Take action in the fight against Alabama’s opioid crisis.

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Learn about opioids

Fentanyl is at the heart of today’s opioid crisis, a silent killer infiltrating communities across the country. This synthetic opioid is 50 to 100 times more potent than morphine, and even the smallest amount can shut down breathing entirely, leading to sudden death. Originally developed for severe pain management, fentanyl has become a deadly force, often mixed into other drugs without users knowing, making every dose a potential death sentence.

Opioids, prescription painkillers like oxycodone and hydrocodone, and synthetic drugs like fentanyl, have claimed countless lives. While prescription opioids can help when used correctly, misuse leads to dependence and addiction. For many, prescription opioid misuse becomes a gateway to heroin—another highly addictive and dangerous opioid.

Despite these harrowing realities, too many people still fail to take notice. Misconceptions persist, with some believing addiction is merely a lack of willpower or a series of bad choices. But addiction rewires the brain, creating an overwhelming need that is nearly impossible to fight alone.

The Drug Enforcement Administration (DEA) offers a critical resource guide on the most commonly misused drugs, from pain pills prescribed by doctors to other substances unknowingly laced with fentanyl. Now is the time to take notice, understand the risks, and take action—because the opioid epidemic is not just a statistic, it’s a crisis costing lives every day.

Common opioids:

How can opioids become dangerous?

OUR BODIES START TO DEVELOP A TOLERANCE TO OPIOIDS, WHICH MEANS WE NEED HIGHER DOSES TO ACHIEVE THE SAME EFFECT. INDIVIDUALS USING OPIOIDS FOR CHRONIC PAIN ARE PARTICULARLY VULNERABLE, AS TOLERANCE CAN KEEP INCREASING EVEN AFTER REACHING THE MAXIMUM PRESCRIBED DOSE. THIS GROWING TOLERANCE CAN RESULT IN PHYSICAL DEPENDENCE, ADDICTION, MISUSE, AND OVERDOSE.

Tolerance

The body quickly adjusts to opioids, often requiring larger doses to control pain, even when used as prescribed. Taking higher doses raises the risk of overdose.

Withdrawal

When someone suddenly reduces or stops taking an opioid, they may experience symptoms such as restlessness, chills, sweating, body aches, and nausea. This occurs because their body has become tolerant to the drug, and discontinuing it abruptly leads to withdrawal. This condition is known as physical dependence.

Addiction

Addiction is a long-term condition where an individual keeps using opioids despite experiencing serious negative consequences. This is clinically referred to as opioid use disorder.

Overdose

Opioids impact the part of the brain responsible for regulating breathing. Taking too much can slow or even halt breathing, which can be fatal.

Signs of an overdose include:

  • Small, constricted "pinpoint pupils"

  • Pale or clammy skin

  • Limp body

  • Purple or blue color in the fingernails or lips

  • Vomiting or making gurgling sounds

  • Inability to wake up or speak

  • Slowed or stopped breathing or heartbeat

  • For individuals with lighter skin, the skin may turn blue or purple, while those with darker skin may show a gray or ashen tone.

How to save a life:

  1. Immediately call 911

  2. Attempt to wake the person

  3. Administer naloxone, if available

  4. Start rescue breathing or CPR

  5. Position the person on their side to prevent choking

  6. Stay with them until emergency help arrives

How to identify if someone has a problem

  • Taking opioids beyond the prescribed amount or duration

  • Unable to stop or reduce opioid use

  • Continuing to use opioids despite social or interpersonal issues

  • Visiting multiple doctors to obtain the same prescription for a "backup" supply

  • Making mistakes at school or work due to substance use

  • Isolating from friends, family, or activities

  • Exhibiting changes in mood, attitude, or behavior

  • Displaying changes in sleep habits

Pain management alternatives

THERE ARE SAFER OPTIONS FOR MANAGING PAIN. THE TREATMENTS LISTED BELOW CARRY FEWER RISKS AND SIDE EFFECTS THAN OPIOIDS:

Speak to your provider about alternative treatments

  • Acupuncture

  • Acetaminophen (Tylenol®)

  • Exercise

  • Interventional Therapies (Injections)

  • Ibuprofen (Advil®, Motrin®)

  • Massage Therapy

  • Medication for Depression or Seizures

  • Naproxen (Aleve®)

  • Physical Therapy

Resources

General Information & Awareness

  • Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Prescription pain medicines are helpful when used correctly under a healthcare provider’s direction. However, misusing prescription opioids risks dependence and addiction. In addition to the serious risks of addiction, abuse, and overdose, the use of prescription opioids can have many side effects, even when taken as directed.

