Opioid Use Disorder

Getting Help for Concerns About Opioid Use

Fear of withdrawal, uncontrolled use, or losing pain treatment can make asking for help difficult. Opioid use disorder (OUD) involves a harmful pattern of use. Physical dependence alone does not establish it.^[1][2]

Physical dependence means the body has become used to opioids and may develop withdrawal symptoms when use decreases. It can happen during prescribed treatment and does not by itself mean someone has opioid use disorder.^[3][2] An assessment can sort out those differences and connect you with treatment, including medication, while addressing your health and pain needs.^[1][3]

If someone cannot wake up or is not breathing normally after possible opioid use, call 911 and give Narcan (naloxone) if available. Stay with them until emergency help arrives.^[4]

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.^[5]

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.^[6][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.^[7] Semisynthetic means a natural opioid has been chemically changed to make the drug.^[8]

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.^[7][2][9]

How Opioid Misuse, Dependence, and Addiction Differ

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

Term	What It Means	Does It Establish Opioid Use Disorder?
Prescribed use	Taking an opioid medication under medical care for a medical reason such as pain	No. Prescribed use alone does not establish a disorder
Nonmedical use or misuse	For prescription opioids, taking medicine differently than prescribed, taking someone else’s prescription, or taking it to get high. Even use for pain relief can count as misuse[6][2]	Not by itself. The national survey separately assesses misuse and disorder criteria[2]
Tolerance	The body gets used to an opioid, so the same amount has less effect over time	No. It can occur during appropriate medical treatment
Physical dependence	The body gets used to an opioid and may develop withdrawal symptoms when the amount is reduced or use stops	No. It can occur during appropriate medical treatment
Withdrawal	Symptoms that can occur when a body used to opioids receives less of them, or when a medicine blocks their effects	No. Withdrawal is a bodily response, not a complete diagnosis
Opioid use disorder	A pattern of opioid use that meets the requirements for diagnosis and causes serious problems in daily life or continues despite harm	Yes. This is the clinical diagnosis[1]

When a Pattern Needs Assessment

Picture two people. One takes an opioid as prescribed after surgery and has withdrawal symptoms when treatment ends. Another keeps using despite serious problems at home or work. The first situation may reflect physical dependence. The second raises concern for a disorder. Both deserve an assessment that considers the whole situation.^[10]

Opioid Use Disorder Diagnosis

An assessment is a chance to explain what has changed: control over use, effects on relationships or responsibilities, and concerns about pain or withdrawal. A clinician reviews the diagnostic criteria with that context in mind.^[10]

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 toward OUD criteria when opioids are taken solely under appropriate medical supervision. The national survey likewise excludes them for prescribed drugs used without misuse.^[10][2]

Opioid Use Disorder Symptoms to Discuss

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:^[10][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.^[10][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.^[10][2] The broader concern is significant impairment (difficulty functioning in everyday life) and continued use despite harmful consequences.^[10]

You do not have to decide which symptoms “count” before seeking care. Bringing specific experiences, such as missed responsibilities or attempts to cut back, gives the clinician something concrete to assess. The list supports that conversation. It cannot diagnose you on its own.^[10]

Tolerance and Withdrawal During Medical Care

Tolerance and physical dependence can develop during prescribed treatment. This means the body becomes used to the medicine. The behavioral pattern of addiction is assessed separately.^[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. Changes that cells make in response to ongoing opioid use also appear to contribute, but the exact pathways responsible for tolerance, dependence, and withdrawal are not fully understood.^[5]

Why an Assessment Needs Context

A label should not replace a careful assessment. A clinician needs to distinguish the body becoming used to opioids from a harmful pattern of use, particularly when opioids are prescribed for chronic pain.

