The United States is in the middle of an opioid crisis. Although some opioids can help people, they are highly addictive and can be misused. Misuse of opioids can be unsafe for both people and communities. For instance, opioid overdoses caused about 33,000 deaths in 2015. That’s about 91 people each day. People all over the country are taking a stand and working to end opioid misuse.

Opioid basics

Opioids, also known as painkillers, can be used to relieve pain when prescribed by a doctor. But some people misuse opioids by using them for non-medical reasons. Opioids can be prescription drugs or street drugs. Prescription opioids can include oxycodone (ox-ee-koh-dohn) or morphine. Heroin, a street drug, is also an opioid. Using heroin or taking opioids differently than prescribed can be fatal.

Substance and opioid use problems can be felt in the District of Columbia today. The Centers for Disease Control and Prevention reports that 11.3 percent of people in the District over age 11 use or are dependent upon drugs or alcohol. This is higher than the U.S. average of 8.9 percent and is the highest rate in the country.

Opioid side effects can include:



Fast, slow, or irregular heartbeat

Nausea and vomiting






Someone with a substance use disorder may want to quit their drug use, but it can be hard to ask for help. A person using opioids may not know where to go or might be afraid of judgment.

The good news is that you can recover from opioid and substance misuse. The first step is to learn about the signs of misuse and the help options available.

Prescription medicines

Many opioids are used as medicine. A doctor or hospital may give a person a painkiller to manage pain or a long-term illness. These drugs often come in a pill or liquid form. Some common prescription opioids include:


Oxycodone (OxyContin® and Percoset®)

Hydrocodone (Vicodin®)



Meperidine (Demerol®)

When used as directed, these drugs can help people with serious health issues. But when they are misused, they can lead to problems like addiction.

Opioid misuse happens when a person takes drugs in the wrong way. This includes using street drugs or taking medicines not prescribed for you or differently than prescribed. If a family member gives you one of his or her pills, or if you take more pills than directed, then you are misusing the medicine.

Misuse is a concern with opioids because of their strength. Up to 1 in 4 people taking prescription opioids for a long-term illness will struggle with addiction. And the chance of addiction is greater when a person misuses the medicine. More than 4 million Americans were using medicines for non-medical reasons in 2014. Almost 2 million of those users were dependent on pain relievers.

There are several risk factors that can lead to opioid misuse, such as:

Having a mental illness

Having a history of other substance use, including drugs and alcohol

Taking high daily doses of pain relievers

Not everyone with the above risk factors will misuse opioids. Many people use prescription opioids to manage long-term pain and health conditions. If you receive a prescription opioid for a health condition, you should not stop taking it unless directed by your doctor.

Since opioids are so strong, it can be difficult to stop taking them. Stopping suddenly can be dangerous. People quitting opioids can suffer from withdrawal symptoms, like sweating, bone and joint pain, tremors, and vomiting or diarrhea. Your doctor can help you to stop taking opioids safely.


Heroin is an illegal opioid that appears as a white or brown powder. It can also appear as a black, sticky substance, known as “black tar heroin.” Nicknames for heroin are horse, H, and smack. Heroin is usually injected with a needle, smoked, or sniffed up the nose.

Heroin is a fast-acting drug, which makes it highly addictive. Almost 23 percent of heroin users are dependent on the drug. There were more than 430,000 regular heroin users in the United States in 2014 — about 10 percent of all opioid users.

Most heroin users also use other substances. About 3 out of 4 new heroin users first used prescription opioids before trying heroin. Many of those users take both heroin and prescription opioids at the same time. People addicted to prescription opioids are nearly 40 times more likely to also be addicted to heroin.

Unlike prescription drugs, heroin is not made in a laboratory. Because of this, the strength of heroin can vary. The drug is often mixed with other materials like sugar and starch. Sometimes it is mixed with other drugs, or with toxic or harmful chemicals. Someone using heroin never knows what is in the drug, which can be dangerous and even fatal. In 2015, nearly 13,000 people died because of the drug.

Heroin may have more side effects than other opioids. For example, people who inject the drug are at risk for diseases like HIV or hepatitis C. These diseases spread through the blood or other bodily fluids. People sharing needles could get the diseases from another user. Overdoses are also a greater threat for heroin users. Although heroin users make up only 10 percent of all opioid users, they account for nearly half of all opioid overdose deaths.

If you or someone you know is using heroin, or is at risk for using heroin, help is available. Speak with your doctor or call one of our Care Coaches to learn more about your health options.

Other substances

There are many substances besides opioids that can be dangerous. Some of these are illegal drugs, while others are legal but may be unsafe when used in excess.

Cigarettes and tobacco products: Tobacco can be found in cigarettes, cigars, snuff, and chewing tobacco. It contains nicotine, an addictive substance. The use of tobacco causes many serious health problems, including lung cancer, oral cancer, bronchitis (bron-ki-tis), and emphysema (em-fa-ze-ma). It also increases the risk of heart disease, heart attack, and stroke.

Marijuana: Marijuana is a drug that can be inhaled or eaten. It is illegal in much of the United States, and its use is governed by law where it is allowed. In the District, marijuana use is legal on private property. It is not legal to sell the drug or to use it in a public place. Health effects of marijuana use include changes in mood, slow thinking and movement, breathing problems, and paranoia.

Cocaine: Cocaine is an illegal drug that looks like a fine, white powder. It can also appear as rock crystals known as crack. Cocaine is snorted through the nose, rubbed into the gums, injected, or smoked as crack. Side effects of cocaine use include changes in blood pressure, faster heartbeat, the loss of the sense of smell, and addiction. People who inject cocaine are also at risk for HIV and hepatitis C. It is possible to overdose on the drug, which can lead to death.

Many opioid users first start by using drugs like marijuana and cocaine. Some of those users will continue using multiple drugs at the same time. This can cause harmful drug interactions. The chance of dangerous side effects including death increases when taking several drugs at once.

Finding help

Although prescription opioids can help some people, there are many risks if opioids are misused. If you or someone you know is using drugs, there is treatment available that can help.

There are resources in the District of Columbia to help Medicaid members with their substance use problems. The DC Department of Health Addiction, Prevention, and Recovery Administration (APRA) can aid you to recover and improve your health. You can contact APRA at 202-727-8473. The DC Department of Behavioral Health may also be able to help and is available 24 hours a day, 7 days a week, at 1-888-793-4357.

The National Suicide Prevention Lifeline is available 24 hours a day, 7 days a week. They do more than suicide prevention and can help with issues like drug and alcohol use. They can also connect you to a nearby professional to assist you. Call them anytime at 1-800-273-TALK (8255).

For people who want to quit taking drugs, there may be medicines that can help cope with withdrawal. Ask your primary care provider (PCP) about what treatments would be best for your condition.

AmeriHealth Caritas District of Columbia members can call us to be connected with a Care Coach. Our Care Coaches can help you make sense of your health care options. Call us at 1-800-408-7511 to learn more about how you can break the cycle of opioid misuse.

Sources: Centers for Disease Control and Prevention; Substance Abuse and Mental Health Services Administration; National Institute on Drug Abuse; National Institute on Alcohol Abuse and Alcoholism

All images are used under license for illustrative purposes only. Any individual depicted is a model.

This correspondent is a guest contributor to The Washington Informer.

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