Prescription Opioid Misuse, Heroin, and Fentanyl
The United States is in the midst of an opioid overdose epidemic to include overdoses involving prescription opioid medications, heroin, and illicit fentanyl (a powerful synthetic opioid medication that is increasingly being produced illicitly). In 2015, more than 33,000 people died from overdoses involving opioids, which is up from more than 28,000 deaths in 2014.
As in 2014, overdose deaths in 2015 involving prescription opioids (excluding the category of synthetic opioids that includes fentanyl) rose only slightly, suggesting that efforts in recent years to reduce the misuse of these drugs may be having an impact. Despite this, in 2015, 17,536 deaths involved an opioid medication and approximately 3.8 million people reported misusing such medications in the month prior to their interview.
In 2015, the overall increase in overdose deaths was driven in large part by continued sharp increases in deaths involving heroin and synthetic opioids such as fentanyl, but we know these trends are inextricably linked. Prescription opioids are inherently addictive. Both use and misuse are risk factors for developing an opioid use disorder and initiation of heroin use. Moreover, fewer than 1 in 4 people with an opioid use disorder received treatment in 2015.
There are several principal factors contributing to the current nationwide heroin crisis: the increased availability of heroin in the U.S. market, including the availability of purer forms of heroin that allow for non-intravenous use; its relatively low price; and some people who use controlled opioid prescription drugs for non-medical purposes transitioning to heroin use. Heroin use has spread into suburban and rural communities and is growing among most socioeconomic classes, age groups, and races. Furthermore, the emergence of clandestinely produced fentanyl and other high potency synthetic opioids in the illicit drug market is fueling the high mortality rate and compounding our country’s current opioid crisis.
To address the opioid epidemic, ONDCP works with Federal agencies and other partners to:
- Understand epidemic trends;
- Expand community-based drug prevention efforts;
- Decrease the excess prescription opioid drug supply in circulation;
- Educate patients and prescribers on the risks involved with opioid prescribing;
- Train health care providers to identify early signs of an opioid use disorder among their patients prescribed opioid medications;
- Expand prescription drug monitoring programs and other tools to detect medication misuse and diversion;
- Provide additional options for safe storage and disposal of controlled prescription medicines;
- Expand access to evidence-based treatment, including medication-assisted treatment, for those with opioid use disorders, including those in the criminal justice system;
- Provide recovery support services;
- Increase access to naloxone to reverse opioid overdose and promote treatment services to those administered naloxone; and
- Address the healthcare needs of those affected by opioid use disorders, including people who inject opioids, pregnant women who use opioids, and infants exposed to opioids when their mothers are pregnant.
ONDCP also works with Federal agencies and international partners to drive the efforts to disrupt the supply of heroin and fentanyl, fentanyl analogues, and precursor chemicals. Detection is key to this effort as we attempt to stop these substances from crossing our borders and moving undetected through our mail handling facilities.
On the international front, we are engaging numerous governments both bilaterally and multilaterally to enact controls on these dangerous drugs and precursor chemicals, share information on their illicit production and distribution, and develop our partners’ capabilities to detect and disrupt their trafficking.
In 2016, Congress passed groundbreaking legislation to improve access to opioid use disorder treatment including authorizing $1 billion to the states to provide increased access to treatment and overdose prevention; the first $500 million was appropriated in 2016. President Trump’s FY 2018 Budget includes a request for the second $500 million to help states increase prevention and treatment capacity to address the epidemic.
For more information on opioids and the Government’s response to the epidemic, including treatment for individuals with opioid use disorders, please visit the following resources:
- HHS’s Hub for More Information on Opioids
- SAMHSA Treatment Locator
- Fact Sheet on Opioids
- Fact Sheet on Fentanyl
- Fact Sheet on MAT
- DEA Drug Disposal Information
- FDA Recommended Drugs for Flushing
- DEA National Takeback Day for Controlled Medicine Disposal
- Pregnancy and Opioid Pain Medicines Fact Sheet
- Opioid Use During Pregnancy and Child Welfare
- Prescription Drug Diversion Report
- BJA Toolkit on Overdose for Law Enforcement
- SAMHSA Overdose Prevention Toolkit (non-law enforcement)