How Diagnostic Definitions Changed One Study’s 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.^[11] 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.^[11]

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.^[11]

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.^[5]

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][9]

How Overdose Differs from Intoxication

Expected or unwanted opioid effects can include sleepiness, nausea, vomiting, constipation, dry mouth, and confusion. In an opioid overdose, breathing can become dangerously slow or stop. 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.^[4]

Naloxone is an opioid antagonist, meaning it blocks opioid receptors. It can reverse dangerously slowed breathing caused by opioids. Friends, relatives, caregivers, or other bystanders can give it to help save a life.^[3]

Naloxone reverses an overdose. It does not treat opioid use disorder.^[2] After giving it and calling for emergency help, try to keep the person awake and breathing, lay them on their side to help prevent choking, and stay until help arrives.^[4]

People who have survived an opioid overdose are at increased risk of another. Follow-up can connect the person with ongoing treatment and a safety plan after the emergency is treated.^[12][9]

How Withdrawal Differs from Overdose

Withdrawal can occur when a body that has become used to opioids receives less of them, or when a medicine suddenly blocks their effects. It is not the same process as overdose.

An overdose involves too much opioid effect, especially on breathing. Withdrawal happens when opioid effects decrease in a body that has become used to them. Naloxone may cause sudden withdrawal in a physically dependent person because it rapidly blocks opioid receptors.^[3]

That possibility should not delay naloxone during a suspected overdose. Serious side effects from naloxone used as directed have been reported but are rare. Dangerously slowed breathing can be fatal if it is not treated.^[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][9] 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]

Treatment with methadone or buprenorphine is associated with lower overdose and death risks compared with receiving no treatment. Both can reduce opioid use and help people stay in care.^[1]

Methadone, buprenorphine, and naltrexone are FDA-approved options. They work differently, so your health, recent opioid use, goals, and access matter when choosing one. No medicine guarantees an individual outcome.^[1][13]

Medication	How It Works	Main Treatment Purpose	Practical Considerations
Methadone	Fully activates mu-opioid receptors, the cell proteins through which opioids produce many of their effects[5]	Reduces withdrawal and craving and supports ongoing treatment	Ongoing treatment for opioid use disorder is provided through opioid treatment programs, specialized services that must meet federal certification and accreditation requirements[3][14]
Buprenorphine	Activates mu-opioid receptors partway and attaches to them strongly[5]	Reduces craving and supports ongoing treatment	Can be prescribed in medical offices or through telehealth. A clinician must plan when and how to start it based on recent opioid use[1]
Naltrexone	Blocks opioid receptors rather than activating them[5]	Diminishes opioid effects if opioids are used while it is active	Requires a period without opioids before starting to avoid sudden withdrawal caused by the medication. Ongoing access and follow-up still matter[1]

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][6]

They also maintain some tolerance to the breathing-slowing effects of opioids. By occupying opioid receptors, they can reduce the effects of another opioid. This does not make additional opioid use safe or eliminate overdose risk, especially when other sedating substances or potent fentanyl are involved.^[5]

Naltrexone blocks opioid receptors. Its long-acting injection is given monthly. Before starting, a person needs a period without opioids to avoid sudden withdrawal. A clinician can help you compare that starting requirement with the other options.^[1]

Treatment Is More Than Withdrawal Management

Medical detox 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.

In a 2017 Yale Medicine article, addiction specialist David Fiellin, MD, cautioned against relying on detoxification: “The evidence shows that this is not a uniformly effective strategy and has a high level of relapse.”^[15] A useful follow-up question is: “What medication and continuing care can begin during or after withdrawal management?”

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][16]

Making Medication Treatment Work for You

Prescribed medication for opioid use disorder is treatment, not evidence that recovery has failed. Methadone and buprenorphine can relieve withdrawal and craving while producing less intense pleasurable effects than other opioids in people with OUD. Physical dependence can occur during effective treatment.^[1]

Access barriers are real: transportation, pharmacy availability, and stigma can make continuing care difficult. Those obstacles deserve practical solutions. Your care team can help you work out where medication will come from and how to reach someone if the plan breaks down.^[1]

Treatment outcomes vary. Other mental and physical health conditions also matter, and the plan may need to change with your goals, health, or previous treatment experiences.^[13]