    Fentanyl and similar compounds like carfentanil are powerful synthetic opioids — 50 to 100 times more potent than morphine. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death.

    Heroin is a highly addictive drug made from morphine, which comes from opium poppy plants. Some prescription opioid pain medicines have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use.

    The Drug Enforcement Administration’s (DEA’s) resource guide is designed to be a reliable resource on the most commonly abused and misused drugs in the United States. This comprehensive guide provides important information about the harms and consequences of drug use.

    Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. Understand Drug Use and Addiction.

  • Chances are good that even young teenagers will have heard about opioids and overdose deaths at some point.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    Talking to kids about drugs: “What if she finds out the truth?”
    “Debbie” has been drug-free for years. She wants her daughter to stay away from drugs. But she’s afraid to talk to her daughter about her past. (This story is based on the experiences of real people whose names have been changed.)

    “My life was built around getting cocaine and getting high.”
    “Stacey” is recovering from her cocaine addiction. She’s thankful that her life is different now than it was before. (This story is based on the experiences of real people whose names have been changed.)

    Pain medicine addiction: “All I wanted was more of the drug.”
    “Max” was addicted to prescription drugs. The addiction slowly took over his life. (This story is based on the experiences of real people whose names have been changed.)

    Quitting marijuana: “I need different people around me.”
    To stop using marijuana, “Cristina” is making positive changes in her life. She finds support from family and friends who don’t use marijuana. (This story is based on the experiences of real people whose names have been changed.)

Prevention & Harm Reduction

  • Standing Order for NaloxoneHB208 was signed into law in 2015 and provided immunity for prescribing and administering an opioid antagonist, such as naloxone. This is commonly known as a “Good Samaritan Law”. In 2016, HB379 was signed into law, providing the State Health Officer or a county health officer the authority to write a standing order for dispensing naloxone.

    Individual/family/friend request for free Naloxone (NARCAN®) Nasal Spray
    To receive your free NARCAN® kit, you will need to complete an online training Naloxone Training. After completing the training your kit will be mailed to you at the address you provide. Click here to access the training.

    First Responders request for Naloxone (NARCAN®) Nasal Spray If you are an agency that responds to emergencies involving individuals who may be at risk of experiencing an opioid-related overdose or to an emergency that may place the first responder at risk for exposure to opioids there are several steps that must be completed prior to receiving NARCAN®. Email narcanadmh@mh.alabama.gov

  • The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the public about the potential for abuse of medications. DEA provides a tool for locating drug disposal locations near you. Although some medications are safe to throw away at home, learn how to properly dispose of your expired prescriptions.

  • A guide for employers to identify and prevent opioid and other substance misuse in the workplace: opioidpreventionatwork.org

Support & Treatment

  • Connect Alabama App
    Connect Alabama, a behavioral health services and treatment finder application, provides individuals instant access to education, information and services related to substance use, mental health, and prevention.

    ADMH Certified Substance Use Provider Directory
    In addition to our state-run facilities, ADMH provides an array of services through a network of over 200 certified community mental health, substance use disorder prevention and treatment, and developmental disability providers in over 600 locations across Alabama.

    Buprenorphine Treatment Practitioner Locator
    Find physicians authorized to treat opioid dependence with buprenorphine by state. Select a state from the map or use the drop-down lists to view all of the physicians certified to provide buprenorphine treatment in a city, state, or zip code.

    SAMHSA’s National Helpline (also known as the Treatment Referral Routing Service) is a confidential, toll-free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can order free publications and request other information. Call (800) 662-HELP (4357) or visit the online treatment locators.

    SAMHSA’s Five Signs of Quality Treatment:

    1. Accreditation

    2. Medication

    3. Evidence-Based Practices

    4. Families

    5. Supports

    You can use these questions to help decide about the quality of a treatment provider and the types of services offered. Quality programs should offer a full range of services accepted as effective in treatment and recovery from substance use disorders and should be matched to a person’s needs. 

  • Understanding Addiction
    Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to.

    SAMHSA Releases New Resources on Addressing Opioid Use Disorder in Mothers-to-be
    The Substance Abuse and Mental Health Services Administration (SAMHSA) has published four Healthy Pregnancy Healthy Baby fact sheets: Opioid Use Disorder and Pregnancy; Treating Opioid Use Disorder During Pregnancy; Treating Babies Who Were Exposed to Opioids Before Birth; and Good Care While Receiving Opioid Use Disorder Treatment. The documents aim to educate patients and healthcare providers about the best options for mother and baby. In an announcement about the fact sheets, SAMHSA notes that the outcomes for those who participate in a program that offers medication-assisted treatment (MAT) are outweighed by the risks of not being in treatment and that when properly managed, continuing MAT during pregnancy is the best choice for the mother and the baby.

