Opioid Use

Opioid misuse is a serious public health concern.

The majority of drug overdose deaths involve opioids. Protect yourself and your loved ones from unwanted consequences of opioid use and prevent overdose death.

What are opioids?

Opioids (oh-pee-oyds) are a class of drugs that include illegal drugs like heroin, as well as prescription pain medications including oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, and many others.  Opioids are drugs that act on nerve cells in the brain and body and can relieve pain, but when taken in larger amounts can also create euphoria (or a “high”) and can put someone at risk for overdose and death.

What Is An Opioid Overdose?

An opioid overdose occurs when a high dose of opioids overwhelms an individual's body, causing their breathing to slow. In some cases, an opioid overdose can lead breathing to stop completely. Opioid overdose is life-threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives. Call 911 immediately if a person exhibits ANY of the following symptoms:

  • Their face is extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

At-Risk Populations For Overdose

  • People with lung, kidney, or liver problems
  • People 65 years or older
  • Pregnant people
  • People who are also taking benzodiazepines, certain sleep medications, muscle relaxants, and/or alcohol (all of these also slow down breathing)
  • People who have had a previous overdose
  • People who were recently incarcerated in jail or prison, people who were recently in abstinence-based treatment

How To Respond To An Overdose With Naloxone

Naloxone is a prescription medication that can be administered to reverse the effects of an opioid overdose and save someone’s life if given right away.  Naloxone usually works within 3-5 minutes.  If the first dose doesn’t work, a second dose may be necessary.  Naloxone wears off after about 30-90 minutes.  For this reason, it is possible for someone to wake up and then overdose again when the naloxone wears off.  It is extremely important that you call 911 for help in the event of an overdose, even if someone wakes up after getting the naloxone.

The Heroin Crisis Act of 2015 requires that:

  1. All Medicaid plans cover naloxone.
  2. Pharmacists who have completed training be able to dispense naloxone without a prescription.
  3. Health care professionals who prescribe medications be able to prescribe naloxone for third-party use (which means they can prescribe for a patient who has a friend or family member who uses opioids).

Save a life - Get Naloxone!

  • Ask your local pharmacist if he/she has completed training to be able to dispense naloxone without a prescription.  The pharmacist can run the medication through your insurance carrier and let you know if there is a cost.
  • Ask your doctor/nurse practitioner/physician assistant to write you a prescription. There is more information for prescribers here
  • You can visit one of the many Chicago Recovery Alliance (CRA) sites across the city where they provide naloxone training and free naloxone kits

Naloxone comes in three different forms: as a nasal(nose) spray, as a syringe (needle), and vial (a vial, or auto-injector, is a device that will inject you with a small needle when you push a button).  There are videos that explain how to use each of these different forms of the medication here

In case of an overdose:

1. Check for signs of  an overdose:

  • No response when you call their name
  • Slow breathing or no breathing
  • Lips and fingernails may turn blue or gray
  • Skin is pale or clammy
  • Slow pulse or no pulse
  • Constricted pupils

2. Call 911 and give naloxone

  • If no reaction after 3 minutes, give a second dose

3. Do rescue breathing and/or chest compressions

  • Follow instructions from the 911 dispatcher
Learn How To Use Naloxone

How To Respond To An Overdose With Narcan

Narcan is available at every Chicago Public Library, and many other sites around the city. Visit: bit.ly/FindNarcan to find publicly-accessible Narcan in Chicago.

The The Illinois Department of Human Services, Division of Substance Use Prevention and Recovery (IDHS/SUPR) makes Narcan available at no cost to medical providers and community organizations in Illinois. Register as a Drug Overdose Prevention Program to get access to this Narcan here: IDHS/SUPR Drug Overdose Prevention Program.

Good Samaritan Law

The state of Illinois has a Good Samaritan Law in place to encourage people to seek out medical attention for an overdose, or follow-up care if naloxone has already been administered. This means that an individual cannot be charged with possession for small amounts of illegal drugs when calling 911 or taking someone to an emergency room for an overdose. Under this law, possession of up to 3 grams or less of heroin would be immune from prosecution. If the person dies from the overdose, as long as the caller sought medical attention for the overdose in good faith – that is, the 911 call was placed when the person was alive – and did not sell the user the drugs, the caller will be immune from possession charges.

