Opioid Facts

Opioids are a type of drug that includes legal prescription pain medications (sometimes called painkillers or pain pills) such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Additionally, this group includes synthetic (drugs made in a lab) opioids like fentanyl and illegal drugs like heroin. The easy access to prescription opioid medications has led to the widespread misuse of both prescribed and non-prescribed opioids. Prescription opioid misuse happens when people use these medications in ways other than prescribed, take someone else’s prescription, or use the medication to get high. Prescription opioid use, even when used as prescribed by a doctor, can lead to a substance use disorder, and it can happen to anyone.

The opioid epidemic has changed over the years. In the beginning, most accidental overdoses and deaths were related to the misuse of prescription opioids. Many prescriptions were diverted or used by people who were not prescribed the drug. Accidental overdose can occur with both the use of prescription opioids and with street or illicit opioids, but most are caused by illegal fentanyl mixed into various substances.

Negative Impacts of Youth Opioid Use

Prescription opioids can be easy to get, and many young people don’t realize how harmful they can be, especially for teenagers whose brains are still developing. Illicit opioids are especially dangerous because their strength is unknown and they are unknowingly mixed into other substances. The risks of misusing opioids include:

Allergic reactions

Coma

Breathing problems

Permanent brain damage

Death

Dangerous and powerful illegal drugs have made their way into street drugs more often, which can lead to deadly overdoses. In the US and New Hampshire (NH), there’s been a rise in illegal fentanyl mixed with xylazine and other substances.

What to Look Out For

Behavior changes (mood swings, social isolation, loss of interest, decline in academic performance)
Physical signs (changes in appetite or sleep patterns, personal hygiene, frequent illness, unexplained health issues, pinpoint or excessively dilated pupils)
Secretive behavior (missing medications, secretive about their activities or whereabouts)
Financial issues (unexplained expenses, borrowing money)
Peer group changes (new, unexplained group of friends, isolation of own friends)
Remember, these signs can be linked to different problems that teenagers go through. So, it’s important to have honest conversations to understand what is happening with the person. Talking to them will help you understand what they’re going through and find solutions together.

Four Proven Prevention Strategies

These strategies are proven and effective ways to prevent and reduce opioid misuse, accidental overdose, and substance use disorder (SUD).

When healthcare professionals, patients, parents/caregivers, and communities work together to support these efforts, everyone benefits! Each of these strategies helps make it less likely for a person to become dependent on opioids and also decreases the overall availability of medication in our communities. They work best together along with other efforts like education and awareness, coalition building, prescription drug monitoring programs, and law enforcement.

Talk with youth about the dangers of use and contaminated substances

talk to your kidsRemember, as parents and caregivers, you are the number one influence on the choices that the youth in your life make. What you say and do is extremely important. Talk with the young people in your life about the real possibility that the substances they are offered could be tainted with other deadly substances. Encourage them to carry naloxone and get trained on how to use it. Find out how on our For Parents & Caregivers webpage and through our Stronger Than You Think campaign.

Consider Alternative Ways to Handle Pain

Alternative pain managementHow you manage your pain is important to think about because these choices can also impact your health and well-being. Work with your healthcare provider to create a plan on how to best manage your pain. You can start with:

  • Knowing your options – Medication is not the only way to manage pain. Ask your healthcare provider questions about what other options are available that are often very effective and carry less risk for developing a substance use disorder or overdose. Here are some tipsfor starting the conversation.
  • Consider alternative ways to manage your pain that do not include opioids. Medication is not the only way to manage pain.  
  • Exploring other strategies. Options such as chiropractic treatments, physical therapy, acupuncture, and massage can be effective ways to get to the root cause of pain.
  • Joining a chronic pain self-management program. In NH, individuals can sign up for an in-person or virtual Living Well with Chronic Pain workshop through the UNH Cooperative Extension or Southern NH Area Health Education Center.

Video: Living Well with Chronic Pain
No matter what technique you use to manage your chronic pain, having support, a plan of action and information from trusted people and resources can help build your confidence and success. Watch this video to learn how the Chronic Pain Self-Management Program is helping people across NH deal with their pain.

