The opioid crisis in the United States has been driven by a range of potent, addictive drugs. While dozens of opioids exist, both illegal and prescription, some are more prevalent in cases of abuse and overdose. Understanding the most commonly abused types is a crucial first step in prevention and treatment.
1. Fentanyl
Fentanyl is a powerful synthetic opioid that is approximately 50 to 100 times more potent than morphine. It is approved for managing severe pain, typically associated with advanced cancer or surgery. However, a major concern arises from illicitly manufactured fentanyl, which is often sold on the street as counterfeit pills or mixed with other drugs like heroin or cocaine, often without the user's knowledge. The potency of fentanyl means that even a small dose can lead to a fatal overdose, a primary driver of the increase in drug overdose deaths in recent years. The Centers for Disease Control and Prevention (CDC) monitors the opioid overdose epidemic and has reported that deaths involving synthetic opioids, primarily fentanyl, have rapidly increased since 2013.
2. Oxycodone
Oxycodone is a semi-synthetic opioid prescribed to treat moderate to severe pain. It is sold under brand names such as OxyContin® and Percocet®, the latter of which combines oxycodone with acetaminophen. In the past, the over-prescription of these medications contributed to the first wave of the opioid epidemic in the 1990s. People may abuse oxycodone by taking it in larger doses or more frequently than prescribed, or by crushing and snorting or injecting the pills to get a faster, more intense effect. This misuse carries a high risk of developing an opioid use disorder and can lead to seeking more potent and dangerous opioids when prescriptions become harder to obtain.
3. Hydrocodone
Hydrocodone is another semi-synthetic opioid commonly prescribed for moderate to severe pain, often combined with acetaminophen and marketed under brand names like Vicodin® and Norco®. Like oxycodone, it is prone to abuse due to its euphoric effects. Patients may start misusing it by taking more than prescribed, and long-term use, even as prescribed, can increase the risk of long-term dependence and addiction. Diversion of these prescription medications to the illicit market has also been a persistent problem.
Comparing Commonly Abused Opioids
| Feature | Fentanyl | Oxycodone | Hydrocodone |
|---|---|---|---|
| Classification | Synthetic | Semi-synthetic | Semi-synthetic |
| Potency | 50–100x stronger than morphine (pharmaceutical grade) | Potent painkiller | Potent painkiller |
| Primary Source of Abuse | Illicitly manufactured is a major driver of overdose deaths; also prescribed. | Pharmaceutical prescriptions diverted to illicit use. | Pharmaceutical prescriptions diverted to illicit use. |
| Risk of Overdose | Extremely high due to extreme potency and inconsistent dosing of illicit product. | High, especially when taken in high doses or combined with other substances like alcohol. | High, particularly when combined with alcohol or benzodiazepines. |
| Common Forms | Powder, counterfeit pills, nasal sprays. | Tablets, extended-release capsules. | Tablets, extended-release capsules. |
Signs and Symptoms of Abuse
Regardless of the specific opioid, the signs of abuse and addiction are often similar. As tolerance builds, a person needs more of the drug to achieve the same effect. Other indicators of an opioid use disorder (OUD) can include:
- Behavioral Changes: Neglecting responsibilities, losing interest in hobbies, and withdrawing from friends and family.
- Physical Symptoms: Constricted pupils, drowsiness, changes in sleep patterns, and flu-like withdrawal symptoms when not using.
- Compulsive Drug Seeking: Spending a significant amount of time and money obtaining, using, or recovering from the drug's effects.
Treatment and Prevention
Effective treatment for opioid use disorder is available and often involves a combination of medication-assisted treatment (MOUD) and counseling or behavioral therapies. The most common MOUD options include buprenorphine, methadone, and naltrexone. Counseling can help address the psychological aspects of addiction and develop coping strategies.
Prevention strategies include:
- Educating patients on the risks of prescription opioids.
- Safe prescribing practices by healthcare providers, including utilizing Prescription Drug Monitoring Programs (PDMPs).
- Promoting safe storage of medications and encouraging the use of community drug take-back programs for unused pills.
- Making naloxone, a medication that can reverse an opioid overdose, more widely accessible.
Conclusion
Fentanyl, oxycodone, and hydrocodone stand out as three of the most commonly abused opioids, each presenting severe dangers to individuals and communities. The emergence of illicit fentanyl has significantly escalated the risk of fatal overdose due to its extreme potency and unpredictability. Prescription medications like oxycodone and hydrocodone, though originally intended for pain management, have contributed to the epidemic through misuse and diversion. Recognizing the signs of opioid abuse and promoting access to both treatment and harm reduction measures, such as naloxone, are critical steps in combating this public health crisis and saving lives.
