Opioid Resources

Opioid use disorder (OUD) is complex. We have curated a list of links and resources from experts in the field. From prevention and treatment to NARCAN, for community support groups or the science behind medically assisted treatment (MAT), see below.

Opioid Prevention

50% of opioid misuse starts with leftover unused pills. Keeping pain pills around the house "just in case" can lead to accidental overdose or OUD before you know they're gone. When teens or young adults try to take alcohol, adults notice. Remembering how many pills were in a bottle in a drawer from a surgery three years ago is less likely to be obvious.

Reduce the risk.

• Who's at risk? What we know so far.

• Feeling euphoria with first opioid exposure
• While most people feel sleepy with opioids, some feel extremely intense dopamine effects: motivation, popularity, happiness, well-being. Research on these feelings differentiates this "euphoria" from the pain relief. One 2022 study of people who misused opioids found that euphoria (and slurred speech!) with their first opioid dose was overwhelmingly correlated with later OUD. The question of whether there is a feeling of euphoria with opioids is rarely asked, so we can't know prospectively how much that feeling or being a rapid metabolizer (see below) matters. 
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• Post-surgical Patients

Different studies use different definitions, but a common one is continued opioid use 90 days after surgery. By this definition, on average 6.5% of people develop OUD after surgery. Risks vary by study, but often include: people taking opioids before surgery; duration of the prescription (risk starts going up after 3 days of home use); history of depression or use of benzodiazapines; fear of pain; history of trauma; history of substance abuse.  

• Rapid metabolizers
  "About 15 percent of people metabolize opioids so quickly, they get a rush of euphoria beyond not caring about the pain. This reward stimulus then wears off quickly, so they notice pain again too soon to take another pill." The liver metabolism can't explain all of the opioid risk, but is part of the genetic picture. Dr. Baxter's advocacy op-ed.

Reward Deficiency Genetics

Reward deficiency syndrome (RDS) is a term Kenneth Blum used in 1995 to describe people with genetically low dopamine experiences, leading to susceptibility to depression and addiction to substances like opioids that activate dopamine receptors. David Borsook also notes that chronic pain can mis-wire the dopamine system, a state called "anti-reward" that can amplify reward deficiency. There are many different genes involved, but this is the reason family history matters so much.

• Take a Risk Assessment from Partnership to End Addiction
• The Partnership to End Addiction is a leading organization dedicated to addiction prevention, treatment, and recovery. Their risk assessment is designed to help parents assess if their child has or is at risk for opioid use disorder (OUD). 
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• Continued Reading

  • Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy
  • Dreamland: The True Tale of America’s Opioid Epidemic by Sam Quinones
  • Empire of Pain: The Secret History of the Sakler Dynasty by Patrick Radden Keefe
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• Opioid FAQs

• Am I at risk for opioid use disorder?
• Risk factors for opioid use disorder vary on genetic and lifestyle factors. Home use of oral opioids begins increasing risk after three days. Many studies find no difference in pain relief after minor surgery when using home opioids or using over the counter medications and a pain plan, so if you have a family history, plan alternate pain relief options. A pain relief workbook is available free here.
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• Someone in my family has an opioid use disorder, and I need surgery. Should I avoid any opioids in the hospital? 
• Because IV opioids after trauma or surgery result in lower risk of PTSD or chronic pain, they should be considered separately from the risk of using opioids at home. Studies find relief from intense pain is different from the euphoria that can be a signal of risk for OUD. Discuss ways to minimize opioid use and eliminate opioid use once you're discharged with your surgeon.
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  What should I do to avoid opioid use disorder?
  To prevent opioid use disorder, you can look to opioid alternatives, and ask about long-acting lidocaine or blocks after surgery. View this page to see some resources for where to start.
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  My friend has been using pills from his parent's medicine cabinets. Can he die from withdrawal? Withdrawal is extremely unpleasant, but unless there are underlying medical conditions it is very rarely fatal. Consider finding an adult you trust to talk to his parents about your worry.
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• Is my state receiving opioid funding from settlements?
• View this link for a full list of State Participation with National Opioid Settlements from the National Opioid Settlement. 
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  How is opioid money being spent?
• Several organizations are working to track this. View the ongoing list by the Appalachia Opioid Remediation Group.