Opioid painkillers: the risks of addiction and overdose
Risky SubstancesKey points
- Opioids carry a high risk of addiction.
- Misuse of prescription opioids is a strong risk factor for heroin use.
- Combining opioids with alcohol or sedatives can dangerously slow breathing.
- Naloxone reverses overdoses and is available over the counter.
What the research shows
From pills to heroin. A review by NIDA researchers found that nonmedical use of prescription opioids is a strong risk factor for heroin use. Most people who began using heroin in the 2000s and 2010s had first misused prescription opioids, although only a small fraction of people who misuse pills go on to heroin (Compton et al., 2016). Since then, illicit fentanyl has driven a sharp rise in U.S. overdose deaths.
Back pain. For low back pain, guidelines recommend education, staying active and exercise rather than opioids (Foster et al., 2018).
Combined sedatives. Combining opioids with benzodiazepines, sleeping pills or alcohol greatly increases the risk of fatal respiratory depression. Sedative hypnotics also carry risks of falls and memory problems in older adults (Glass et al., 2005).
How to lower the risks
- Use opioids only for severe acute pain, at the lowest dose for the shortest time.
- Never share or sell prescription opioids.
- Store them locked and dispose of leftovers at a take-back site.
- Do not combine opioids with alcohol or sedatives.
- Keep naloxone at home if anyone in your household takes opioids.
Frequently asked questions
Where can I get naloxone?
Naloxone nasal spray has been available over the counter in U.S. pharmacies since 2023, and many health departments give it out free.
Are opioids good for chronic back pain?
For most people, no. U.S. guidelines recommend nondrug treatments and non-opioid medications first.
Sources
- Compton et al. (2016). Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. New England Journal of Medicine 374(2):154-163. doi:10.1056/NEJMra1508490
- Foster et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet 391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6
- Glass et al. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331(7526):1169. doi:10.1136/bmj.38623.768588.47
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