Behavioral Care and Recovery Support

Counseling and other support can address behavior, emotional needs, relationships and practical circumstances alongside medication. Clinicians may call this behavioral or psychosocial care. 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][17]

Contingency management is a reward-based behavioral approach studied alongside opioid agonist treatment. A review of 72 randomized controlled trials suggested considering this approach to help people stay in treatment.^[17] In these trials, researchers assigned people to comparison groups by chance. The review noted that implementation details, such as how often rewards were provided, were missing from many included studies.^[17]

For outcomes other than staying in treatment, the review found few consistent differences between adding counseling or other psychosocial support to opioid agonist medication and using that medication 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.^[17]

This does not mean counseling has no value. It means the review did not establish one psychosocial method as superior across outcomes and populations.^[17] Ask what a service’s counseling involves and which needs it can address, such as skills practice, recovery education, or practical support.

What a Study of Counseling Intensity Can Tell Us

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.^[16]

What Research Shows About Peer Recovery Support

A systematic review included 24 reports from 23 original studies involving 6,544 participants.^[16] 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.^[16]

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.^[16] The study was nonrandomized: group assignment depended on provider and patient discretion rather than chance.^[16]

At 12 months, researchers did not find clear differences in starting medication, repeat overdose visits to the same emergency department, or deaths. The study could not distinguish the observed differences from chance variation. That does not prove the approaches were equally effective.^[16]

Another outreach pilot identified 88 people actively using opioids.^[16] Of these, 72 were eligible and 70 attended a treatment-linkage meeting after peer outreach.^[16] 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.^[16] 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 the requirements for a diagnosis, without formal treatment. Others need medical care to address immediate health problems, ongoing treatment and practical support. Care that combines several kinds of help over time can be useful, as it is for other long-term health conditions.^[16]

Needing 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]

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 cover how pain affects daily activities, treatment benefits, side effects, mental health, substance use, sleep conditions, other medicines, and overdose risk. Any medication change, including gradually reducing a dose (tapering), should be planned with a clinician.

Health Conditions That Affect Opioid Care

Opioid use disorder can occur alongside other substance use, depression, and chronic pain.^[17] 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 who also had mental health conditions.^[17] Only one trial focused on people with chronic pain using prescription opioids, and none of the eligible trials specifically studied youths or incarcerated people.^[17]

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]

Opioid Use Disorder During Pregnancy and Infant Care

Do not suddenly stop opioids because you are pregnant. Contact your pregnancy-care or opioid-treatment clinician to make a plan. For pregnant people with OUD, methadone or buprenorphine is recommended rather than withdrawal alone because medication offers better outcomes and a lower risk of return to opioid use.^[18]

These treatments have benefits and risks for both parent and baby. A newborn may have withdrawal symptoms after exposure to medication in the uterus, but that possibility alone is not a reason to withhold recommended treatment. The pediatric team can monitor the baby and treat symptoms if needed.^[18]

If you already take naltrexone, its pregnancy safety evidence is more limited. Continuing or changing it needs an individual discussion that weighs those uncertainties against the risk of returning to opioid use. Do not make that decision on your own.^[18]

Newborn withdrawal reflects the end of opioid exposure after birth. It does not mean the infant has the adult behavioral diagnosis of opioid use disorder.^[3]

Your prenatal and opioid-treatment teams should coordinate care through pregnancy and after delivery. A useful question is: “Who handles my medication, who will monitor my baby, and who do I contact if something changes?” The American Academy of Pediatrics also calls for sustained support for the parent and infant.^[18][19]

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.^[20]

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 suggested longer buprenorphine treatment and a slower, clinician-managed dose reduction rather than shorter treatment. The evidence supporting that suggestion was limited.^[20]

For many other adolescent substance-use treatments, the research was too limited to support a recommendation.^[20] 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 give naloxone to reverse dangerously slowed breathing caused by opioids.^[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 include naloxone, attention to risky medication combinations, and connection to risk-reduction services and evidence-based treatment.^[3][9]

