Opioids & mental health
Opioid use disorder is a health condition, not a character flaw. People recover every day.
By the numbers
How many people are affected, and signs of hope.
Opioids touch millions of families. These numbers are a reminder that no one facing this is alone, and that things can change for the better.
United States
World
What are opioids?
A family of drugs that ease pain and slow the body down.
Opioids are a group of natural, partly man-made and fully lab-made drugs. They include heroin, illegally made fentanyl, and some prescription pain relievers. They can ease pain and bring a feeling of calm or pleasure.
Opioids also slow down breathing. That is why taking too much, or mixing them with other drugs, can be deadly. Prescription opioids and heroin are chemically similar and can give a similar high.
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Prescription opioids can be helpful for serious pain when used exactly as directed. Misuse means taking them in a different way, in larger amounts, or without your own prescription.
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About 556,000 people aged 12 or older in the U.S. used heroin in the past year (2024). Today, heroin is often mixed with fentanyl, which makes it far more dangerous.
In older data, about 80% of people who used heroin had first misused prescription opioids. More recent research shows heroin is now often the first opioid people use.
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Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. Illegally made fentanyl is behind most overdose deaths today.
How dependence develops
Tolerance, dependence and addiction are not the same thing.
Nobody plans to become dependent on opioids. With repeated use, the brain and body slowly adapt. Over time, a person can feel they need opioids just to feel normal.
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With tolerance, a person may need a larger amount, or take it more often, to feel the same effect. This raises the risk of harm, including overdose.
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Dependence happens when the body adjusts to having an opioid around. If the person stops, they can go into withdrawal. Withdrawal can start within hours of the last dose.
Withdrawal can bring
- Anxiety and strong cravings
- Chills and goose bumps
- Muscle and bone aches
- Restless legs
- Sleep problems
- Stomach upset
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Addiction is a long-term health condition where a person keeps seeking and using a drug even when it is hurting them. Opioid use disorder is complex, long-lasting and treatable.
Only a trained professional can diagnose it. If you are worried, that is a good reason to talk to someone, not a reason for shame.
Opioids and mental health
Pain, stress, trauma and opioid use often go together.
Many people with a substance use disorder also live with another mental health condition, and the other way around. People with depression, anxiety or PTSD are more likely to use substances and to develop a substance use disorder.
In 2024, about 21.2 million U.S. adults had both a mental illness and a substance use disorder in the past year.
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People living with anxiety, stress, depression or pain may use drugs to try to feel better. This is more likely when mental health care is hard to reach.
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Family history, hard living conditions, trauma and stress can all raise the risk of both mental health conditions and substance use problems.
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Withdrawal can bring anxiety and sleep problems. Feeling low or anxious can then make cravings stronger. Breaking the loop usually means caring for both at once.
Fentanyl & fake pills
Why the drug supply is more dangerous than ever.
Illegally made fentanyl is often mixed into heroin, cocaine and meth. It is also pressed into fake pills made to look like real prescription opioids. Many people do not know their drugs contain fentanyl.
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Fake pills can be made to look just like pills from a pharmacy. Any pill that did not come from a pharmacy with your name on it may contain fentanyl.
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Because fentanyl is 50 to 100 times stronger than morphine, a very small amount can stop someone’s breathing.
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Fentanyl test strips are inexpensive and usually give results within 5 minutes. A negative result does not mean a drug is safe, because strips may miss even stronger fentanyl-like drugs.
How the crisis unfolded
Three waves, and why this is not about bad people.
The CDC describes the U.S. opioid overdose crisis in three waves. Knowing the history helps explain why so many ordinary families have been affected.
- Wave 1 (1990s): more opioid prescribing, and rising deaths from prescription opioids.
- Wave 2 (from 2010): fast increases in deaths involving heroin.
- Wave 3 (from 2013): big increases in deaths involving lab-made opioids, mainly illegal fentanyl.
Stigma & the words we use
Shame keeps people from help. Kind words open doors.
Stigma can make it hard for people to get the help they need. Fear of judgment can stop someone from telling a partner or family member about their health. Stigma can also come from inside, as feelings of shame or failure.
