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Definitions and Commonly Used Terms

Opioids: The term opioids refers to a class of drugs, both legal and illegal, that act on particular receptors in the brain. Doctors prescribe opioid medications to treat moderate-to-severe pain, often after injury or surgery or for health conditions such as cancer. They work by attaching to the receptors on nerve cells in the body and brain, reducing the intensity of pain signals and feelings of pain. Opioid pain medications are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can lead to dependence and misuse. When misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths. 1 In addition to prescription medications, opioids are also used in illegal street drugs such as heroin. 2

Types of opioids include:

Natural opiates: derived from chemicals found in plants, like the opium poppy, and are included in drugs, such as morphine and codeine.
Semi-synthetic opioids: created in labs from natural opiates; examples of semi-synthetic drugs include hydrocodone, oxycodone, and heroin.
Synthetic opioids: developed without any natural opiates and are completely “man made.” Examples include fentanyl, tramadol, and carfentanil. 3

Opioid crisis: The recent increase in opioid-related overdose deaths is often referred to as the opioid crisis or opioid epidemic. Emergency department visits for opioid overdoses rose 30 percent in the United States from July 2016 through September 2017, with the greatest increase occurring in the Midwest with a 70 percent rise in opioid overdoses.  In specific areas around the country, the increase in opioid-related deaths is considered an epidemic. An epidemic refers to the occurrence of more cases of a disease than expected in a given area or among a specific group of people over a particular period of time.4

Overdose: An overdose is when a person takes an amount of a drug that causes serious, acute harm to the body, or even death.

Fatal overdose: A fatal overdose is a death due to consuming too much of a drug. This is also known as an overdose death.

Prescription drug misuse: According to the National Institute on Drug Abuse, prescription drug misuse means taking a medication in any way other than how it was prescribed by a doctor.5 Taking a larger dose or taking a medication prescribed to someone else, even for a health concern or pain, is still considered misuse. Misuse of prescription opioids is a serious public health concern in the United States.

Opioid use disorder: An opioid use disorder is a measurable, medical diagnosis that manifests as a pattern of distress and dysfunction in a person’s life because of opioid use. The symptoms include the following:6

- Opioids are taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, using the opioid, or recovering from its effects.
- Craving, a strong desire or urge to use, opioids.
- Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational, or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous.
- Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- A tolerance for opioids has developed, meaning it takes a larger amount of opioids to achieve the same effects or ‘high.’

Opioid use disorders are diagnosed on a scale of severity depending on how many symptoms are present within a 12-month period.
Mild opioid use disorder: presence of 2-3 symptoms
Moderate opioid use disorder: presence of 4-5 symptoms
Severe opioid use disorder: presence of 6 or more symptoms7

Opioid withdrawal: Withdrawal occurs if a person’s body has grown accustomed to the release of opioids in the brain and then the person stops or decreases their use of opioids. Symptoms of opioid withdrawal include dysphoria, nausea, vomiting, GI upset, tremor, restlessness, muscle or joint aches, sweating, pupillary dilation, diarrhea, yawning, fever, insomnia, irritability, and anxiety.8

Medication-assisted treatment (MAT): MAT is the use of certain medications, such as buprenorphine, methadone, and naltrexone, to treat opioid use disorders and prevent opioid overdoses. MAT drugs are divided into two classes based on the way in which they suppress withdrawal symptoms and cravings. The first set of drugs are called antagonists, and they work by blocking opioids from attaching to the opioid receptors in the brain and activating them. The second set of drugs are called agonists, and they work by activating those receptors but to a much lesser degree than an opioid would. Advocates of MAT encourage its use in treatment alongside counseling and behavioral therapies. MAT, when used to treat opioid use, is also referred to as medications for opioid use disorders or pharmacotherapy.

The Scope of the Crisis: Statistics

Graph illustrating opioid deaths
  • 130 Americans die every day from an opioid overdose.9
  • In 2017, 11.4 million people misused prescription opioids, and 2.1 million people had an opioid use disorder.10
  • Emergency department visits for opioid overdoses rose 30 percent in all parts of the US from July 2016 through September 2017, with the greatest increase in opioid overdoses occurring in the Midwest with a 70 percent rise in opioid overdoses. Opioid overdoses in large cities increased by 54 percent in 16 states.11
  • The five states with the highest rates of fatal opioid overdoses in 2016 were West Virginia, Ohio, New Hampshire, Pennsylvania, and Kentucky.12
  • Nearly 80 percent of people who use heroin report misusing prescription opioids prior to heroin.13
  • A recent Center for Disease Control analysis found that fentanyl was involved in 56 percent of opioid overdose deaths in 10 states from July 2016 through December 2016.14

Overdose

An overdose occurs when a person takes an amount of a drug that causes serious, acute harm to the body, or even death.