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 dangerously slowed breathing caused by opioids.^[3][4]
• 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][9]
• 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.^[12]
• 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.^[4]

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 survey of people ages 12 or older in U.S. households and certain group living arrangements, such as shelters and college dormitories. It measures substance use, substance use disorders, treatment and mental health.^[21]

The survey describes this as the “civilian, noninstitutionalized” population. It excludes active-duty military personnel, people living in institutions such as jails or hospitals, and people without a fixed household address who are not in shelters. Its estimates therefore do not count everyone in the country.^[21]

Prescription Misuse and Opioid Use Disorder

In 2025, an estimated 6.881 million people ages 12 or older, or 2.4% of that population, misused prescription opioids in the past year.^[22] The same survey estimated that 3.972 million people, or 1.4%, had a past-year opioid use disorder involving heroin or prescription opioids.^[23]

These figures measure different things. Misuse is a behavior. OUD requires a qualifying pattern of symptoms. The disorder estimate does not capture symptoms arising solely from illegally made fentanyl. Both estimates apply to the U.S. civilian, noninstitutionalized population, not everyone in the country.^[21]

Survey methods and definitions have changed. These figures should not be placed beside the older 2019 estimates as though any difference were a directly comparable trend.^[2]

Opioid-Involved Overdose Deaths

Overdose deaths measure lives lost. They do not tell us how many people have 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.^[9]

In 2023, approximately 105,000 people died from a drug overdose in the United States, or about 287 people per day.^[12] Nearly 80,000 deaths (about 76%) involved an opioid, whether prescription or illegal.^[12]

Nearly 73,000 overdose deaths involved synthetic opioids other than methadone, primarily illegally made fentanyl and fentanyl analogs (substances chemically related to fentanyl).^[12] That represented nearly 92% of opioid overdose deaths in 2023.^[12]

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.^[12]

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.^[9] Illegally made fentanyl was involved in approximately two-thirds of opioid deaths in those states during that period.^[9][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.^[9][3]

Finding Opioid 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.^[14]

FindTreatment.gov is the U.S. government’s treatment-search resource.^[24] 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 and insurance requirements, 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][14]

Finding Opioid Treatment Near You or Online

Look for a service that can evaluate opioid use disorder and explain its medication options. A counseling appointment and a medication appointment may be with different professionals. HHS describes telehealth services that can provide medications for OUD or individual and group therapy. Ask what the particular service offers before booking.^[25]

For local care, start with FindTreatment.gov or ask your usual clinician for an opioid-treatment referral.^[24] For online care, your insurer may help you identify participating telehealth providers. Confirm coverage and out-of-pocket costs with the insurer or provider.^[25]

When comparing an in-person program with online treatment, ask:

• Will this appointment include an OUD assessment and medication evaluation, counseling, or both?
• Can you treat me in the state where I will attend the appointment?
• Which visits, tests or medication services require an in-person location?
• How soon can care begin, and what should I do if withdrawal or medication access becomes a problem before then?
• Who coordinates care with my pain clinician, pregnancy-care team or other prescribers?
• What are the full visit, testing and medication costs, and who can confirm insurance coverage?

Counseling can help, but being unable to access it or choosing not to participate should not prevent medication treatment for OUD.^[3] Ask how the provider can start appropriate medication care while arranging other support.

For a video appointment, gather your medication list and questions, test the connection, and find a quiet place where you can speak comfortably.^[25] Telehealth arrangements do not replace emergency care. For a suspected overdose, call 911 and give naloxone if available.^[4]

Take the Next Step Toward Opioid Recovery

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 other health 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.^[4]

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.^[4][3] You can also ask a medical or risk-reduction service what support it offers without committing to a treatment plan.

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Compare opioid treatment options and learn about medications used in addiction treatment. If you are looking for a program, use the treatment center directory and ask which opioid medications it provides or coordinates.

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In the United States, call 988 or text 988 for mental health or substance-use crisis support.^[26]