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Substance and addiction prevention branch

Opioids
What are opioids?

Opioids are “narcotic” drugs that relieve pain by decreasing the intensity of pain signals that reach the brain. They can also affect regions of the brain that control breathing and emotion. Opioids can be prescribed by doctors to treat pain and diarrhea, put people to sleep, and repress cough. Opioids include prescription medications such as oxycodone (OxyContin®), morphine, fentan​​yl​, codeine, methadone, buprenorphine, and hydrocodone (Vicodin®). They also include illicit substances such as heroin and illicitly manufactured fentanyl and fentanyl analogs.

The effects of opioids can create a general sense of well-being and decrease anxiety, aggression, and tension. While these attributes may be helpful in a therapeutic setting, they can contribute to opioid misuse (used not as prescribed) and produce undesired effects such as apathy, difficulty concentrating, and drowsiness. Both the pain relief and harmful effects of opioids become more noticeable with larger doses of an opioid. The regular use of opioids can cause psychological dependence and increase a person’s tolerance to the drug. Misuse of prescription and/or illicit opioids can result in a substance use disorder (SUD).

Learn more by downloading the DEA’s Drug Fact Sheet (PDF).

Opioids can be found in different forms.

Opioids can come in various forms including capsules, tablets, powder, liquid, chunks in different colors, lollipops, and syrups. They c​an be used by sniffing, smoking, injecting, or swallowing/ingesting. Other forms include rectal suppositories and skin patches. Learn more by downloading the DEA’s Dru​gs of Abuse (PDF).

Fenta​nyl is an extremely potent opioid. It is a tablet or powder that can be smoked, snorted/sniffed, injected, or ingeste​​d orally. Fentanyl can be sold by itself or in combination with drugs. Illicit fentanyl can be added to other substances such as heroin and counterfeit pills to make them cheaper, more addictive, and more powerful. The likelihood of a fatal overdose increases when fentanyl is combined with another drug. Illicitly manufactured fentanyl has driven the increase in overdose deaths that involve synthetic opioids. Fentanyl test strips can be used to tell if a drug contains fentanyl. 
fentanyl
​Heroin is a brownish or white powder, or a black sticky substance typically known as “black tar heroin.” It can be snorted, smoked, or injected. Street heroin is often mixed, “cut,” with other drugs such as fentanyl or substances such as starch, sugar, or powdered milk. 
heroin powder

Hydromorphone is legally manufactured in the United States and can be prescribed by a doctor, commonly as Dilaudid®. Hydromorphone can be acquired illegally from forged prescriptions, from acquaintances or friends, or stolen from pharmacies. It is typically ingested in capsules and tablets. Tablets can also be crushed or dissolved to create injectable solutions. 
hydromorphone
Methadone is a synthetic opioid that can be legally used with a doctor’s prescription to treat pain or opioid use disorder. It can be taken as an oral solution, tablet, or injectable liquid. 

methadone
Morphine comes from opium and is a non-synthetic narcotic used to treat pain. It can be injected or taken orally in capsules and tablets. Common brand names and generic products of morphine include MS-Contin®, Oramorph SR®, MSIR®, Roxanol®, and RMS®. 

morphine vial

Oxycodone is prescribed on its own as OxyContin® and in combination products, such as Percoset®. It can be taken orally in tablet form or injected intravenously after a tablet is crushed and dissolved in water. Powder from a crushed tablet can also be snorted/sniffed. Oxycodone can be inhaled by heating a tablet and placing it on a piece of foil. 

oxycodone
Opium is extracted from Papave somniferum, a poppy plant, and it is a source for many opioids such as heroin, codeine, and morphine. Opium comes in solid, powder, or liquid form. It can be ingested orally, smoked, or intravenously injected. 

opium

​Opioids in California

The graph below shows the age-adjusted rate for deaths due to any opioid-related overdose. Any opioid-related overdose deaths refers to drug-related overdose deaths caused by acute poisonings that involve any opioid as a contributing cause of death, including opioids such as heroin, fentanyl, opium, and prescription opioid pain relievers (e.g., oxycodone, morphine, and hydrocodone).
The California Department of Public Health Substance and Addiction Prevention Branch (CDPH-SAPB) monitors fatal and non-fatal opioid-related overdose trends over time in California, by sex, age, race/ethnicity, and substance type. These indicators and tre​nds are also available by geography, county, and zip code on the California Overdose Surveillance Dashboard​.