 

Opioid overdose is life threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.

Call 911 immediately if a person exhibits any of these symptoms:15

  • Their face is extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

 

Preventing or Reversing an Overdose

Naloxone, also known as Narcan, is a medication that rapidly reverses opioid overdoses. Naloxone binds to opioid receptors to not only block the effects of opioids but also reverses the effects of opioids. This medication is administered as an injection or as a nasal spray. It can take as little as 20 minutes to be trained to administer naloxone. Many states have made naloxone easily attainable without a prescription.16

Photo of ambulance

Good Samaritan Law

Some people may hesitate to call 911 if they think that someone has overdosed; however, the time that is wasted debating whether to call emergency services can be critical to saving that person’s life. Many states have enacted legislation to encourage people to seek medical attention for an overdose or to seek follow-up treatment after naloxone has been administered. This type of legislation is often referred to as Good Samaritan Laws. These laws generally provide immunity from arrest, charge, or prosecution for certain drug offenses when a person who is experiencing an opiate-related overdose or observing one calls 911 to seek medical assistance. These laws vary by state, but it is estimated that 40 states and the District of Columbia have enacted a Good Samaritan Law.17

 

To find out the laws governing naloxone administration and availability in your state, visit Prescription Drug Abuse Policy System.18  http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

 

Further Resources on Overdoses

Opioid Overdose Prevention Toolkit: Safety Advice for Patients & Family Members. SAMHSA, 2016.

Law Enforcement Naloxone Toolkit to support law enforcement agencies in establishing a naloxone program in their jurisdiction.

MAT for Opioid Use Disorder

Medication-assisted treatment (MAT) is the use of certain medications to treat opioid use disorders and prevent opioid overdose. MAT drugs help in recovery by suppressing withdrawal symptoms and cravings.

 

Common medications include:

  • Methadone, taken in a daily pill, liquid, or water
  • Buprenorphine, taken as a daily thin-film or sublingual tablet (brand name is Suboxone)
  • Naltrexone, administered as an injection (brand name is Vivitrol)

 

MAT augments the chemistry of the brain. The medications currently approved to treat opioid addiction are divided into two classes:

  • Antagonists: act on the brain's opioid receptors by blocking the euphoric effects of opioids. Examples of antagonists are naloxone and naltrexone.
  • Agonists: act on the brain's opioid receptors by substituting as a less rewarding, intensive drug. Methadone is an example of an agonist.

Buprenorphine acts as a partial agonist and antagonist at the same time.

 

Both classes relieve physiological cravings and stabilize body functions as it goes through withdrawal. The goal of MAT is to decrease the use of the more addictive and lethal opioids and stop the cycle of addiction. Advocates of MAT encourage its use in treatment alongside counseling and behavioral therapies.

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Further Resources on MAT

Extended-Release Naltrexone. National Drug Court Institute, 2013.

Medication-Assisted Treatment for Opioid Use Disorders in Drug Courts. National Drug Court Institute, 2016.

Medication-Assisted Treatment for Opioid Use Disorder in the Criminal Justice System. American Association for the Treatment of Opioid Dependence, Inc.

Naloxone: Overview and Considerations for Drug Court Programs. National Drug Court Institute, 2016.

Medication Assisted Treatment Course. This online training curriculum was “designed to educate drug court professionals on medication-assisted treatments (MAT) for substance use disorders with a major focus on opioid use disorders.”

Medication-Assisted Treatment in Drug Courts: Recommended Strategies. Center for Court Innovation and Legal Action Center, 2015

Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families. SAMHSA, 2018.

The National Public Health Emergency

On October 26, 2017, under section 319 of the Public Health Service Act, the Department of Health and Human Services declared a nationwide public health emergency to address the opioid crisis, as directed by President Donald J. Trump.19 This was one of the preliminary recommendations made by The President’s Commission on Combating Drug Addiction and the Opioid Crisis.20

 

The federal government identified five specific strategies that the Department of Health and Human Services will implement:

  • Improve access to treatment and recovery services;
  • Promote use of overdose-reversing drugs;
  • Strengthen public understanding of the epidemic through better public health surveillance;
  • Provide support for cutting-edge research on pain and addiction; and
  • Advance better practices for pain management.

 

Many agencies, including the Center for Disease Control, the Food and Drug Administration, the Department of Justice, the Department of State, the National Institutes of Health, the Department of Defense, the Department of Veterans Affairs, and the Department of Health and Human Services have been directed to address the opioid crisis through pre-existing and new programs. For more information about public health emergency declarations under section 319 of the Public Health Service Act, visit the Public Health Emergencies website, managed by the Office of the Assistant Secretary for Preparedness and Response, under the US Department of Health and Human Services.

