Opioid Use Disorder

What Is Opioid Use Disorder?

Opioid use disorder is a diagnosable pattern of opioid use that causes meaningful impairment or harm and continues despite harmful consequences. It is different from taking an opioid as prescribed, developing tolerance, or becoming physically dependent, and those differences matter when discussing symptoms, diagnosis, and care.^[1][2]

Opioids and Patterns of Use

“Opioid” describes a group of substances that act on opioid receptors—proteins on cells that respond to opioids. These receptors help regulate pain and other functions. The mu-opioid receptor is especially important because it contributes to pain relief as well as euphoria, an intense feeling of pleasure, tolerance, physical dependence, and dangerous slowing of breathing.^[1]

Prescription opioids can be important pain medicines, but they also carry risks. Common effects include constipation, nausea, vomiting, dry mouth, drowsiness, confusion, tolerance, physical dependence, and withdrawal symptoms after stopping.^[3]

Long-term prescription use is associated with risks including overdose and misuse, while evidence establishing long-term benefit for chronic pain remains insufficient.^[3] Prescription opioid misuse means taking medicine differently than prescribed, taking someone else’s prescription, or taking it to get high. Using a higher dose or taking it more often than prescribed counts as misuse even when the purpose is pain relief.^[5][2]

Oxycodone, Hydrocodone and Fentanyl

Oxycodone and hydrocodone are prescription opioids used to treat moderate to severe pain in some patients. The Centers for Disease Control and Prevention glossary classifies them as semisynthetic opioids, a prescription-opioid category that includes these medicines. This category does not indicate whether a person taking them has opioid use disorder.^[6]

Fentanyl is a synthetic, or laboratory-made, opioid. Pharmaceutical fentanyl is approved for treating severe pain. Illegally made fentanyl is sold through illegal drug markets and may be sold as heroin or pressed into counterfeit pills resembling prescription medicines. Heroin itself is an illegal opioid.^[6][2][7]

Taking a prescribed opioid for pain, developing physical dependence, and having opioid use disorder are distinct. Physical dependence means the body has adapted to regular use, so stopping can cause withdrawal. It can occur during appropriate treatment. Opioid use disorder instead requires a problematic pattern meeting diagnostic criteria; prescribed use or physical dependence alone does not establish it.^[6][2]

How Key Terms Differ

These terms describe different experiences and should not be used interchangeably.

The distinction between physical dependence and opioid use disorder is particularly important for people receiving pain treatment. The 2024 National Survey on Drug Use and Health uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a guide to clinical diagnoses. It assesses 11 criteria for people who misused prescription drugs, but excludes tolerance and withdrawal for those who used them without misuse.^[2]

Misuse also does not automatically mean that someone has opioid use disorder. Diagnosis depends on a broader pattern and the number of applicable criteria met within the diagnostic timeframe, rather than on one event or one medication-taking decision.^[2]

An Illustrative Example

Imagine that one person takes a prescribed opioid after surgery and develops mild withdrawal symptoms when treatment ends. Another repeatedly uses opioids in a way that causes serious problems but continues despite those harms.

The first situation may reflect physical dependence without opioid use disorder. The second raises concern for a disorder and warrants a full assessment. This example is illustrative, not a description of a real patient.

Opioid Use Disorder Diagnosis

Opioid use disorder is assessed through applicable diagnostic criteria over the past year, not opioid use alone. A professional assessment helps distinguish physical dependence during prescribed treatment from a harmful pattern involving impairment or continued use despite harm.^[2][1]

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, uses 11 possible criteria. Meeting at least two applicable criteria during the past year is the threshold for opioid use disorder. Tolerance and withdrawal do not count for people taking opioids solely under appropriate medical supervision. The national survey likewise excludes them for prescribed drugs used without misuse.^[8][2]

The distinction is between a harmful pattern of use and the body’s adaptation to a drug. In the national survey, nine criteria remain applicable even when prescription drugs are used without misuse; tolerance and withdrawal are the other two. Physical dependence alone therefore cannot establish the diagnosis in someone using a prescription opioid appropriately under medical supervision.^[2]

What Experiences Matter in an Assessment?

