Opioids are a class of drugs that include the illicit drug heroin and legal prescription analgesics oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.16 Opioids interact with opioid receptors in the central nervous system and brain to produce pleasure and reduce pain and have a high rate of misuse and abuse.16 Substance abuse disorder is a primary, chronic, and relapsing brain disease characterized by the pathologic pursuit of reward and/or relief by substance abuse.17 Drug misuse is defined as the use of medications for purposes for which they were not prescribed.18 Roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them19 and between 8 and 12% develop an opioid use disorder.20-22 An estimated 4 to 6% who misuse prescription opioids transition to heroin abuse.20-22 This is a major shift the method of introduction to heroin for abusers. In 1960, 80% patients entering treatment for heroin reported that heroin was the first opioid drug that they had abused, whereas in the 2000s, 75% of individuals seeking treatment for heroin addiction reported that their first opioid was a prescription drug.21 This has led to an overwhelming epidemic of opioid abuse that results in 115 overdose deaths each day10 and has caused a 21% increase in the number of opioid-related deaths between 2015 and 2016 (Figure 1).1 A concomitant increase in neonatal abstinence syndrome due to opioid use during pregnancy23 and HIV and hepatitis C rates due to intravenous drug abuse,24,25 are some of the additional public health crises associated with this epidemic.
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