}
==Further reading== * Pryma, Jane. 2022. "Technologies of Expertise: Opioids and Pain Management's Credibility Crisis." ''American Sociological Review''.
Category:Opioid epidemic