What are opioids?
An opioid is a type of medication that acts within the central nervous system and the brain to provide pain relief. The most commonly used opioids are morphine, hydromorphone, oxycodone and fentanyl, which all have different strengths and potencies. Opioids are usually prescribed for moderate to severe acute (short-term) pain and are important for managing pain following surgery, cancer pain, or in end-of-life settings. The goal of prescribing opioids is to control pain symptoms to improve quality of life and daily function.
Side effects of opioids and opioid withdrawal
Opioids have a number of side effects including drowsiness, itchiness, nausea and vomiting, constipation, and shallow or slow breathing. There are also side effects to suddenly stopping opioid use you have been taking them for a long period of time (e.g., weeks or longer). These are called withdrawal symptoms and can include sweating, nausea, diarrhea, agitation, muscle pain and restlessness. Withdrawal can be prevented by slowly decreasing or ‘weaning’ the amount of opioids in your system over days or weeks until the medication can be stopped safely. A weaning schedule should be determined by a health-care provider.
Opioid overdose
Taking too much of an opioid or taking opioids with other substances that can cause drowsiness (like alcohol, benzodiazepines, and some antihistamines and antidepressants) can result in an overdose. An opioid overdose can cause your breathing to slow down or even stop, which can result in death. The risk of overdose is quite low when opioids are taken as prescribed by a health-care provider. Overdose risk may increase when opioids are misused.
See Know How to Recognize an Opioid Overdose, published by the Government of Canada, for more information.
Non-medical use of opioids and ‘addiction’
Opioids can cause a feeling of euphoria, or an intense feeling of happiness and relaxation, because of their effect on the ‘reward system’ in the brain. Some people may misuse non-prescription, or non-medical, opioids to experience this ‘high’. This is also sometimes called ‘recreational’ use. Non-medical opioids can be taken as pills, snorted as a powder, smoked, or injected into veins. Some people who misuse opioids for this high can go on to develop a substance use disorder, or addiction, where cravings for the drug lead to a loss of control and physical dependance. People who are addicted to opioids feel unable to stop the medication even after it starts to cause them harm.
Intentional misuse
Intentional opioid misuse is very dangerous.
- If you take opioids that have not been prescribed to you, the exact type of drug and dose may be unknown, leading to a risk of overdose and death.
- Taking opioids with other substances can make the side effects of opioids stronger, increasing the risk of overdose.
- The sharing of unsterile equipment, like syringes, can lead to infections like hepatitis or human immunodeficiency virus (HIV).
- Since opioids are a controlled substance in Canada, finding opioids to misuse illegally may mean having to interact with dangerous people and putting yourself at risk of harm from violence.
Unintentional misuse
Non-medical opioid use can also be unintentional. This means taking a pill, powder or smoking from a pipe without knowing that there is an opioid present. Opioids, such as the very potent fentanyl, may be added to or contaminate other non-medical substances. The unknown presence of an opioid in other non-medical substances can lead to an opioid overdose, which may not be recognized or acted on, leading to death.
How common is opioid misuse in young people in Ontario and Canada?
An Ontario-based study showed that over 20% of students in Grade 7-12 reported using opioids without a prescription at least once in the past year. The rate of reported non-medical opioid use among teens almost doubled between 2019 and 2023. A Canadian Centre for Substance Use and Addiction (CCSA) report identified that 9.8% of youth aged 15-19 reported misusing opioids.
In Ontario, death rates from opioid toxicity nearly tripled among teens between 2014 and 2021. In 2021, 9% of all opioid-related emergency department visits and 8% of deaths related to opioids in Ontario occurred among those aged 15 to 24 years.
Reducing the harms of opioids
There are several things that you, your family, and friends can do to reduce the risks of both prescription and non-medical opioids. These strategies fall under the umbrella of ‘harm reduction’, which acknowledges that, if and when people choose to use non-medical opioids, there are ways of reducing the risk of infection, overdose and death.
- Store prescription opioids safely. Always store prescription opioids in a safe place, locked away and not easily accessible to small children or those who may misuse them. When opioids are no longer needed (e.g., pain has resolved after a surgery), return any unused opioids to a pharmacy for disposal.
- Use prescription opioids as prescribed. Follow the instructions of a health-care provider and do not take larger doses or more frequent doses than what is prescribed. Avoid taking opioids with other substances that cause drowsiness, like alcohol or benzodiazepines. If you have concerns or questions about a prescription or how an opioid might interact with other prescribed medications, talk to a health-care provider or pharmacist.
- Choose not to use non-medical opioids. The safest way to prevent opioid harm is choosing not to use non-medical opioids. Know the risks of non-medical opioid use and talk to your family and friends about them.
- Choose to use drug testing strips. Anyone who chooses to take non-medical opioids or substances should consider using drug testing strips to identify the presence of unexpected substances. If an opioid (especially the very potent opioid, fentanyl) is present unexpectedly, choose not to use the substance. It is important to know that drug testing strips are not 100% accurate and only detect the substance they are designed to look for.
- Choose not to use alone. Anyone who experiences an overdose of opioids cannot seek medical attention for themselves. Using non-medical opioids in the presence of other people may allow them to recognize an opioid overdose and save a life by contacting emergency services and administering naloxone.
- Get and know how to use a naloxone kit. Naloxone is a life-saving medication used to reverse an opioid overdose. You may hear naloxone called by its brand name, Narcan. Naloxone can be given as a spray into the nose or as an injection into the muscle. A pharmacist can show you how to give naloxone, and videos are available online (nasal spray, injection).
For more information on what naloxone does, when it should be used, and how to give it, see Naloxone.