 
Further Reading

The President’s Commission on Combating Drug Addiction and the Opioid Crisis  

https://www.whitehouse.gov/ondcp/presidents-commission/

Fact Sheet: President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis

https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-taking-action-drug-addiction-opioid-crisis/

Treatment Courts and the Opioid Crisis

What Drug Courts and Communities Can Do

The opioid crisis is complex and thus solutions to the crisis need to be multifaceted and multidisciplinary. Solutions are also not universal, each jurisdiction will develop responses based on their unique needs. However, successful responses usually begin with collaboration across many fields.

 

Work Collaboratively

  • Work with local legislative bodies and councils to form a task force including law enforcement, social services, nonprofits, Treatment Assessment Services for the Courts (TASC), judges, physicians, and active community members
  • Organize partners to encourage state legislators to allocate funds for a Prescription Drug Monitoring Program
Woman standing in room full of people

Make the Community Part of the Solution and Raise Local Awareness

 

For more details about policies to combat the opioid crisis and how one treatment court transformed their model to respond to their community’s opioid crisis, watch NDCRC’s webinar “Responding to the Opioid Crisis: National and Local Approaches.”.

The webinar covers:

  • Overview of Bureau of Justice Assistance initiatives to address the opioid crisis
  • Opioid overdose prevention in New Jersey
  • Responding to opioid overdoses
  • Description of the Buffalo Opioid Intervention Court

  1. "Opioid Overdose." Centers for Disease Control and Prevention, last modified August 28, 2017. https://www.cdc.gov/drugoverdose/opioids/terms.html.
  2. Krieger, Carrie."What Are Opioids and Why Are They Dangerous?" Mayo Clinic. March 21, 2018. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270.
  3. Bellum, Sara. "Real Teens Ask: What Are the Different Types of Opioids?" NIDA for Teens. July 16, 2014. https://teens.drugabuse.gov/blog/post/real-teens-ask-what-are-different-types-opioids-0.
  4. "Lesson 1: Introduction to Epidemiology." Centers for Disease Control and Prevention, last modified, May 18, 2012. https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html.
  5. "National Institute on Drug Abuse (NIDA)." NIDA. Accessed July 30, 2018. https://www.drugabuse.gov/.
  6. "Substance-Related and Addictive Disorders." Diagnostic and Statistical Manual of Mental Disorders, 2013. doi:10.1176/appi.books.9780890425596.dsm16.
  7. "National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use." American Society of Addiction Medicine, 2015, 1-64. doi:https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf.
    Please consult a medical doctor for advice and diagnosis.
  8. "Clinical Opiate Withdrawal Scale." Drug Abuse.gov. Accessed July 30, 2018. doi:https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf.
  9. "Opioid Overdose." Centers for Disease Control and Prevention, last modified August 30, 2017. https://www.cdc.gov/drugoverdose/epidemic/index.html
  10. “Opioid Epidemic By the Numbers.” Health and Human Services, last modified January 2018. https://www.hhs.gov/opioids/sites/default/files/2018-01/opioids-infographic.pdf
  11. "Opioid Overdose Crisis." National Institute on Drug Abuse, last modified March 06, 2018. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.
  12. "Opioid Overdose." Centers for Disease Control and Prevention. December 19, 2017. https://www.cdc.gov/drugoverdose/data/statedeaths.html.
  13. "Prescription Opioid Use Is a Risk Factor for Heroin Use."National Institute on Drug Abuse. Accessed July 30, 2018. https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use.
  14. O’Donnell,, Julie K., John Halpin, Christine L. Mattson, Bruce A. Goldberger, and Matthew R. Gladden. "Morbidity and Mortality Weekly Report (MMWR)." Centers for Disease Control and Prevention. November 02, 2017. https://www.cdc.gov/mmwr/volumes/66/wr/mm6643e1.htm.
  15. Walsh, Lynne. “Opioid Overdose.” Veterans and Military Families | SAMHSA - Substance Abuse and Mental Health Services Administration, 16 June 2015, www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose.
  16. National Institute on Drug Abuse. “Opioid Overdose Reversal with Naloxone (Narcan, Evzio).” NIDA, 4 Apr. 2018, www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio.
  17. “DRUG OVERDOSE IMMUNITY AND GOOD SAMARITAN LAWS.” National Conference of State Legislatures, 6 June 2017, www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx.
  18. “Naloxone Overdose Prevention Laws.” Prescription Drug Abuse Policy System, Last modified July 1, 2017. http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139.
  19. "HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis." U.S. Department of Health and Human Services.HHS.gov. May 23, 2018. https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html.
  20. "President's Commission." The White House. March 29, 2017. https://www.whitehouse.gov/ondcp/presidents-commission/.