Misuse of opioids (prescription and nonprescription) affects people of all ages, races and ethnicities, sexes, genders, and socioeconomic levels. Physical dependence can develop in a relatively short period of time, and the severe nature of withdrawal symptoms can lead to continued and increased use of opioids to prevent withdrawal
At high doses or when combined with other substances, opioids can cause potentially fatal respiratory depression. Over 75% of drug overdose deaths in 2022 involved an opioid.
Three distinct waves:
Since 1999, the number of opioid-related deaths has been rising continuously. In the 1990s, opioid-related deaths were associated with an increase in prescriptions for pain management. In 2010, a second wave of opioid overdose deaths was driven by heroin use. Most recently, from 2013 to the present, synthetic opioids, especially illegally produced fentanyl, have been the primary driver of opioid-associated mortality.
Public health emergency:
In 2017, the opioid crisis was declared a public health emergency nationwide. This designation was renewed in December 2023 by the US Department of Health and Human Services Secretary.
Naloxone antidote:
In May 2023, the US Food and Drug Administration approved a naloxone hydrochloride nasal spray for over-the-counter administration and use. Naloxone quicky reverses the effects of opioid overdose. There is also an injectable form that anyone can use without medical training or authorization.
Xylazine adulteration:
Xylazine is a nonopioid alpha-2 adrenergic agonist veterinary anesthetic agent that increasingly has been found to be added to illicit drugs such as fentanyl powder and pills.
- Xylazine intoxication can cause difficulty breathing, dangerously low blood pressure and slowed heart rate, and even death. (Note: Naloxone will not reverse the effects of xylazine, but it should be administered in response to any suspected drug overdose.)
- Chronic injection use of xylazine, either intentionally or unintentionally with adulterated drugs, has been associated with the development of abscesses and ulceration that primarily occur on the extremities.
Additional Related Topics in VisualDx:
- Neonatal abstinence syndrome (Neonatal opioid withdrawal syndrome)
- ACEP clinical policies – Opioids
- Alpha-2 adrenoceptor agonist poisoning (includes Xylazine toxicity)
Additional Information and Resources:
- Opioid prescribing resources: Links to public health guidelines and protocols for prescribing opiates including substance use screening tools, nonopioid treatment options, and prescription drug monitoring programs.
- Opioids – to prescribe or not to prescribe (2018 article)
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