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Opioids

Heroin, fentanyl, oxycodone, hydrocodone. Brutal, but rarely fatal on its own.

Risk: moderate

About opioids

Opioids bind to mu-opioid receptors, blocking pain and triggering dopamine release. They include prescription pain meds, heroin, and synthetic fentanyl — the latter is potent enough that street supply is often contaminated.

HeroinFentanylOxycodoneHydrocodoneMorphine

Health statistics

~81,800

US overdose deaths involving opioids (2022)

Source: CDC

~88%

Share involving synthetic opioids (fentanyl)

Source: CDC

26,000+ since 1996

Lives saved by naloxone (US, est.)

Source: CDC

Short-term effects

•Pain relief, euphoria, drowsiness ('the nod')
•Constipation, nausea, pinpoint pupils
•Slowed breathing — the mechanism of overdose death

Long-term health risks

•Tolerance and physical dependence
•Hormonal disruption, sexual dysfunction
•Infection risk from injection (HIV, hepatitis C, endocarditis)
•Fatal overdose, especially with fentanyl contamination

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What to expect — timeline

8–24 hrs
Anxiety, yawning, sweating, runny nose, muscle aches. 'Feels like the flu starting.'
Day 1–3
Peak: vomiting, diarrhea, chills, deep bone aches, no sleep, cravings.
Day 4–7
Physical symptoms ease. Energy stays low. Mood is fragile.
Weeks 2–8
PAWS — fatigue, low motivation, anhedonia. Slowly lifts.

What helps

•Loperamide (Imodium) for diarrhea — over the counter, very effective.
•Hot showers help bone aches more than almost anything.
•Electrolytes (Pedialyte, LMNT, broth). Don't get dehydrated.
•Melatonin + magnesium at night may help the insomnia.
•Have naloxone (Narcan) on hand — relapse risk after detox is high and tolerance drops fast.

Red flags — go to ER

Dehydration: dizzy when standing, no urination for 8+ hours.
Inability to keep any fluids down for 24+ hours.
Suicidal ideation.

When to get help

MAT (medication-assisted treatment) with buprenorphine or methadone hugely improves your odds. Call SAMHSA to find a provider same-day. Carry naloxone.

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