Research cited by the CDC suggests more than 75% of people do not see substance use disorders as a long-term illness. Seeing addiction as a moral problem instead of a health problem is one of the beliefs that keeps stigma going.
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Labels like "addict" or "junkie" can make people feel less than human. Person-first language puts the person before the condition.
Swaps that help
- "Abuse" → "use" or "misuse"
- "Addict" or "junkie" → "person with a substance use disorder"
- "Clean" → "in recovery" or "not taking drugs"
- "Dirty" → "testing positive"
- "Former addict" → "person in recovery"
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Shame can come from within, based on feelings of personal failure. This inner shame can make reaching out feel impossible.
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Sharing accurate information helps. Substance use disorders are treatable, and people with them need support like anyone with any other illness.
- Correct myths gently when you hear them
- Listen to people with lived experience
- Use person-first language
- Treat recovery stories as hopeful news
Recovery paths
Opioid use disorder is treatable, and there are many ways forward.
Opioid use disorder is a treatable medical condition. Research shows that treatment can lower the risk of returning to use and of dying from an overdose. Talk with your clinical provider about treatment options that fit you.
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There are proven medical treatments for opioid use disorder. Your clinical provider can talk them through with you, including what fits your health and your life.
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Behavioral therapy for opioid use disorder works best when it is part of a full treatment plan. Therapy can help with stress, trauma, relationships and building a new routine.
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Peer support workers and mutual-help groups can make recovery feel less lonely. See Building recovery support for groups, peers and recovery communities.
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Recovery is about more than not using. It is about building a life with health, a stable home, purpose and people who care. See Recovery & relapse: understanding it for more.
There is real hope. In 2024, about 74% of U.S. adults who felt they ever had a drug or alcohol problem said they were in recovery or had recovered.
How community helps
Friends, families and neighbors can save lives and support recovery.
Recovery is easier when people feel welcome, not judged. Communities that treat substance use as a health issue help more people reach out early.
Ways anyone can help
- Check in on someone who seems withdrawn, without lecturing
- Learn the overdose warning signs in the Substance Use guide
- Offer a ride to an appointment or a meeting
- Speak up when you hear people being shamed
- Support local recovery events and sober social spaces
When and where to get help
Free, confidential help, any time of day or night.
Reach out if…
- Cutting down feels impossible, or withdrawal scares you
- You are taking pills that did not come from a pharmacy
- You are using to cope with pain, trauma or low mood
- Someone you love is using and you are worried
- You have thoughts of ending your life
Where to turn
- SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7, English and Spanish; referrals to treatment, support groups and community services)
- FindTreatment.gov: search for treatment near you
- Your doctor, clinic or a counselor you trust
- Outside the U.S.: findahelpline.com lists free helplines in over 175 countries
📝 Worksheets for this guide
Fill these in privately in the app. Your answers stay on your phone.
Sources
- National Institute on Drug Abuse (NIDA). Opioids
- National Institute on Drug Abuse (NIDA) (2021). Prescription Opioids DrugFacts
- National Institute on Drug Abuse (NIDA). Mental Health
- National Institute on Drug Abuse (NIDA). Words Matter: Preferred Language for Talking About Addiction
- National Institute on Drug Abuse (NIDA). Methamphetamine (includes the SAMHSA Helpline and FindTreatment.gov)
- Centers for Disease Control and Prevention (CDC). Fentanyl Facts
- Centers for Disease Control and Prevention (CDC). Understanding the Opioid Overdose Epidemic
- Centers for Disease Control and Prevention (CDC). Stigma Reduction
- CDC National Center for Health Statistics (NCHS) (2025). U.S. Overdose Deaths Decrease Almost 27% in 2024
- Substance Abuse and Mental Health Services Administration (SAMHSA) (2025). Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health
- World Health Organization (WHO) (2025). Opioid overdose (fact sheet)
- Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA’s National Helpline
- 988 Suicide & Crisis Lifeline. 988 Suicide & Crisis Lifeline
- ThroughLine (Find A Helpline). Find A Helpline
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.
