What Is the Scope of Opioid Use Today?

Opioids remain at the center of the drug addiction nightmare covering the nation, but opioid addiction today looks a bit different than it did 25 years ago when the crisis began.

Medical first responder

Opioid drugs have consistently made headlines as the leading cause of drug-related death in America. Since the late 1990s, opioids have been at the center of America’s surging addiction crisis. And while the face of the opioid crisis has evolved over the last 25 years, the crisis remains at epidemic-level proportions.

What Are Opioids?

Opioids refer to a class of drugs that includes heroin, fentanyl, prescription painkillers, and synthetic opioids. Some opioids are legal, like prescription painkillers, whereas other opioids are illegal, like heroin, illicitly obtained painkillers, and counterfeit painkillers or other synthetic opioids that are made in clandestine drug labs.1

Opioids usually fall into one of three categories:

  • Natural opioids (like morphine and codeine, derived from the opium poppy)
  • Semisynthetic opioids (such as prescription drugs like hydrocodone and oxycodone, and illicit drugs like heroin, i.e., drugs that are partially derived from the opium poppy but which also have synthetic, manmade elements)
  • Fully synthetic opioids that are not derived from the opium poppy (like methadone, tramadol, and fentanyl)

The Timeline of the Opioid Epidemic

To understand the scope of opioid use today, one has to understand the timeline of the epidemic. The number of people who died from a drug overdose in 2021 was six times higher than in 1999, and opioids accounted for the overwhelming majority (about 75%) of those deaths. About 645,000 people died from opioid drug overdoses between 1999 and 2021.

Understanding how the crisis expanded from 1999 to the present day is critical for developing solutions to the problem. The three phases of the ongoing opioid addiction epidemic are as follows:2

Under pressure from pharmaceutical companies, doctors began to increase prescribing opioids to patients in the late 1990s, operating under assurances from pharma reps that name-brand opioids like OxyContin were not addictive. The first wave of addiction and overdose deaths began with these prescription opioids, as patients took them thinking they were safe and then became addicted to them.

Heroin addict sits on a staircase

By 2010, the secret was out that pharmaceutical opioids were addictive and dangerous, even when used as prescribed. Doctors began to pull back on their prescribing, and patients and other individuals already addicted to pills started seeking their fix elsewhere. That began the second wave of the opioid epidemic, in which millions of people with an addiction turned to heroin for a quicker, cheaper, more readily available high. Even as prescription opioid overdoses leveled out, heroin overdose deaths skyrocketed from 2010 to 2013.

Starting in 2013 and continuing into the present day, Centers for Disease Control and Prevention researchers noted an alarming increase in overdose deaths involving synthetic opioids, particularly fentanyl. Ten times more potent than heroin and 50–100 times more potent than morphine, fentanyl quickly became popular among drug users for its cheap, powerful high. Once pharmaceutical fentanyl became popular as a drug of choice, drug dealers and traffickers began illicitly manufacturing the drug.

Today, synthetic opioids, primarily illicitly-manufactured fentanyl, are the leading cause of not only all opioid drug-related deaths, but fentanyl overdoses alone account for more fatalities than all other drug overdoses combined. Case in point, the CDC published 2022 drug overdose numbers, and the data show about 68% of the 107,081 people who died from drug overdoses that year died from synthetic opioids like fentanyl (provisional data for 2023 suggests a similar trend).3

What Are the Effects of Opioids?

Even when used as intended, opioids can have negative effects on users. Common, short-term side effects of opioids include:4

  • Nausea
  • Sedation
  • Vomiting
  • Dizziness
  • Constipation
  • Muscle rigidity

Respiratory depression is another common side effect of using opioids and is the first sign one may be about to experience an overdose. When one takes opioids, the drug slows heart rate and breathing. If one takes too much of the drug, an overdose occurs, and heart rate and breathing slow to the point where both stop entirely. That is what occurs during an overdose, and unless the person is revived by Narcan, the user will likely die.

