The opioid crisis refers to the rapid increase in opioid overuse, misuse, and overdose deaths since the 1990s. It involves both prescription opioids and opioids that people use recreationally.

People may also refer to the opioid crisis as the opioid epidemic.

Doctors primarily prescribe opioids for pain relief.

This article explores the opioid crisis in more detail, including its history and how different organizations are trying to combat it.

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In over 20 years, almost 600,000 people have died from opioid overdose in the United States and Canada. This figure may reach 1.2 million people by 2029.

Between 2020 and 2021, opioids were involved in over 75% of about 107,000 drug overdose deaths in the U.S. Opioid-related deaths have occurred in waves since the late 1990s, and there are specific factors that contribute to each wave.

First wave

The first wave of opioid overdose deaths occurred in the 1990s. Increased prescribing of natural opioids, semi-synthetic opioids, and methadone contributed to rising rates of lethal overdoses. Researchers estimated this wave began in 1999, though it is also likely that it occurred before then.

Second wave

The second wave began in 2010, and researchers associated this with an increase in heroin use.

Heroin is an illegal opioid in the U.S.

Third wave

The third wave started in 2013. Researchers found that synthetic opioids, such as illicitly manufactured fentanyl, were contributing to a rise in lethal overdoses. People may unknowingly take fentanyl in combination with heroin, cocaine, and counterfeit pills.

Opioids, or their compounds, come from the poppy plant (Papaver somniferum), or more specifically opium — the resin from the poppy plant. People sometimes refer to natural opioids as opiates. Examples of natural opioids are morphine and codeine.

People make synthetic or semi-synthetic opioids in laboratories and these have similar properties to natural opioids. Synthetic opioids include:

All opioids interact with opioid receptors in the brain to reduce pain and cause sedative effects.

Opioids are highly effective and potent pain relievers. However, these properties also increase the risk of dependence.

Generally, opioid overdoses, both fatal and nonfatal, tend to involve four categories of opioids. These categories are the focus of the Centers for Disease Control and Prevention (CDC) Injury Center:

  • Natural opioids: Examples are morphine and codeine. This category also includes semi-synthetic opioids, such as oxycodone, oxymorphone, hydrocodone, and hydromorphone.
  • Methadone: While this is a type of synthetic opioid, it has its own category.
  • Synthetic opioids: This category includes synthetic opioids that are not methadone, such as tramadol and fentanyl.
  • Heroin: An illegally manufactured opioid derived from morphine.

The CDC track patterns in opioid overdosing, both fatal and nonfatal, to inform their actions to tackle the opioid epidemic.

In addition to this, they are:

  • Improving research: High-quality research directs resources to areas that require assistance and greater prevention efforts.
  • Equipping states with resources: Evidence-based strategies aim to use data to inform public health decisions.
  • Supporting healthcare providers: Guidance, data, and other analytical tools help guide evidence-based decision-making regarding opioid prescribing and safety.
  • Partnering with community organizations: This includes community outreach groups and law enforcement to tackle increasing illicit opioid use.
  • Increasing public awareness: Education on prescription opioid misuse and overdose.

Naloxone (Narcan) can reverse the effects of an opioid overdose, but a person must have access to it immediately for it to be effective. For this reason, naloxone is available over the counter.

While North America is at the center of the opioid epidemic, opioid use is also increasing in other countries, including the United Kingdom, where opioid prescriptions are growing. Because of this, the UK, among other countries, including Australia, Canada, Italy, and Ukraine, have also made naloxone available without a prescription.

The U.S. Health and Human Services Office of Inspector General (OIG) found that 52,000 people enrolled in Medicare experienced opioid overdoses in 2022, though the figure is likely to be higher. About 1.1 million people with Medicare have opioid use disorder (OUD).

The OIG suggested that the Centers for Medicare and Medicaid Services (CMS) clearly communicate their services and inform people of the overdose-reversal medication that their plans cover. It said the CMS should update enrollees when cover for opioid-related treatments and over-the-counter options, such as naloxone, change.

A person should always call 911 or seek emergency medical care if they think someone is experiencing an opioid overdose. Under no circumstances should they leave someone alone if they think they might have overdosed.

Symptoms of opioid overdose include:

  • constricted pupils that can look like pinpoints
  • falling asleep or a loss of consciousness
  • slow and shallow breathing
  • gurgles or choking sounds
  • cold and pale skin, which may vary depending on a person’s skin tone. People with lighter skin tones can have blue-tinged skin, and people with darker skin tones may have grey or white-tinged skin.
  • the body becoming limp

The opioid epidemic is a growing concern, and over the years, different factors have contributed to it.

Early on, the overprescription of opioids led to an increase in dependence and overdoses. The most recent third wave, however, is driven by an increase in synthetic and illicit opioid use.

The CDC and other health organizations are using sophisticated pattern-tracking techniques to develop public health strategies to prevent overdoses in addition to preventing OUD before it begins.