Opioid Addiction: A Rapidly Growing Public Health Concern
- 9 hours ago
- 7 min read
Written by: Jessica Karlovcec, MSc
Edited by: Ayush Halder
What are opioids?
Opioids are the strongest and most effective pain-relieving drugs available (Veilleux et al., 2010). Some opioids, like morphine and codeine, are derived from the opium poppy and are considered “natural” opioids (Pathan & Williams, 2012). Others, such as oxycodone and hydromorphone, are made in laboratories through the modification of natural opioids and are known as “semi-synthetic” opioids (Pathan & Williams, 2012). Finally, some opioids, including fentanyl and methadone, are made entirely in a laboratory and are called “synthetic opioids” (Pathan & Williams, 2012). Opioids work by binding to opioid receptors and turning down pain signals sent to the brain (Mallick‐Searle & Fillman, 2017; Trescot et al., 2008).
While many clinicians consider opioids the “gold standard” for pain relief, their use is associated with numerous side effects due to the location of opioid receptors throughout the brain and body (Listos et al., 2019). Because there are opioid receptors located in the gastrointestinal tract, opioid use is associated with symptoms such as constipation, nausea, and vomiting (Listos et al., 2019; Mallick‐Searle & Fillman, 2017). Opioid receptors also exist in brain centers that control our breathing rate, and when opioids bind to these receptors, they slow breathing and can cause fatal overdoses (Boom et al., 2012; Listos et al., 2019). Finally, because opioid receptors exist in brain pathways that regulate reward processing, taking opioids can easily lead to addiction (Listos et al., 2019).
Why are opioids addictive?
Opioids cause addiction by altering the mesocorticolimbic circuit in the brain, often called the reward pathway (Cao et al., 2021; Hyman et al., 2006). Dopamine release from neurons in this pathway is associated with feelings of pleasure (Cao et al., 2021; Hyman et al., 2006). This pathway plays an important role in humans because it makes functions that are necessary for survival feel rewarding (Hyman et al., 2006). For example, eating food triggers the release of dopamine in this pathway, which makes us consider eating a pleasurable experience and, in turn, encourages us to eat again in the future (Hyman et al., 2006). However, drugs like opioids also cause the release of dopamine in the mesocorticolimbic circuit, and importantly, repeated administration of opioids can cause an excessive release of dopamine in this pathway (Koob, 2020). This excessive activation of the reward pathway can cause a user to want to continue taking opioids even when they are not experiencing pain and can therefore lead to addiction (Koob, 2020).
How are opioids impacting public health?
Clinicians commonly prescribe opioids following surgeries and for the management of chronic pain conditions (Listos et al., 2019). However, opioid abuse and subsequent addiction can develop even when they are prescribed by a doctor or pharmacist, due to opioids’ impact on the mesocorticolimbic circuit, as previously discussed (National Institute on Drug Abuse, 2021). Individuals also abuse opioids recreationally because of their pleasurable effects (National Institute on Drug Abuse, 2021). Unfortunately, when people misuse opioids, no matter how they first started using them, they face a much higher risk of overdose and death (Centers for Disease Control and Prevention, 2024a; National Institute on Drug Abuse, 2021).
Additionally, investigators are increasingly detecting fentanyl contamination in drugs from the illegal supply (Centers for Disease Control and Prevention, 2024b). This is concerning because fentanyl is 100 times more potent than morphine, and therefore even a very small amount of fentanyl can cause an overdose, especially when drug users combine it with other drugs or take a substance without realizing that it contains fentanyl (Centers for Disease Control and Prevention, 2024b; Trescot et al., 2008). Additionally, people are increasingly using opioids in combination with other drugs, which greatly increases the risk of overdose (Ford et al., 2021). These factors and more have contributed to a concerning rise in the number of opioid-related deaths worldwide, a large proportion of which are related to fentanyl (Centers for Disease Control and Prevention, 2024b; World Health Organization, 2025). In fact, in recent years, opioid misuse has reached epidemic levels; in 2019, there were approximately 125,000 opioid overdose deaths worldwide (Shipton et al., 2018; World Health Organization, 2025). Additionally, of the 600,000 drug-related deaths recorded globally in 2019, about 80% were related to opioids, highlighting the devastating impact opioids are having on public health (World Health Organization, 2025).
While rising overdose and mortality rates are highly concerning impacts of opioid abuse on public health, it also impacts several other factors relating to public health. Additional harms include: illness, injuries, violence, car accidents, criminal activity, and impacts on interpersonal relationships. These harms also impose a substantial economic burden on society by increasing costs in health care, the criminal justice system, and the workforce (Substance Abuse and Mental Health Services Administration [US] & Office of the Surgeon General [US], 2016).
What can we do about it?
Researchers are currently working to develop new pain-relieving drugs that are as effective as opioids but do not produce opioid-related side effects. However, another approach in research involves developing opioid-sparing techniques that aim to limit opioid use and related side effects (Ghai et al., 2022). These techniques include administering lower doses of opioids alongside other classes of pain-relieving drugs that are unable to provide effective pain relief on their own, using therapeutic methods like cognitive behavioral therapy, or offering alternative therapies such as virtual reality or hypnosis (Firoozabadi et al., 2020; Ghai et al., 2022). Although researchers have made substantial progress in these fields in recent years, they have not yet developed a solution that sufficiently replaces opioids in healthcare. The public therefore needs to understand how to prevent opioid misuse in their communities.
Firstly, avoiding opioids, when possible, is the best safeguard against the development of opioid addiction. For example, patients can discuss pain management plans with their doctors, including non-opioid treatment options, to ensure safe and effective care. Further, teaching children about the dangers of recreational drug use can prevent experimentation with drugs such as opioids, or drugs that may contain opioids (Centers for Disease Control and Prevention, 2024a).
Next, acquiring and learning how to use naloxone kits can save someone’s life if they are overdosing on opioids. Naloxone is a drug that can reverse an opioid overdose by removing opioids from opioid receptors and binding to these receptors itself, without activating them (Government of Canada, 2026; Trescot et al., 2008). Pharmacies and community organizations provide naloxone kits in two formulations (intranasal spray and intramuscular injection) at no cost to users (Government of Canada, 2026). Although naloxone has a rapid onset of action and has a good safety profile, its duration of action may be shorter than that of the administered opioid (Government of Canada, 2026). Therefore, the caregiver must contact emergency services immediately if they suspect an overdose, even after they administer naloxone (Government of Canada, 2026). Fentanyl test strips are another harm reduction strategy that can detect whether a drug contains fentanyl (Centers for Disease Control and Prevention, 2024b). While fentanyl test strips are a low-cost screening tool, they do not reliably detect all fentanyl analogs such as carfentanil and norfentanyl (Government of Canada, 2018; Norman et al., 2023). Therefore, users should combine fentanyl test strips with other harm reduction strategies (Centers for Disease Control and Prevention, 2024b).
Finally, we must work together as a society to change the culture surrounding addiction. Addiction is a medical condition and not a moral failure. Discrimination and prejudice regarding drug use and addiction reduce individuals’ willingness to seek help from healthcare professionals and loved ones. Compassionately supporting those struggling with addiction and encouraging them to seek professional support and treatment, and remaining well-informed through reliable sources, are effective ways to address this public health concern (Substance Abuse and Mental Health Services Administration [US] & Office of the Surgeon General [US], 2016).
References
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