If you and your healthcare provider think the use of prescription medication is the best option to manage your pain, then before you start:

  • Check to see if the medication contains opioids, and if it does, discuss the risks and side effects.
  • Share your concerns about any past experiences with misuse or dependency on medication or other drugs, including alcohol.
  • Learn how to reduce the risk of a substance use disorder (SUD). Your body might start depending on a substance after just a few days.
  • Monitor your use and know the signs of potential misuse/overuse. If you suspect you or someone you love is misusing or overusing a prescription opioid medication, talk to their healthcare provider right away.

Practice Safe Use, Storage, and Disposal of all Medication, Substances, and Supplements

Safe use, storage and disposal of prescriptionsIt is important to use, store, and dispose of prescription pain medication (including cannabis) safely to prevent the likelihood that someone will find and misuse them or to prevent accidental overdose.

The Life Cycle of a Prescription Drug (Video)

Learn the life cycle of a prescription drug including important steps you can take to prevent putting yourself or others at risk when taking a prescription, from Annika Stanley-Smith, Director of Substance Misuse Prevention for the Capital Area Public Health Network.

Tips on Safe Use
  • Never take prescription opioids in greater amounts or more often than prescribed.
  • Always let your healthcare provider know about any side effects and concerns you may have about using opioids.
  • Avoid taking opioids with alcohol and other substances or medications. It is very dangerous to combine opioids with other drugs, especially those that cause drowsiness like:
    • Benzodiazepines (such as Xanax® and Valium®)
    • Muscle relaxants (such as Soma® or Flexeril®)
    • Hypnotics (such as Ambien® or Lunesta®)
    • Other prescription opioids
  • Do not share or sell your prescription opioids.
Tips on Safe Storage
  • Store prescription opioids and other substances in a safe place, out of reach of others (including children, family, friends, visitors and even pets). 
  • Always keep count of your prescription.
Tips on Safe Disposal

Getting rid of unused or expired prescription medicine right away can lower the chance of others accidentally taking it or using it the wrong way. Throwing unused medicine in the trash or flushing it down the toilet isn’t safe because it can harm the water and the environment. The best and most eco-friendly way to get rid of your prescription medicine is by using a drug take-back program. In addition, twice a year you can dispose of prescription medications at a Drug Enforcement Administration (DEA)-sponsored Drug Take Back Day, taking place in most communities every April and October.

If there are no disposal sites in your area, there are ways to safely dispose of your medication at home. First, read the packaging label on your medication, the label might have special instructions that you should follow. If not, you can dispose of your prescription medication in the following ways:

  • Reach out to your Regional Public Health Network to find out how to access lock boxes and safe disposal kits and to connect to other resources to prevent substance misuse.
  • Mix your medications with an inedible substance like dirt, cat litter, or used coffee grounds, put them in an airtight container, and throw them away.
  • Use a home disposal kit, such as a Deterra bag.
Before you toss your empty medication bottle, remember to scratch out all the personal information on the label to make it unreadable. Then dispose of the empty medication bottle.

Want to learn more about safe disposal? Watch our Safe Medication Storage playlist – This series of videos about how to store, use and dispose of medications in the home were created by the Community Anti-Drug Coalitions of America (CADCA) / AmerisourceBergen Foundation. These videos are for anyone who is looking to learn more about safe practices with medication, particularly parents, caregivers, and grandparents.

For more information on efforts to prevent the misuse of prescription medicines, visit the following educational campaigns: Up and Away (CDC), Ready to Rescue, RALI USA.

Adopt Harm Reduction Strategies to Prevent Accidental Overdose

Overdose preventionAn overdose (OD) happens when the body gets too much of a drug, or a mix of drugs, and disrupts normal breathing. A person can overdose when using prescription or non-prescription opioids.