Assessment considers control over opioid use, its effects on daily life and relationships, use despite risks or harm, and the body’s adaptations. The Centers for Disease Control and Prevention diagnosis guidance provides a DSM-5-based checklist. The 11 criteria address the following experiences within the same past-year period:^[8][2]

1. Taking opioids in larger amounts or for longer than intended.
2. Persistently wanting to cut down or making unsuccessful efforts to control use.
3. Spending a great deal of time obtaining opioids, using them, or recovering from their effects.
4. Craving—a strong desire or urge to use opioids.
5. Repeated use that interferes with major responsibilities at work, school, or home.
6. Continuing use despite persistent or repeated social or relationship problems caused or worsened by opioids.
7. Giving up or reducing important social, work, or recreational activities because of opioid use.
8. Repeated use in physically hazardous situations.
9. Continuing use despite knowing that opioids are likely causing or worsening a persistent or repeated physical or psychological problem.
10. Tolerance—needing markedly more for the desired effect, or getting markedly less effect from the same amount.
11. Withdrawal, or taking opioids or a closely related substance to relieve or avoid withdrawal.^[8][2]

The medical-supervision exception for tolerance and withdrawal remains important when interpreting the criteria. The other criteria still require careful assessment; this list is not a substitute for diagnosis.^[8][2] The broader concern is significant impairment—difficulty functioning in everyday life—and continued use despite harmful consequences.^[1]

Illustrative examples: Repeatedly being unable to fulfill work or caregiving responsibilities because of opioid use illustrates interference with major responsibilities. Continuing opioid use despite recognizing that it is causing harm illustrates continued use despite harmful consequences. These examples describe concerns to discuss, not real patients or a self-diagnosis checklist.^[2][1]

An assessment examines the full set of applicable criteria, not just these examples. Ask the clinician: “Which specific criteria apply to my experience during the past year? How are you distinguishing them from tolerance or withdrawal during prescribed treatment?” The threshold concerns applicable criteria, not simply the number of adverse events someone describes.^[2]

Overdose requires a separate, immediate safety response: call 911 and give naloxone if available when an overdose is suspected.^[9] People who have had an opioid overdose are at increased risk of another, making follow-up care important regardless of the outcome of a diagnostic assessment.^[4]

Tolerance and Withdrawal During Medical Care

Tolerance means that the body has adapted to an opioid’s effects. Physical dependence means that reducing or stopping opioid exposure can produce withdrawal. Both can develop during medically appropriate opioid treatment and should not automatically be labeled addiction or opioid use disorder.^[2][3]

Research continues to investigate how these adaptations occur. Opioid receptors may become less responsive or less effectively connected to cellular signaling pathways—the processes cells use to pass signals internally. Compensatory changes within cells also appear to contribute, but the exact pathways responsible for tolerance, dependence, and withdrawal are not fully understood.^[1]

Why Diagnostic Frameworks Can Produce Different Results

Different classification systems do not necessarily identify exactly the same people. One study examined 1,134 people prescribed opioids for chronic noncancer pain and compared three definitions over the previous 12 months. Twenty-four percent met the study’s pain-medicine definition of “addiction,” 18% met DSM-5 opioid use disorder criteria, and 19% met dependence criteria in the International Classification of Diseases, Eleventh Revision, another diagnostic classification system.^[10]

Those percentages do not mean that one system was definitively correct. The broader pain-medicine definition captured more people, including some with fewer behaviors involving not following the medication plan, fewer medication concerns, and less psychological distress than people who also met the DSM-5 and International Classification of Diseases definitions.^[10]

For a reader, the practical lesson is that labels should not replace a careful assessment. A clinician needs to distinguish physiological adaptation from a harmful behavioral pattern, particularly when opioids are prescribed for chronic pain.

Opioid Use and Harm in the United States

Population estimates answer different questions depending on whether they measure any use, prescription misuse, opioid use disorder, nonfatal overdose, or deaths involving opioids. These categories should not be combined as though they describe the same group.