Long-term effects of using opioids include:

  • Tolerance
  • Addiction
  • Physical dependence

The Opioid Overdose

Paramedics checking pulse

The most concerning aspect of the rise in opioid addiction is the stark increase in opioid overdoses that have followed. All forms of drug use are dangerous, and many other drugs do cause overdose deaths, but none on the scale of opioids.

According to the National Institute on Drug Abuse (NIDA), 106,699 people died from drug overdoses in 2021, the most recent year NIDA has information for. At least 70,601 of those deaths were caused by fentanyl overdoses, and another 10,000 deaths were caused by heroin and opioid painkillers, making opioids responsible for about eight out of every ten drug overdoses in 2021.5

As mentioned earlier, the CDC recorded 107,081 drug overdose deaths in 2022. Provisional reports for 2023 suggest as many as 109,000 Americans died from drug overdoses that year, the vast majority of whom died from opioid overdoses.6

Finally, according to a study published by the University of Rochester Medical Center, it’s likely that the alarming numbers for annual opioid overdoses are significantly undercounted. “A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to underreporting of opioid-related death rates and a misrepresentation of the extent of the opioid crisis,” said Elaine Hill, Ph.D., an economist and assistant professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences and senior author of the study. “The corrected estimates of opioid-related deaths in this study are not trivial and show that the human toll has been substantially higher than reported, by several thousand lives taken each year.” In its conclusion, Elaine Hill’s study explained how an accurate figure for opioid overdoses may be as much as 28% higher than current reporting suggests.7

How Widespread Is Opioid Use Today?

According to NIDA, at least three million Americans have had or currently struggle with an addiction to opioids. More than 500,000 Americans are addicted to heroin.8 The American Society of Anesthesiologists published similar figures, suggesting at least two million Americans are addicted to prescription opioid painkillers.9

These figures are likely an underestimate, as researchers rely on self-reporting to determine how many people in any given area are struggling with an addiction.

The Need for Opioid Addiction Treatment

Opioids are the most lethal drugs in America, measured by the sheer number of people who lose their lives to these drugs each year and the increasing number of people who experiment with such substances and become hooked on them.

Comunity comes together, holding hands

Opioid addiction is a life-or-death predicament. Any time someone uses such drugs, it could lead to a fatal overdose. According to the Drug Enforcement Administration, opioid experimentation has become even more dangerous in recent years, as the drug supply is increasingly tainted with extremely potent opioids like fentanyl and carfentanil. Citing warnings from one DEA report, six in ten pills seized in DEA drug busts test positive for fentanyl.10

If you know someone who is addicted to opioids, please help them find and enter a qualified drug and alcohol addiction treatment center as soon as possible. Please do not wait until it is too late.

Sources Cited:

  1. Urban. “Comprehensive Opioid Abuse Program Assessment: Examining the Scope and Impact of America’s Opioid Crisis.” The Urban Institute, 2019. urban.org ↩︎

  2. CDC. “Understanding the Opioid Overdose Epidemic.” Centers for Disease Control and Prevention, 2023. cdc.gov ↩︎

  3. CDC. “Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022.” Centers for Disease Control and Prevention, 2023. cdc.gov ↩︎

  4. NIH. “Opioid complications and side effects.” National Institutes of Health, 2008. pubmed.ncbi.nlm.nih.gov ↩︎

  5. NIDA. “Drug Overdose Death Rates.” National Institute on Drug Abuse, 2023. nida.nih.gov ↩︎

  6. CDC. “Provisional Drug Overdose Death Counts.” Centers for Disease Control and Prevention, 2023. cdc.gov ↩︎

  7. UR. “Study: The Opioid Crisis May Be Far Worse than We Thought.” University of Rochester Medical Center, 2020. urmc.rochester.edu ↩︎

  8. NIH. “Opioid Addiction.” National Institutes of Health, 2023. ncbi.nlm.nih.gov ↩︎

  9. ASA. “Opioid Abuse.” American Society of Anesthesiologists, 2024. asahq.org ↩︎

  10. DOJ. “Opioid And Fentanyl Awareness Initiative.” United States Attorney’s Office, Central District of California, 2023. justice.gov ↩︎