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For decades, cocaine was the narcotic of choice in the United States. For decades it drove the so-called "war on drugs" against Colombian and Mexican drug cartels, depicted in films like "Clear and Present Danger" and more recently in the popular Netflix series "Narcos." Narcotics consumption in the United States, however, has recently shifted from cocaine to opioids like heroin and, increasingly, from plant-based to synthetic drugs like methamphetamines and fentanyl. Heroin use has spread into suburban and rural communities and is growing among most socioeconomic classes, age groups, and races. Potent synthetic opioids like fentanyl have become mixed into black-market supplies of heroin, cocaine, and methamphetamine and are fueling a high-mortality rate, and compounding the crisis. Unfortunately, U.S. military veterans, many of whom suffer from chronic pain as a result of their service, are twice as likely as the average American to die from a drug overdose involving an opioid. Members of the armed forces are not immune to the substance use problems that affect the rest of society. Although illicit drug use is lower among U.S. military personnel than among civilians, heavy alcohol and tobacco use, and especially prescription drug abuse, are much more prevalent and are on the rise. Most of the prescription drugs misused by service members are opioid pain medications. This crisis is adversely impacting public health, social welfare, the economy, and the national security of the United States. Canada and Mexico are similarly experiencing increased opioid trafficking, use, and addiction.
The New Opium War: A National Emergency: https://cco.ndu.edu/News/Article/1767465/the-new-opium-war-a-national-emergency/
Statistics:
Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. People misuse prescription opioids by taking the medicine in a way other than prescribed, taking someone else's prescription, or taking the medicine to get high. When misusing a prescription opioid, a person may swallow, inject, or snort the drug. Opioids bind to and activate opioid receptors on cells located in the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure, and can strongly reinforce the act of taking the drug, making the user want to repeat the experience.
People who use prescription opioids can feel relaxed and happy, but also experience drowsiness, confusion, nausea, constipation, and slowed breathing. Prescription opioids have effects similar to heroin. While prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse opioid pain relievers switch to heroin. Prescription opioid use, even when used as prescribed by a doctor can lead to a substance use disorder, which takes the form of addiction in severe cases. Withdrawal symptoms include muscle and bone pain, sleep problems, diarrhea and vomiting, and severe cravings. A range of treatments including medicines and behavioral therapies are effective in helping people with an opioid use disorder.
NIDA Prescription Opioids DrugFacts: https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
Higher dosages of opioids are associated with higher risk of overdose and death - even relatively low dosages (20-50 morphine milligram equivalents (MME) per day) increase risk. Higher dosages haven't been shown to reduce pain over the long term. One randomized trial found no difference in pain or function between a more liberal opioid dose escalation strategy (with average final dosage 52 MME) and maintenance of current dosage (average final dosage 40 MME).
Center for Disease Control (PDF): https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
Synthetic Opioids: Clandestinely produced synthetic opioids have been encountered in powder form and were identified on bottle caps and spoons, detected within glassine bags, on digital scales, and on sifters which demonstrates the abuse of these substances as replacements for heroin or other opioids. These drugs are also encountered as tablets, mimicking pharmaceutical opioid products. Clandestinely produced synthetic opioids are encountered as a single substance in combination with other opioids (fentanyl, heroin, U-47700) or other substances. Many of these illicitly produced synthetic opioids are more potent than morphine and heroin and thus have the potential to result in a fatal overdose. Some drugs that cause similar effects include other opioids such as morphine, hydrocodone, oxycodone, hydromorphone, methadone, and heroin.
DEA resource guide (PDF page 90 of 94): https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf#page=90
Do you know the difference between an Opiate and an Opioid? 
Opiate vs. Opioid - Do You Know the Difference: https://recoverycentersofamerica.com/blogs/opiate-vs-opioid-do-you-know-the-difference/
Reddit r/opiates: https://www.reddit.com/r/opiates/
Drug overdose deaths in the United States currently outnumber deaths from car crashes. We are in the midst of a tragic opioid epidemic. Fentanyl has become frequently mixed with heroin, raising the death toll from opioid overdoses at a steep rate. Yet, this recent appearance of carfentanil in batches of heroin is far more troubling. Despite the wreckage fentanyl has left in its wake, carfentanil can potentially take even more lives at an even faster rate. With the general prevalence of heroin across the nation, there is a fear that carfentanil will spread further into other communities. Caution must always be taken if a person decides to use or abuse any drug. It's becoming evident that the danger of purchasing street drugs - particularly heroin - is only increasing. As we move towards the future, it seems a drug user will know less and less of what substance they are actually putting inside of their body.
Excerpt from Sober Nation: https://sobernation.com/deadly-carfentanil/
Map of the U.S. depicting Opiates positivity: https://www.questdiagnostics.com/home/physicians/health-trends/drug-testing/map_opiate/
HHS 5-point Strategy to Combat the Opioids Crisis
US Department of Health and Human Services /opiods: https://www.hhs.gov/opioids/
Poppies, Opium and Herion - Production in Columbia and Mexico (PDF 40 pages): https://www.tni.org/files/publication-downloads/poppiesopiumheroin_13042018_web.pdf
Heroin, Fentanyl & Other Opioids - A Comprehensive Resource for families with a teen (PDF 52 pages): https://drugfree.org/wp-content/uploads/2018/04/Heroin-Fentanyl-Other-Opioids-eBook-Partnership-for-Drug-Free-Kids.pdf
Prescription Nation 2018 report:
Prescription Nation 2018: Facing America's Opioid Epidemic: https://www.nsc.org/home-safety/safety-topics/opioids/prescription-nation?gclid=CjwKCAjwopTYBRAzEiwAnU4kb-h6R6rx-XhERYDXLoZC7aEeSYLFoPK-XK4JZh_K5ZZm_amAqP5VshoC7rUQAvD_BwE
Overview of the Public Health Burden of Prescription Drug and Heroin Overdoses (2015) (PDF 31 pages): https://www.fda.gov/media/93249/download
Lost of Opioids: Brand Names, Generic Names, and Street Names: https://www.asam.org/docs/default-source/education-docs/opioid-names_generic-brand-street_it-matttrs_8-28-17.pdf?sfvrsn=7b0640c2_2
EEOC: Use of Opioids at work:
Use of Codeine, Oxycodone, and Other Opioids: Information for Employees: https://www.eeoc.gov/laws/guidance/use-codeine-oxycodone-and-other-opioids-information-employees
CALCULATING TOTAL DAILY DOSE OF OPIOIDS FOR SAFER DOSAGE: https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
Using Opioids:
Opioid Addiction: https://www.hopkinsmedicine.org/opioids/what-are-opioids.html
Erowid Experience Vault: https://erowid.org/experiences/subs/exp_Opioids.shtml
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