Opioids (used to treat pain): Prescription opioids act on the same receptors as heroin and can be highly addictive. People who abuse them sometimes alter the route of administration (e.g., snorting or injecting) to intensify the effects. Some even report moving from prescription opioids to heroin. It is estimated that approximately 1.9 million people in the U.S. meet the abuse or dependence criteria for prescription opioids. Abuse of opioids, either alone or with alcohol or other drugs, can depress respiration or lead to death. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999 and now outnumber those from all other drugs combined, including heroin and cocaine. (Figure 10). Injecting opioids increases the risk of HIV and other infectious diseases through use of unsterile or shared equipment. Non-injection drug use can also increase these risks through drug-altered judgment and decision making.
While hydrocodone and oxycodone may be most familiar as the opioid analgesics commonly abused, there are two more about which the dental healthcare provider should be aware: fentanyl, a synthetic opiate and carfentanil, a derivative of fentanyl. Fentanyl is a powerful analgesic similar to morphine but 50 to 100 times more powerful. The legitimate use of fentanyl is generally limited to end-of-life pain management. Since 2013, law enforcement encounters (drugs submitted for analysis) testing positive for fentanyl have sharply increased.7 In 2013, zero states reported more than 500 encounters; in 2014 two states and in 2015 eight states reported more than 500 encounters. The total number of encounters has more than doubled in the U.S. from 5,343 in 2014 to 13,882 in 2015. States like New Hampshire and Ohio are noting rapid increases in encounters.7 These increases are primarily due to illicitly made fentanyl that is being mixed with or sold as heroin, with or without the users’ knowledge. Carfentanil is 100 times stronger than fentanyl. Due to this extreme strength, the legitimate use of carfentanil is limited to elephant and other large animal sedation. Veterinarians licensed to use carfentanil cover their hands, arms and faces to protect them from contact, and keep an antidote close by. Carfentanil is illegally obtained by diverting legal veterinarian supplies or synthesized in street labs.41
CNS Depressants (used to treat anxiety and sleep problems): These drugs are addictive and, in chronic users or abusers, discontinuing them without a physician's supervision can bring about severe withdrawal symptoms, including seizures, which can be life-threatening.
Stimulants (used to treat ADHD and narcolepsy): Misuse of stimulants can cause addiction and other health consequences. These include psychosis, seizures, and cardiovascular complications.31
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