What is California doing?
  • ​Connecting partners to improve health care access and health equity
  • ​Building community engagement to reduce stigma  
  • ​Supporting harm reduction services & holistic approaches to wellness
  • ​Statewide surveillance to provide data for evidence-based decisions 

CDPH-SAPB works with many partners throughout the state to monitor and address current trends at the statewide and local level. Working closely with local health departments, drug safety coalitions, and other partners at the local level allows CDPH to support local prevention and intervention efforts that address the unique trends and specific needs of California’s communities.

A statewide Naloxone Standing Order​ has been issued by CDPH to increase access to naloxone​​ in California to reduce the morbidity and mortality associated with opioid overdose.

Negative health consequences and impacts

Treatment

Medication-assisted treatment (MAT) refers to medications used in combination with behavioral therapies and counseling. MAT is effective in treating opioid use disorder. Medications for opioid use disorder include buprenorphine (Suboxone®, Subutex®), methadone, and extended-release naltrexone (Vivitrol®).

Mixing drugs is dangerous

Mixing opioids with other central nervous system depressants such as alcohol, xylazine, or benzodiazepines (e.g., Xanax or Valium) can increase the risk of a drug overdose by slowing breathing and causing sedation. Risk of brain damage, damage to other organs, impaired cognitive function, and death also increases when mixing depressants.

Mixing opioids with stimulants (e.g., ecstasy [MDMA], methamphetamine, cocaine) increases the risk of overdose because combining the drugs can have unpredictable results and may trick someone into thinking that the drugs have no effect on them.

Opioid Overdose

An opioid overdose may occur when someone uses an illicit opioid, misuses a prescription opioid, uses an opioid or other drug that is contaminated with a more potent opioid (e.g., fentanyl), does not understand the directions for use, or takes the opioid as told but the prescriber miscalculated the dose of the opioid.

Other risk factors for opioid overdose include taking opioids by injection, resuming opioid use after a period of abstinence (e.g., after detoxification or stopping treatment), using a high prescribed dosage of opioids, using prescription opioids without medical supervision, and having a concurrent medical condition such as a liver or lung disease, mental health condition, or HIV.

Learn more about drug-related overdose, including signs of​ o​verdose and how to respond using naloxone.

Naloxone

Naloxone can be used to reverse an opioid overdose and is available as a nasal spray, an injectable needle solution, or an auto-injector.

Negative Health Consequences

Misuse of prescription and/or illicit opioids can lead to harmful health effects.

Negative health effects:

Short-term effects:

  • slowed breathing (“respiratory depression”)
  • slowed physical activity
  • nausea
  • vomiting
  • constipation

Long-term effects:

  • substance use disorder or dependence
  • increased tolerance
  • infertility in women
  • liver damage
  • worsening pain (known as “opioid-induced hyperalgesia”)
  • life-threatening withdrawal symptoms in babies born to mothers taking opioids
  • fatal overdose

Withdrawal:

Early withdrawal from opioids includes symptoms such as sweating, runny nose, yawning, and watery eyes. As withdrawal progresses, symptoms may include:

  • nausea                                                        
  • vomiting
  • loss of appetite
  • restlessness
  • increased heart rate and blood pressure​
  • drug craving
  • irritability
  • chills alternated with excessive sweating and flushing

Withdrawal symptoms can be managed through medical care, including the use of drugs such as clonidine, methadone, and buprenorphine.

Overdose effects:

  • slowed breathing
  • clammy and cold skin
  • convulsions
  • constricted pupils
  • confusion
  • extreme drowsiness
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