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    Alcohol and Drug Addiction Happens in the Best of Families
    Describes how alcohol and drug addiction affect the whole family. Explains how substance abuse treatment works, how family interventions can be a first step to recovery, and how to help children in families affected by alcohol abuse and drug abuse.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

Healthcare & Professional Resources

  • In order to prescribe or dispense buprenorphine, physicians must qualify for a physician waiver, which includes completing eight hours of required training and applying for a physician waiver. Physicians can complete the Online Request for Patient Limit Increase.

    Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. Chronic pain is common, multidimensional, and individualized, and treatment can be challenging for healthcare providers as well as patients.

    Naloxone: The Opioid Reversal Drug that Saves Lives How Healthcare Providers and Patients Can Better Utilize this Life-Saving Drug

    SAMHSA Releases New Resources on Addressing Opioid Use Disorder in Mothers-to-be
    The Substance Abuse and Mental Health Services Administration (SAMHSA) has published four Healthy Pregnancy Healthy Baby fact sheets: Opioid Use Disorder and Pregnancy; Treating Opioid Use Disorder During Pregnancy; Treating Babies Who Were Exposed to Opioids Before Birth; and Good Care While Receiving Opioid Use Disorder Treatment. The documents aim to educate patients and health care providers about the best options for mother and baby. In an announcement about the fact sheets, SAMHSA notes that the outcomes for those who participate in a program that offers medication-assisted treatment (MAT) are outweighed by the risks of not being in treatment, and that when properly managed, continuing MAT during pregnancy is the best choice for the mother and the baby.

    Free Download
    CDC’s new Opioid Guideline App is now available for free download on Google Play (Android devices) and in the Apple Store (iOS devices).

    The American Medical Association is leading the effort to end the opioid epidemic.

    About the Addiction Medicine Subspecialty

    Addiction Medicine (ADM) is now a recognized physician subspecialty of the American Board of Medical Specialties (ABMS). Credentialed ADM subspecialists serve as clinical experts, faculty, teachers, researchers, and change agents. They provide prevention, evaluation, diagnosis, and treatment services for patients with unhealthy substance use or substance-related health conditions. ADM physicians also help family members who are affected by a loved one’s substance use or addiction.

    CME/CE Activities
    Take advantage of the ADA’s free online continuing education courses covering the latest techniques for prescribing opioids safely and effectively. The webinars are:

    • Free

    • Convenient to access

    • Tailored to pain management in dentistry

    • Available to members and non-members alike

    Plus, the ADA CERP credential provides a sound basis for state regulatory agencies to accept continuing education (CE) credit for licensure.

    Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model was incited by an Institute of Medicine recommendation that called for community-based screening for health risk behaviors, including substance use.

    CDC’s New Quality Improvement and Care Coordination Resource
    Providers wrote approximately 4.45 billion opioid prescriptions in 2016—with wide variation across states. In addition, almost 1.8 million Americans, aged 12 or older, either abused or were dependent on prescription opioids in 2016. Improving the way opioids are prescribed through clinical practice guidelines, can ensure patients have access to safer, more effective pain treatment while reducing the number of people who misuse or overdose from prescription opioids.

    The CDC National Center for Injury Prevention and Control has developed and released the Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain. The quality improvement (QI) measures provided in the resource are meant to be flexible so that healthcare systems and practice leaders can pick interventions that will work best for their practice and patient population. They are offered as voluntary measures that could help incorporate the evidence contained in the CDC’s Guideline for Prescribing Opioids for Chronic Pain in clinical workflow. The purpose of the resource is to encourage careful and selective use of long-term opioid therapy in the context of managing chronic pain through:

    1. Evidence-based prescribing

    2. Quality improvement (QI) measures to advance the integration of the guideline into clinical practice

    3. Practice-level strategies to improve care coordination

    4. A resource toolkit

    Learn More

  • Opioid Overdose Toolkit for first responders, treatment providers, and those recovering from opioid overdose:
    SAMHSA Overdose Prevention and Response Toolkit

    VITAL/ADMH videos

    The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released an updated version of its Opioid Overdose Prevention Toolkit. The toolkit offers information and facts from the literature, and links to resources to prevent opioid-related overdoses and deaths. The toolkit is divided into four sections each target a specific audience: community members, first responders, prescribers, patients, and families.

Reports and Additional Information