Medications & Opioids

In this section: What is it? | What should I know? | What is the impact in our region? | More information

What is it?

Some prescription medications have psychoactive (mind-altering) properties and, because of that, are sometimes misused or abused. In fact, prescription drugs are, after marijuana and alcohol, the most commonly abused substances by Americans aged 14 or older. Because Washington State, like many others across the U.S., is currently experiencing an opioid overdose crisis, stemming from misuse of both prescription pain medications and heroin, this section will focus primarily on those substances.

Prescription medications

Commonly abused prescription drugs include opioid pain relievers, such as Vicodin or Oxycontin; stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin; and central nervous system depressants for relieving anxiety, such as Valium or Xanax.

Opioids

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, like oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and others.

These drugs are chemically related and all interact with opioid receptors on nerve cells in the body and brain. Synthetic and prescription opioids come in a variety of formats, including pills, powders, patches placed on the skin, and even lollipops (Actiq, a strong formulation of fentanyl used for severe cancer pain).

Heroin is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. It usually appears as a white or brown powder, or as a black, sticky substance, known as "black tar" heroin.

All of these substances can be ingested, snorted, smoked, or injected, and they are all highly addictive and harmful.

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What should I know?

Call WA Recovery Help Line 1-866-789-1511Non-opioid prescription medications

Stimulants can have strong effects on the cardiovascular system, causing irregular or rapid heartbeat, or even heart failure or seizures. CNS depressants, like benzodiazepines, slow down brain activity and can cause sleepiness or coordination. When abused, both classes of drugs directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain's reward pathway. Continued use of stimulants or CNS depressants can lead to physical dependence and addiction.

Opioids

Opioids can produce drowsiness, cause constipation, and, depending on the amount taken, depress breathing. The latter effect makes opioids particularly dangerous, especially when they are snorted or injected, or combined with other drugs or alcohol. Long-term misuse of opioids may also cause brain damage; studies have shown some deterioration of the brain's white matter due to heroin use, which may affect decision-making, the ability to regulate behavior, and responses to stressful situations.

More people die from overdoses of prescription opioids than from all other drugs combined, including heroin and cocaine.

Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels, leading to permanent damage of vital organs.

Opioid overdose

When there is too much opioid in the body, a person can lose consciousness and stop breathing -- this is an overdose.

An opioid overdose can happen suddenly or come on slowly over a few hours. Without oxygen, a person can die.

Signs of an opioid overdose include:

If you think someone may be overdosing, call 9-1-1 immediately and stay until help arrives. The Washington State Good Samaritan/Overdose Law protects both you and the overdose victim from drug possession charges; don't be afraid to call for help!

Naloxone (trade name "Narcan") is a prescription medication that can temporarily stop the effects of opioids and help a person start breathing again. If you or someone you know takes opioids for any reason, including medications taken as directed by a physician, it is a good idea to obtain and learn how to use naloxone. Learn more about naloxone and opioid overdose at the StopOverdose.org website.

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What is the impact on our region?

Infographic with meth statsThe effects of opioid abuse continue to devastate the state of Washington. Opioid abuse and addiction crosses nearly all demographic boundaries, and the effects on communities are widespread, resulting in increased overdose deaths, increased healthcare costs, lost productivity, increased criminal justice system costs, and other harmful impacts to communities.

Treatment admissions and deaths

In 2016, 31% of all people admitted for treatment cited heroin as their primary drug of use, an increase compared to 2012. Heroin deaths have declined somewhat from a peak of 156 deaths in 2014, with 132 deaths in 2015 and 118 in 2016, however other heroin indicators overall remain high. For example, there were more than 4 calls a day to the Washington Recovery Help Line seeking assistance regarding heroin in 2016 (including 25 calls from minors, 476 from young adults, and 1,179 from adults 26 and older).

Prescription-type opioid-involved treatment admissions constituted 5% of admissions in the second half of 2016, similar to previous years and down from the peak in 2010. However, deaths involving prescription opioids totaled 107 in 2016, up slightly from the previous two years (though still lower than the peak of 164 seen in 2009).

Increases in deaths caused by overdoses of the powerful synthetic opioid fentanyl, as well as fentanyl-like substances, are occurring in much of the U.S., including Washington State. Fentanyl was involved in 70 fatal overdoses in 2016 in Washington.

Availability

Heroin availability is high and stable in the Seattle area, according to the 2016 National Drug Threat Assessment. The majority of the drug in the western U.S. comes from Mexico and is usually brown powder or black tar heroin. Heroin is typically not produced in the U.S., but instead shipped here in wholesale amounts and then prepared for further distribution and sale. It may be mixed with other drugs such as fentanyl, in order to stretch the product amount and increase revenue.

In 2016, over 73 million retail prescription drugs were filled in Washington pharmacies -- enough to provide each resident in the state with 10 bottles of pills. While there is ample supply of prescription drugs, however, the means of acquiring them legally is becoming more difficult for some longtime users. Prescription drugs for illicit use are commonly obtained through forged prescriptions, armed robberies, improper prescribing, illegal internet pharmacies, doctor-shopping, and stealing prescriptions from family members or friends.

Outlook

The abuse of painkillers and the subsequent rise of heroin addiction in Washington and across the nation should be enough to encourage more responsible prescribing. Heroin will continue to flow into Washington, as the drug remains in high demand by a large demographic group. An increase in the use of both prescription opioids and heroin may result in greater treatment admissions numbers and overdose deaths. As opioid abuse affects all areas of Washington, the continued availability of naloxone throughout the state is vital to help reverse overdose deaths by users and accidental exposures by law enforcement personnel investigating opioid-related crimes.

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