Powerful prescription opioids were once reserved for cancer or end-of-life pain management.

But in recent years, opioids have been increasingly prescribed for short-term pain management after medical procedures, like having wisdom teeth removed or knee surgery, as well as to manage chronic non-cancer pain. There is a lack of evidence to support the long-term benefits of prescription opioid use to manage chronic pain.

But science confirms that opioid overprescribing has many dangerous effects. Opioids are highly addictive, and produce both tolerance and dependence quickly.

Patients may find themselves needing to take more and more of the drug to experience the same relief it once provided. And if they try to stop taking the drug, or to reduce their dosage, they may experience painful withdrawal symptoms. These circumstances can lead to addiction and misuse.

Once a person is addicted to prescription painkillers, progressing to heroin use is easy to understand.

Heroin is cheaper, and easily available from street drug dealers. According to the American Society of Addiction Medicine, four out of five people who are addicted to heroin report that their addiction began with prescription pills.

Heroin is part of a larger substance abuse problem.

According to the Centers for Disease Control (CDC), the amount of opioids prescribed in the U.S. has quadrupled in the past 15 years, even though there's been no change in the amount of pain American patients report. In 2013, health care providers wrote enough opioid prescriptions for every adult American to have their own bottle of pills.

In 2014, 6 out of 10 overdose deaths involved an opioid. And at least half of those opioid overdose deaths involved a prescription opioid, specifically.

Opioids keep getting more and more potent.

Carfentanil is a synthetic opioid so powerful, it’s most frequently used as a sedative for large animals like elephants. According to the Drug Enforcement Agency (DEA), it’s 100 times deadlier than fentanyl (and fentanyl itself is 30–50 times deadlier than heroin.)

These powerful opioids are easily produced in labs. Dealers often lace their heroin with Carafentanil or fentanyl in order to make the drug even more potent—and even more addictive.

Huge outbreaks of overdoses involving Carfentanil have been happening all over the country. In August 2016, Hamilton County, Ohio saw 200 overdoses in one week. Louisville, Kentucky saw 24 overdoses in just one day—August 23, 2016.

Heroin is part of a larger substance abuse problem.

What are “abuse-deterrent formulations” of opioids?

Abuse-deterrent formulations (or ADFs) are engineered to prevent users from crushing or dissolving the pills.

People who misuse opioids often crush pills up, then snort or inject them. This is because the high is more immediate and more potent when the drugs enter the body this way. Abuse-deterrent opioids seek to make it harder or impossible for people to do this.

However, and this is important: In terms of potency and effects, ADFs are no different from regular opioids.

Calling these formulations “abuse-deterrent” is confusing at best, misleading at worst.

There’s nothing in the chemical make-up of these pills that make them less addictive. In this context, “abuse-deterrent” just means that these pills can’t be misused as easily in certain capacities—snorting, injecting. These abuse-deterrent pills can still foster addiction and be misused, even when taken orally.

What to ask your doctor before taking opioids
Here are some important questions you should ask when getting a new prescription.

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Choices Matter

There are a wide range of medications available for treating pain. Get to know your options and talk with your doctor to create your custom pain management plan.

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