The National Survey on Drug Use and Health is an annual, nationally representative survey of the U.S. civilian, noninstitutionalized population aged 12 or older. It measures substance use, substance use disorders, treatment, mental health conditions, and related indicators.^[2] Because it excludes institutionalized populations, its estimates should not be treated as counts of every person in the country.

Prescription Opioid Use and Misuse

During 2015 through 2018, approximately 6% of U.S. adults reported using at least one prescription opioid during the previous 30 days. In 2020, approximately 143 million opioid prescriptions were dispensed by U.S. pharmacies.^[3] Prescription counts are not counts of individual patients, and neither measure establishes how many people had opioid use disorder.

Among U.S. residents aged 12 or older in 2019, 9.7 million reported prescription opioid misuse during the past year, down from 12.5 million in 2015. About 1.4 million met criteria for past-year prescription opioid use disorder in 2019, down from 2.0 million in 2015.^[3]

The difference between 9.7 million reporting misuse and 1.4 million meeting disorder criteria illustrates an important point: misuse is a behavior, while opioid use disorder is a diagnosis requiring a sufficient pattern of symptoms and impairment.^[3]

Opioid-Involved Overdose Deaths

Overdose deaths describe harm, not the prevalence of opioid use disorder. A death may involve prescription opioids, heroin, illegally made fentanyl, other drugs, or several substances together. “Involved” means the drug was identified as contributing to the death; it does not necessarily mean it was the only drug involved.^[7]

In 2023, approximately 105,000 people died from a drug overdose in the United States, or about 287 people per day. Nearly 80,000 deaths—about 76%—involved an opioid, whether prescription or illegal.^[4]

Nearly 73,000 overdose deaths involved synthetic opioids other than methadone, primarily illegally made fentanyl and fentanyl analogs—substances chemically related to fentanyl. That represented nearly 92% of opioid overdose deaths in 2023.^[4]

These categories can overlap. A death involving fentanyl, cocaine, and methamphetamine may appear in more than one drug category, so the category percentages should not be added together.

The Importance of Multiple-Drug Exposure

Opioid harm increasingly involves more than opioids alone. Among 37 states and the District of Columbia in 2023, 47% of drug overdose deaths involved both opioids and stimulants, drugs such as cocaine and methamphetamine that increase alertness and activity.^[4]

An earlier analysis covering 25 states found that 62.6% of opioid-involved deaths during January through June 2018 included at least one commonly detected nonopioid drug: cocaine, methamphetamine, or a benzodiazepine, a type of sedating medicine. Illegally made fentanyl was involved in approximately two-thirds of opioid deaths in those states during that period.^[7][3]

That earlier finding should not be treated as a national 2018 estimate because it covered only participating states. It nevertheless helps explain why opioid safety cannot be considered in isolation from benzodiazepines or other sedating medications, stimulants, and an unpredictable illegal drug supply.^[7][3]

Opioid Effects Overdose and Withdrawal

Opioids can reduce pain, cause drowsiness, and produce euphoria. They can also slow breathing. Their beneficial and dangerous effects arise largely through opioid receptors, especially the mu-opioid receptor.^[1]

The body’s response depends on the opioid, the amount reaching the body, other substances present, and the person’s tolerance. Fentanyl is estimated to be 50 to 100 times stronger than morphine, so exposure can carry substantial overdose risk, especially for someone whose body is not accustomed to opioids.^[2]

Illegally made fentanyl creates an additional problem because it may be present in products sold as heroin or counterfeit prescription pills. A person may therefore be exposed without knowing the substance or strength involved.^[2][7]

How Overdose Differs from Intoxication

Expected or unwanted opioid effects can include sleepiness, nausea, vomiting, constipation, dry mouth, and confusion. An overdose is different because breathing becomes dangerously suppressed. Severe respiratory depression means breathing is too slow or ineffective to provide the body with enough oxygen.^[3]

If someone may have taken opioids and cannot be awakened or is not breathing normally, treat the situation as a possible overdose. Call 911 and give naloxone if it is available. The Centers for Disease Control and Prevention (CDC) advises treating an uncertain situation as an overdose rather than waiting to be sure.^[9]