Signs and symptoms of an overdose include:

  • Face becomes extremely pale and/or feels clammy to the touch
  • Body goes limp
  • Fingernails or lips have a purple or blue color
  • Vomiting occurs or you hear them making gurgling noises
  • Cannot be awakened or are unable to speak
  • Breathing or heartbeat slows or stops

What to Do in the Event of an Overdose - Naloxone and rescue breathingWhat to Do in Case of an Overdose

Opioid overdose is life-threatening and requires immediate medical attention. It may be hard to tell if a person is “high” or experiencing an overdose. If you aren’t sure, handle the situation like an overdose. If you suspect someone is experiencing an overdose, follow these emergency steps:

  1. Call 911 Immediately.
  2. Give naloxone, if available. Follow the “How to Use” instructions on the product.
  3. Give rescue breaths, as needed, until person starts breathing or help arrives.
  4. If person is still not breathing after 2 – 3 minutes of rescue breathing, give another naloxone dose, if available.
  5. Once the person wakes up, try to keep the person awake and breathing.
  6. Turn the person on their side to prevent choking.
  7. Stay with the person until emergency workers arrive.

For the latest recommendations, access this visual guide on how to safely respond to an overdose using naloxone (both nasal and injectable) and rescue breathing.

 

What is Naloxone?
Naloxone (sometimes called Narcan) is a safe, easy-to-use medication that can quickly reverse an opioid overdose. It blocks the effects of opioids on the brain, and, if used in time, restores normal breathing and saves the person’s life. Since overdose can happen to anyone—even someone using opioids for the first time—it’s important for everyone to carry naloxone, have it at home, and learn how to use it.

Naloxone can be sprayed into the nose or is available as an injection. Sometimes more than one dose of naloxone is needed to reverse the effects of an overdose. You do not need to have a prescription for naloxone and you do not need to be a medical provider to administer or give naloxone. Naloxone is not addictive and will not hurt a person if they do not have opioids in their body.

Where Can I Get Naloxone?
In NH, this life-saving medication is available in three ways:

  1. The public can get free naloxone at any of the nine Doorways.
  2. A patient can ask their healthcare provider to write a prescription for the medication to have their insurance cover the cost.
  3. The medication is available without a prescription at many pharmacies throughout NH.
What is Fentanyl?
Fentanyl is a powerful opioid prescribed for people who have severe pain due to an injury, surgery, cancer, and to manage pain at the end of life. Fentanyl is often mixed into street drugs such as heroin, cocaine, methamphetamine, and pills that can look like prescriptions, such as Oxycodone™, Xanax™, and Adderall™. It exists as a powder and as a liquid, and you cannot see, smell or taste it. It acts extremely fast and it takes only a little bit to cause an overdose. Fentanyl is estimated to be 50 times more powerful than heroin and 100 times more powerful than morphine. Just two milligrams of fentanyl, the size of two grains of salt, is enough to end a young person’s life.
What Are Fentanyl Test Strips?

Fentanyl test strips (FTS) are small strips of paper used to check if fentanyl is present in a drug. While FTS are very accurate, they don’t tell you how much fentanyl is in the substance or tell you if non-fentanyl drugs are in the substance. FTS help people protect themselves from an overdose. Test strips, especially when paired with other harm-reduction strategies like having naloxone on hand, not using alone, and starting slow, can save lives.

In New Hampshire, fentanyl test strips are not considered drug equipment or “drug paraphernalia” making them legal to carry.

Where Can I Get Fentanyl Test Strips?
The Doorway-NH provides free fentanyl test strips while also helping people who use drugs to access every level of treatment they desire. To find a local Doorway in your area, visit The Doorway. Individuals can also call 2-1-1 to get free fentanyl test strips.
What is Xylazine?

Xylazine is an animal tranquilizer that is used for veterinary surgery. It is not approved for use in humans. It is most often mixed with fentanyl, but it has also been found in stimulants like cocaine and methamphetamine. Learn more about xylazine.

Other Resources, Supports & Services

For more information about opioid misuse, overdose, and substance use disorder prevention efforts, follow the links:

Essential Tools for Opioid Overdose Prevention: Fentanyl Test Strips & Naloxone (Narcan™)

Strategies to Prevent an Accidental Overdose

Strategies to Avoid Opioid Misuse

New Hampshire naloxone (Narcan) training “Become a Community First Responder” – This free online training is offered by the University of New Hampshire and after completing the training module, you will be mailed free Naloxone.