Overdose Prevention Tips

If you’re taking prescription opioids under medical care:

  • Let your medical provider know about any new diagnoses or new medications that you are currently taking.
  • Avoid using alcohol, benzodiazepines, or other medications that make you tired in combination with opioids
  • Use your medication as prescribed.  If it is not relieving your pain, speak with your medical provider right away
  • If you have concerns related to the risks or side effects from opioids, talk to your doctor about other medication and non-medication options

People using opioids (could be prescription pain medication or heroin) who are not under medical care:

  • Use one drug at a time
  • If you are mixing more than one drug, use less of each drug
  • Try to avoid mixing opioids with alcohol or benzodiazepines
  • Try to avoid using alone.  If you are using alone, have a friend or someone you trust check on you
  • Use less after any period of abstinence or decreased use – even after a few days, your tolerance will go down
  • Use less when you are sick or your immune system is down
  • Do a tester shot
  • Use a less risky method (for example, snort instead of inject)
  • Leave the door unlocked whenever possible
  • Have an overdose prevention plan

Test your drugs for fentanyl with fentanyl test strips (FTS). FTS are available at CDPH Mental Health Clinics and STI Clinics. Email osu.cdph@cityofchicago.org for access to FTS.

Prescription Opioids

Medical providers may prescribe opioids to relieve moderate to severe pain. Opioid pain relievers are usually safe when taken for short periods of time and as prescribed by a medical professional (doctor, dentist, etc). Even when taken as prescribed, opioids have risk for side effects. Common side effects include: sleepiness, dizziness, confusion, itching, and constipation. With continued use, hormone levels are often affected and men may experience low levels of testosterone that can affect sex drive and the ability to have sex. Women may experience irregular menstrual cycles. Additionally, people who take opioids regularly are likely to develop tolerance (higher doses of the medication are needed to provide the same level of pain relief) and withdrawal symptoms (flu-like symptoms when someone stops or misses a dose of the medication).

Opioid pain medications can be misused - when taken at higher doses than prescribed, more frequently than prescribed, or if taking someone else’s medication, they can produce euphoria (positive sensations) in addition to pain relief.  Additionally, when opioids are taken in large amounts, they can cause someone to stop breathing and even die. When opioids are mixed with other “downers” like alcohol or benzodiazepines (medicines that are sometimes used for anxiety treatment), risk for overdose and death goes up even more.

Getting Rid Of Unused Opioids

Because of the many potential negative side effects of opioids, it is recommended that if you do have prescription opioids in your home that they are kept in a safe place, out of the reach of children and when possible in a locked cabinet.  If you have unused opioid pain medications in your home, you can safely dispose of them at the locations listed below.  These locations have drop boxes where you can safely and anonymously dispose of unused medications.

  • Walgreens Safe Medication Disposal offers kiosks that provide a safe and convenient way to dispose of unwanted, unused or expired medication at no cost, year-round. Kiosks are available at select locations during regular pharmacy hours and offer one of the best ways to ensure medications are not accidentally used or intentionally misused by someone else. Click here for all locations.
  • Chicago Police Department Drug Take Back Locations: The Chicago Department of Public Health has partnered with the Chicago Police Department to provide residents with a place for the safe and proper disposal of unused or expired prescription and over-the-counter medications (for households only). Residents may take their pharmaceuticals to one of the following designated drop off locations 24 hours a day, 7 days a week.  Look for the blue box in the lobby. Click here for all locations.

Symptoms Of Opioid Use Disorder

Opioid use disorder is the medical term for opioid addiction.  Scientists do not fully understand why some people who are exposed to opioids go on to develop opioid use disorder while others do not.  It is understood that all types of substance use disorders have a genetic component and people with personal or family histories of substance use disorders seem to be at higher risk.  It is also known that people who have experienced trauma have higher rates of substance use disorders.  

Opioid use disorder may be diagnosed when someone has two or more of the following symptoms:

  • Opioids are taken in larger amounts or for a longer period of time than was intended
  • Desire or unsuccessful attempts to cut down or control opioid use
  • A lot of time is spent trying to get opioids, use opioids, or recover from the effects of opioids
  • Cravings or strong urges to use opioids
  • Continued use of opioids that cause failure to fulfill duties at work, school or home
  • Continued use despite having social or relationship problems that were caused or worsened by opioids and their effects
  • Continued use despite having physical or emotional problems that are likely to be caused or worsened by opioids
  • Tolerance* (needing more of the drug to get the same effect or the same dose of the drug not causing the same level of response)*
  • Withdrawal* (feeling sick when dose is missed or continuing to use to avoid feeling sick)

*If tolerance and withdrawal are the only two symptoms and the individual is taking opioids as prescribed by a medical professional, the individual does not have opioid use disorder, as these are normal responses of the body to regular opioid use.  If the individual has these symptoms plus additional symptoms, he/she may have an opioid use disorder.