Naloxone is an opioid antagonist, meaning it blocks opioid receptors. It can reverse severe opioid-related respiratory depression, and administration by friends, relatives, caregivers, or other bystanders can save a life.^[3]

Naloxone is an emergency medicine, not treatment for opioid use disorder.^[2] Calling 911 and staying with the person until emergency assistance arrives remain part of the response even when naloxone is given.^[9] After an overdose, ask about ongoing risk reduction and evidence-based treatment; people who have had one opioid overdose are at increased risk of another.^[4][7]

How Withdrawal Differs from Overdose

Withdrawal occurs when a physically dependent person’s opioid exposure decreases or opioid receptors are suddenly blocked. It is not the same process as overdose.

Overdose is dangerous because opioid effects are excessive, especially the suppression of breathing. Withdrawal reflects the body’s response to reduced opioid effects. Naloxone may trigger acute withdrawal in a person who is physically dependent because it rapidly blocks opioid receptors.^[3]

That possibility should not delay naloxone during a suspected overdose. Serious adverse effects from labeled naloxone use have been reported but are rare, while untreated severe respiratory depression can be fatal.^[3]

Tolerance and Unpredictable Exposure

Fentanyl poses substantial overdose risk, especially for someone whose body is not accustomed to opioids. Risk can also be harder to judge when fentanyl is present in products sold as heroin or counterfeit prescription pills.^[2]

Keep naloxone available and ask about evidence-based treatment or risk-reduction support.^[3][7] If your opioid use or treatment has changed, a practical question for a clinician is: “What does this change mean for my overdose risk and safety plan?”

Medications for Opioid Use Disorder

Medication for opioid use disorder, often shortened to MOUD, means medication prescribed specifically to treat the disorder. It does not mean a medicine used only to ease short-term withdrawal, and it does not include naloxone used to reverse an overdose.^[2]

The three U.S. Food and Drug Administration-approved medications are methadone, buprenorphine, and naltrexone.^[1][11] They work differently and have different benefits and limitations. Useful questions include: “Which options fit my medical needs? Which can I access? What would taking each medicine involve?”

Methadone and buprenorphine are opioid agonist treatments. An agonist activates a receptor; a partial agonist activates it less fully. Methadone can reduce withdrawal and craving. Buprenorphine binds strongly to mu-opioid receptors and can ease cravings.^[1][5]

They also maintain some tolerance to opioid-induced respiratory depression and can reduce the effects of another opioid by occupying the receptor. This does not make additional opioid use safe or eliminate overdose risk, especially when other sedating substances or potent fentanyl are involved.^[1]

Naltrexone is an antagonist. It blocks opioid receptors and diminishes opioid effects if a person uses opioids while the medication is active.^[1] Ask a qualified clinician: “Is naltrexone suitable for me, and what would starting and continuing it involve?”

Treatment Is More Than Withdrawal Management

Withdrawal management focuses on getting through the immediate period after opioid exposure falls or stops. It can be an entry point into care, but it is not the same as ongoing treatment for opioid use disorder.

The 2024 National Survey on Drug Use and Health explicitly separates medication for opioid use disorder from medicines used to manage withdrawal symptoms and medicines used to reverse overdose.^[2] When discussing withdrawal care, ask what ongoing treatment will be offered afterward rather than assuming that withdrawal management includes it.

Ongoing care can combine medication, counseling or other behavioral therapies, recovery management, and practical support. Evidence for multifaceted, longer-term care comes from research on substance use disorders more broadly, not only opioid use disorder.^[2][13]

Benefits Without Overpromising

Medication is an important treatment option, but access, taking medication as prescribed, stigma, and return to opioid use remain challenges.^[1] Co-occurring mental and physical health conditions also matter when considering medication treatment.^[11]

Medication should not be dismissed as “replacing one drug with another.” Methadone is used to reduce withdrawal and craving, and buprenorphine reduces craving through partial activation of opioid receptors. Naltrexone uses a different strategy by blocking those receptors.^[1]

Treatment outcomes vary, and access and adherence remain important limitations.^[1] Useful questions for a treatment discussion include: “How does this option fit my goals and previous treatment experiences? What support could help me continue treatment? What alternatives are available if access becomes difficult?”

