What drugs make up America's opioid epidemic

Fentanyl, heroin, hydrocodone most common forms of opioids

By RJ Marquez - Digital Content Curator , Adrian Garcia - Digital Journalist

SAN ANTONIO - The national epidemic of prescription painkillers as an addiction is killing an unprecedented number of people and leaving millions of people in a cycle of life-­altering dependence.

Drug overdoses are the leading cause of accidental death in the U.S., according to the the American Society of Addiction Medicine.

It reported that 21.5 million Americans 12 or older had a substance abuse disorder in 2014.

Of those, 1.9 million had a disorder involving pain relievers. More than a half-million had a substance abuse problem that involved heroin. There is a distinction to be made among the broad term “opioid." 

Opioids are a class of drugs that include both illicit drugs but also lawful, prescribed pain relievers.

Below are the primary drugs that fall into the opioid category.  

Oxycodone 

Oxycodone is a semisynthetic opioid that is sold under the brand names OxyContin and Percocet, among others.

It is a powerful narcotic pain reliever prescribed for moderate to high pain relief.

Though highly addictive, oxycodone is not thought to be as frequently abused as hydrocodone, according to the U.S. Food and Drug Administration. 

Patients are warned not to break, crush, chew or dissolve tablets because the rush of oxycodone into the system could cause serious health issues.  

Hydrocodone 

Hydrocodone, also referred to as Vicodin, is a semisynthetic opioid that is a more powerful form of codeine and is often mixed with acetaminophen.

Hydrocodone is the most frequently prescribed painkiller in the country and the most abused, according to the U.S. Food and Drug Administration.

It is a prescribed painkiller used orally for relief of moderate to severe pain but is also commonly taken in liquid form. 

Fentanyl

Fentanyl is a powerful synthetic opioid that has been approved for treating severe pain, typically advanced cancer pain.

It is 50 to 100 times more potent than morphine, according to the Centers for Disease Control and Prevention.

Illegally made and distributed fentanyl has been on the rise in several states.

The type of fentanyl associated with overdoses is bought on the street and mixed with heroin.

Street names include Apache, China girl, goodfella, jackpot murder 8, TNT and Tango and Cash. 

Heroin 

Heroin is the most common form of illegal opioid, and usage has increased across the U.S. among men and women, most age groups and all income levels.

According to the CDC, some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured and people with higher incomes.

Between 2002 and 2014, the rate of heroin-related overdose deaths more than quadrupled, and more than 10,500 people died in 2014.

Today’s typical heroin addict starts at 23 years old, is more likely to live in affluent suburbs or large metropolitan areas and was led to heroin through the abuse of prescription opioids.

Codeine 

Codeine is one of the weakest opioids and is typically used to treat moderate pain. It is often given when other pain relievers such as ibuprofen and acetaminophen fail to work.

Codeine decreases activity in the part of the brain that controls coughing, so it is frequently mixed with other liquids to develop cough syrups for colds and flu.  

It is also used for pain relief for dental procedures in children, but the FDA is investigating codeine-based remedies for children and teens because of concerns that it can cause difficulty breathing.

In Europe, it is not recommended as a cough medicine for children under 12 years old.

Morphine 

Morphine is a powerful opioid sold under many trade names, including Avinza and Astramorph.

It acts directly on the central nervous system as a pain medication and is also used to treat acute and chronic pain.

It can be used during childbirth and is often administered via a syringe, but it can come in pill form.

As with other opioids, it can cause serious health problems if mixed with alcohol, other medications or street drugs. 

Methadone 

Methadone is an opioid used to treat severe chronic pain and sold under the brand names Dolophine and Methadose among others.

It is also commonly used to help recovery patients detox from an opioid dependence, but it has many of the same side effects as opioids.

According to the CDC, more than 4 million methadone prescriptions were written for pain in 2009, despite U.S. Food and Drug Administration warnings about the risks associated with methadone.  

Methadone is available as a low-cost generic drug. It is often listed as a preferred drug by insurance companies. 

Buprenorphine 

Buprenorphine is an opioid used as an alternative to methadone to help addicts recover from heroin use.

It is different from other opioids because its a partial opioid agonist, which means that it produces less euphoria and dependence. It is available under the trade names Cizdol and Subutex.

Suboxone is a combination of buprenorphine and naxolone, an opioid antagonist. The antagonists block opiate receptors in the brain and prevent the high that abusers cave.  

Studies show that the effectiveness of buprenorphine and methadone are almost identical. 

Hydromorphone 

Hydromorphone is a potent prescription painkiller most commonly known by the brand names Dilaudid and Exalgo.

Liquid hydromorphone is often mistaken for morphine and has been associated with "wrong drug” errors, when hospitals provide the wrong pain medication for patients. 

Meperidine/pethidine

Meperidine or pethidine is another synthetic opioid analgesic similar to morphine.

The most common brand name is Demerol, and it’s often used to put people to sleep before an operation and to provide pain relief after childbirth.

For much of the 20th century, pethidine was the most prescribed opioid among physicians. In 1975, 60 percent of doctors prescribed it for acute pain and 22 percent for chronic severe pain.

Pethidine was initially thought to be safer than morphine and carry a lower risk of addiction, but that was later discovered to be a myth. 

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