Opioid use disorder is a chronic condition.  Like many chronic conditions, people often need life-long support to be able to effectively manage the condition.

Opioid Use Disorder Treatment

Not all substance use disorders have medications that can be used to aid in treatment. There are 3 medications that are approved to be used in the treatment of opioid use disorder and they are described below. Research has shown that people who receive both medication and behavioral therapy are more likely to stay in treatment and less likely to continue to use opioids than people who receive only behavioral therapy with no medication.

In Illinois, anyone can access immediate medications to treat opioid use disorder through the Medication Assisted Recovery NOW (MAR NOW) Program. Call 833-234-6343 and ask for MAR NOW to be connected to a provider. Through MAR NOW, you can receive a telephonic prescription for buprenorphine without first visiting a clinic in person. You can also receive a same or next-day methadone appointment. The MAR NOW program is available to everyone in Illinois, regardless of insurance status or ability to pay. Transportation is provided to anyone who needs it. https://e.helplineil.org/mar-now/

Methadone

Methadone can only be prescribed for opioid use disorder treatment from specialized programs called “Opioid Treatment Programs” (OTPs). Methadone works by reducing cravings for opioids. Research has shown that people who receive methadone treatment live longer, are more likely to stay engaged in treatment, and are less likely to use opioids, die of an overdose, have legal problems, or contract HIV or hepatitis C, compared with those who engage in treatment but don’t use methadone. Methadone is an opioid, and if taken in high doses, it is possible to overdose on methadone. For this reason, OTPs follow very specific rules around methadone dosing. Methadone is dispensed on-site and clients have to go to the program at least six days per week during the initial months of treatment.

Buprenorphine (Suboxone, Subutex, Zubsolv, Bunavail)

Buprenorphine works in a similar way as methadone in that it reduces cravings. Buprenorphine can be prescribed outside of a medical office setting, but only physicians, nurse practitioners and physician assistants who have completed additional training can prescribe it. Research has shown that people who receive buprenorphine treatment are more likely to stay engaged in treatment, less likely to use opioids, less likely to die of an opioid overdose, and less likely to contract HIV or hepatitis C than those who engage in treatment without buprenorphine. Buprenorphine is a partial opioid agonist, which means that even when taken at very high doses, it does not fully activate the opioid receptors in the brain, which makes it much less likely to cause an overdose.

Naltrexone (Vivitrol)

Naltrexone works differently than methadone or buprenorphine. It is typically offered as an injection that lasts for 28 days. During those 28 days, it actually blocks all opioid receptors in the brain. When opioid receptors are blocked, using opioids (heroin or prescription opioids) does not lead to any positive effects (no feeling of being high). Naltrexone can also help reduce cravings. There is not as much research available on naltrexone because it is a newer medication, but studies have shown that people are less likely to use opioids while receiving naltrexone compared to people who do not receive naltrexone. One study showed that people who received naltrexone at the time of release from incarceration were less likely to relapse than people who left incarceration and did not receive naltrexone.

You should talk to your healthcare provider about which form of treatment might be right for you.

Treatment for opioid use disorder can include different types of services depending on the severity of that individual’s substance use disorder, as well as their psychological, social and environmental/living situation. Typically when someone is ready to enter treatment, he/she will go through an assessment. During the assessment, questions will be asked about substance use, other medical conditions, other emotional or behavioral problems/challenges, readiness for treatment, relapse risk, and about an individual’s recovery or living environment. Based on this assessment, the treatment provider will usually recommend a “level of care.” Levels of care are listed below:

  • Outpatient Program - typically 2-8 hours of services per week<
  • Intensive Outpatient Program - typically >9 hours of services per week
  • Residential Programs - there are different types of residential services, but most offer intensive full-day programming
  • Medically Monitored Detoxification - typically 3-7 day in-patient stays when an individual receives medications to help with the symptoms of withdrawal.

Most treatment programs include individual and/or group counseling, as well as case management services.