Behavioral Care and Recovery Support

Behavioral and psychosocial care—counseling and approaches addressing behavior, psychological needs, and social circumstances—is often used alongside medication. Examples studied in opioid treatment include recovery education, interactive exercises, skills training, and engagement in activities unrelated to drug use. Evidence does not establish one added approach as best for everyone.^[3][14]

Contingency management is a reward-based behavioral approach studied alongside opioid agonist treatment. A systematic review of 72 randomized controlled trials—studies assigning participants to comparison groups by chance—suggested considering this approach to improve treatment retention, meaning helping people stay in care. The review noted that implementation details, such as how often rewards were provided, were missing from many included studies.^[14]

Beyond retention, however, the review found few consistent differences between psychosocial interventions added to opioid agonist treatment and opioid agonist treatment alone. The trials varied in their counseling content, intensity, implementation, follow-up, and definitions of usual care, limiting firm conclusions about which behavioral approach is best.^[14]

This does not mean counseling has no value. It means the review did not establish one psychosocial method as superior across outcomes and populations.^[14] Ask what a service’s counseling involves and which needs it can address, such as skills practice, recovery education, or practical support.

A study of prescription opioid dependence used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), an earlier version of the diagnostic guide. It did not demonstrate added benefit from intensive opioid-dependence counseling over buprenorphine with standard medical management.^[3]

Standard management included basic counseling about abstinence and self-help groups. Neither standard management nor intensive counseling without buprenorphine prevented return to drug use in that study.^[3]

This comparison was not medication alone versus medication plus any counseling. It compared two levels of support alongside buprenorphine, so it does not establish that all counseling approaches are equivalent or unnecessary.^[3]

Peer Recovery Support

A peer recovery coach is a trained person who provides informational, emotional, social, and practical support. In many programs, peers have personal experience with substance-related problems or recovery, although terminology and role requirements vary.^[13]

A systematic review included 24 reports from 23 original studies involving 6,544 participants. Follow-up ranged from one week to three years, and studies measured varied outcomes including treatment attendance, substance use, health appointments, hospital use, social functioning, and deaths.^[13]

The findings were mixed. In an emergency-department study of 151 people treated after opioid overdose, researchers compared peer support plus naloxone and usual care, naloxone education plus usual care, and usual care alone. The study was nonrandomized: group assignment depended on provider and patient discretion rather than chance.^[13]

At 12 months, researchers found no statistically significant differences in medication initiation, repeat overdose visits to the same emergency department, deaths, or time to death. In plain language, the comparisons did not meet the statistical threshold for distinguishing a difference from chance variation. This does not establish that the approaches were equivalent.^[13]

Another outreach pilot identified 88 people actively using opioids; 72 were eligible and 70 attended a treatment-linkage meeting after peer outreach.^[13] This suggests that peers can sometimes help people connect with care, but it does not prove that every peer program improves long-term clinical outcomes.

Peer support is therefore best understood as an option that may improve connection and practical support, with effects that vary across programs and studies.^[13] Ask how a peer service connects people with medical treatment and what help it offers between appointments.

Ongoing and Individualized Care

Some people with substance use disorders reach remission—a period when they no longer meet disorder criteria—without formal treatment. Others need medical stabilization, sustained treatment, recovery management, and practical support over time. Multifaceted, longer-term models can be helpful, much as continuing care is used for other chronic health conditions.^[13]

A need for ongoing care is not a failure. Practical questions include: “Can we review the plan if my health or circumstances change? What help is available if I return to opioid use? How would I reconnect after missing appointments?”

Chronic Pain and Opioid Use Disorder

Pain and opioid use disorder can occur together, and neither condition should be ignored. Opioids can be essential in some pain situations, but long-term prescription opioid treatment also carries risks. Evidence available to the Centers for Disease Control and Prevention was insufficient to demonstrate long-term benefits for chronic pain, while long-term use was associated with overdose and misuse risks.^[3]

A person who develops tolerance or physical dependence during pain treatment does not automatically have opioid use disorder. Concern increases when there is a broader pattern of impairment or continued use despite harm.^[2][1]

If signs of opioid use disorder are present, CDC guidance advises clinicians to discuss those concerns, offer or arrange medication treatment for patients who meet criteria for opioid use disorder, and continue appropriate pain care.^[3]

Pain treatment should not be abruptly reduced to a single question of whether opioids are “good” or “bad.” Useful discussions consider pain function, treatment benefits, side effects, mental health, substance use, sleep conditions, other medicines, and overdose risk. Any medication change should be planned with a clinician rather than through an improvised personal taper.

Health Conditions That Affect Opioid Care

Opioid use disorder can occur alongside other substance use, depression, and chronic pain.^[14] Other conditions relevant to opioid safety include sleep apnea, which interrupts breathing during sleep, pregnancy, and reduced kidney or liver function. CDC pain guidance recommends considering these conditions when assessing opioid therapy risks.^[3]

The evidence comparing behavioral treatments is less complete for people with complex needs. In a review of 72 opioid agonist treatment trials, fewer than 10% specifically recruited participants with co-occurring mental health conditions. Only one trial focused on people with chronic pain using prescription opioids, and none of the eligible trials specifically studied youths or incarcerated people.^[14]

This limited representation means average trial results should not be assumed to answer every question for these groups. It supports coordinated assessment rather than excluding someone from care because their situation is complicated.

Combinations of opioids with benzodiazepines or other sedating medicines require particular caution because of overdose risk. CDC pain guidance advises careful review of concurrent sedating medicines, along with conditions such as sleep apnea, pregnancy, kidney or liver impairment, mental health conditions, and substance use disorders.^[3]

Pregnancy and Infant Care

Pregnancy and infant care benefit from a coordinated approach. The clinical statement “Neonatal Opioid Withdrawal Syndrome” described rising opioid use disorder among pregnant women and withdrawal among infants after opioid exposure in the uterus. It also identified gaps in access to evidence-based treatment, including medication for opioid use disorder, and variable care for exposed infants.^[15]

Neonatal opioid withdrawal syndrome is a group of symptoms that can occur after a newborn’s opioid exposure in the uterus ends at birth. It reflects withdrawal after exposure; it does not mean that the infant has the adult behavioral diagnosis of opioid use disorder.^[3]

The clinical statement calls for systematic, coordinated, enduring, and holistic support for the mother-infant pair rather than fragmented care. It also highlights pressures on child welfare and early-intervention systems, which provide support for children’s developmental needs.^[15]

If you are pregnant and using opioids or taking medication for opioid use disorder, ask your care team: “Who will coordinate my pregnancy and opioid treatment? What monitoring and support might my baby need? Who should I contact before considering a medication change?” Pregnancy is one of the conditions CDC guidance says should inform opioid risk assessment.^[3]

Opioid Care for Adolescents and Young Adults

Adolescents and young adults need assessment that takes youth-specific evidence into account. A guideline from the American Academy of Child and Adolescent Psychiatry addresses both treatment research and expert guidance on assessment and clinical management; evidence remains limited for many treatment options.^[16]

An American Academy of Child and Adolescent Psychiatry guideline reviewed psychosocial, behavioral, and medication treatment for adolescents and young adults with substance use disorders or problematic substance use. For opioid use disorder, it offered a low-strength evidence suggestion supporting longer-term buprenorphine treatment and a slower clinician-managed buprenorphine taper rather than shorter treatment.^[16]

The strength of evidence was insufficient to support recommendations for many other adolescent substance-use treatments.^[16] That is an evidence gap, not proof that care is ineffective. It means young people should receive individualized specialist evaluation without assuming that adult trial findings apply unchanged.

Family members can offer help finding qualified care and learn overdose response, including naloxone use. Friends, relatives, and caregivers can administer naloxone to reverse severe opioid-related breathing suppression.^[3] Useful questions for the care team include: “How can family participate safely? What information can be shared? Who can help if family support is unavailable?”

Harm Reduction and Overdose Prevention

Harm reduction focuses on reducing drug-related injury and death. Practical measures discussed here include naloxone, attention to risky medication combinations, and connection to risk-reduction services and evidence-based treatment.^[3][7]

A manageable safety plan can include the following steps:

• Keep naloxone available and help people nearby learn how to use it, because bystanders can reverse severe opioid-related respiratory depression.^[3][9]
• Review opioids taken with benzodiazepines or other sedating medicines with a clinician, because these combinations can increase overdose risk.^[3]
• Remember that illegally made fentanyl may be present in heroin or counterfeit pills, making the contents and potency unpredictable.^[2][7]
• Recognize that fentanyl is especially risky for someone whose body is not accustomed to opioids.^[2]
• Seek care after a nonfatal overdose, because people who have experienced one opioid overdose are at increased risk of another.^[4]
• Ask about ongoing medication treatment as well as withdrawal management; they are distinct forms of care.^[2]

One manageable starting point is to obtain naloxone and learn how to use it. CDC guidance notes that naloxone is available over the counter without a prescription.^[9]

Responding to A Suspected Overdose

Inability to awaken and slow, shallow, or difficult breathing are signs of possible opioid overdose. If you are unsure whether someone is intoxicated or overdosing, CDC advises treating the situation as an overdose.^[9] Take these steps:

1. Call 911 and give naloxone if it is available.
2. Try to keep the person awake and breathing.
3. Lay the person on their side to help prevent choking.
4. Stay with the person until emergency assistance arrives.^[9]

Naloxone may cause acute withdrawal in someone who is physically dependent, but this should not prevent its use during a suspected life-threatening overdose.^[3]

Finding Treatment and Support

Treatment can be received in outpatient settings, meaning without staying overnight. These include medical clinics, mental health centers, treatment programs, hospitals providing outpatient care, school health or counseling centers, and clinicians’ offices.^[2] Specialized opioid treatment programs provide services for opioid use disorder and must meet federal certification, accreditation, and other regulatory requirements.^[12]

FindTreatment.gov is the U.S. government’s treatment-search resource.^[17] When contacting a service, it may help to ask directly whether it evaluates and treats opioid use disorder and whether it offers or coordinates methadone, buprenorphine, or naltrexone.

Other practical questions include:

• How soon can an assessment occur?
• Which medications for opioid use disorder are available?
• Is counseling required, optional, or available by referral?
• Can the program address pain, pregnancy, mental health, or other substance use?
• What costs, insurance rules, transportation needs, or identification requirements apply?
• Is naloxone available for the person and household members?
• What happens if the person returns to opioid use or misses appointments?

A program’s fit matters. A person should not have to accept stigmatizing language or the unsupported claim that medication is not “real recovery.” At the same time, availability and regulatory requirements vary, so asking specific questions can clarify what the service can provide and what requirements apply.^[1][3][12]

Next Steps for Opioid Use Disorder

If you are learning about opioids before starting or continuing a prescription, ask what benefits are expected, how progress will be evaluated, what side effects to watch for, and whether naloxone is appropriate. Share information about sedating medicines and relevant conditions such as sleep apnea, pregnancy, mental health concerns, or past substance problems.^[3]

If you are worried about your own opioid use, request an opioid use disorder assessment rather than trying to diagnose yourself from tolerance or withdrawal alone. Ask specifically about methadone, buprenorphine, and naltrexone, and whether the service can also address pain or co-occurring conditions.

If you are concerned about someone else, begin with a calm, specific observation rather than a label. Offer help locating an assessment, obtain naloxone if possible, and learn how to respond to an overdose. You can support treatment without controlling every decision.

If someone may have taken opioids and cannot be awakened or is not breathing normally, call 911 and give naloxone if available. Stay until emergency assistance arrives. Emergency response comes first; treatment and longer-term planning can follow.^[9]

If you are not ready to pursue treatment, choose one immediate safety step: obtain naloxone and learn how to use it, or ask a clinician to review any benzodiazepines or other sedating medicines taken with opioids.^[9][3] You can also ask a medical or risk-reduction service what support it offers without committing to a treatment plan.

In the United States, call or text 988 for mental health or substance-use crisis support. Call 911 for a life-threatening emergency.