Learn More About the Opioid Epidemic and Substance Misuse

Not sure where to start? Get an overview of some of the most important topic areas in these brief lessons.

Contact Information

Phone: 1-877-SAMHSA-7


Email: dwp@samhsa.hhs.gov

  • Lesson 1: Substance Misuse

    What is Substance Misuse?

    Substance misuse is the use of illegal drugs and/or the inappropriate use of legal substances such as alcohol or prescription drugs.

    Prescription drug misuse includes taking a medication in a manner or dose other than prescribed, using someone else’s prescription, or taking a medication just for the feeling it causes.

    What is Substance Use Disorder?

    Substance use disorder, or addiction, is defined by the National Institute on Drug Abuse [Go To Resource] as a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” Substance use disorder is a brain disease because the drugs can cause long-lasting changes to the way the brain functions.

  • Lesson 2: Opioids

    What are Opioids?

    Opioids attach to receptors in the brain, spinal cord, and other organs. This allows them to block pain messages from other parts of the body. They increase dopamine, a chemical that produces euphoria and relaxation. Opioids include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription [Go To Resource].

    What are the Risks?

    • Respiratory depression, or slowed breathing resulting in reduced oxygen to the brain and other organs, is the biggest risk associated with opioids.
    • Mixing opioids with other substances—such as alcohol, sleeping pills, and anti-anxiety medications—can enhance respiratory depression and lead to a person passing out, stopping breathing, or dying.
    • Common side effects of opioids include drowsiness, confusion, nausea, and constipation.
    • Serious reactions may include muscle weakness, low blood pressure, respiratory depression (slowed or stopped breathing), and coma or death.
    • Opioids carry a risk for tolerance, physical dependence, and overdose.
    • Opioids are dangerous because the difference between the amount needed for someone to feel their effects and the amount needed to kill someone can be very small.

    Types of Opioids

    • Prescription Pain Relievers


      • hydrocodone (Vicodin)
      • oxycodone (OxyContin)
      • fentanyl

      These medications decrease how much pain you feel, but do not treat the cause of the pain.

    • Other Opioids


      • heroin
      • fentanyl

      Heroin [Go To Resource]  is a powerful illegal drug that can quickly lead to tolerance and physical dependence. Chronic heroin use may cause psychological and physical health problems. People who inject heroin are at increased risk of contracting viral hepatitis and HIV.

      Fentanyl [Go To Resource] is a prescription drug for severe pain, but it is also produced and distributed illegally. Fentanyl’s high potency makes it extremely dangerous because a very small amount can lead to an overdose.

  • Lesson 3: Cannabis/Marijuana

    What is Marijuana?

    Marijuana [Go To Resource] is the dried cannabis plant, which contains the mind-altering chemical THC and hundreds of other compounds. Marijuana’s effects on the brain include altered senses, mood changes, impaired body movement, and difficulty with thinking. There is ongoing research exploring potential medical uses for cannabis compounds. CBD is a compound in cannabis that is not intoxicating, but may have medical uses, including reducing pain and inflammation, controlling epileptic seizures, and possibly treating mental illness. The Federal Drug Administration recently approved a CBD-based medication to treat childhood epilepsy [Go to Resource].

    The potency of cannabis has increased over the past few decades and is not well regulated or accurately labeled for consumers. Cannabis, and its extracts, can be smoked or mixed into food (called “edibles”). The method of consumption affects how quickly and how long a user experiences the effects of the drug. For example, it takes longer to feel the effect of an edible cannabis product than it takes to feel the effects of smoking cannabis.

    Developing a workplace policy to cover cannabis use can be challenging for several reasons:

    • Although currently classified as an illegal drug at the federal level, cannabis is legal for medical use in many states and legal for nonmedical use in several states. This presents a special challenge for employers with multistate locations.
    • Cannabis can be detected in a person’s system weeks after it is consumed. An employee who is not impaired on the job may test positive for past cannabis use.
    • Different jobs may have different requirements. It is not acceptable for employees in safety-sensitive positions subject to drug testing under Department of Transportation regulations to use cannabis.

    What are the Risks?

    Heavy cannabis use can lead to dependence and withdrawal symptoms. It may also cause problems with learning, memory, and concentration.

  • Lesson 4: Stimulants

    What are Stimulants?

    Stimulants are substances that increase norepinephrine and dopamine (both are neurotransmitters, or messengers) in the brain. This can lead to mental stimulation, increased energy, and euphoria (feeling a “rush”). Prescription stimulants increase alertness, attention, and energy. They are generally prescribed to treat attention deficit disorder, narcolepsy and to control appetite [Go to Resource].

    What are the Risks?

    • Misuse of prescription or illicit stimulants can have serious side effects that may lead to a substance use disorder or overdose.
    • Side effects include nervousness/acting “jittery,” fast heart rate, sleep problems, headaches, dizziness, appetite loss, stomach pains or diarrhea, and dry mouth.
    • Overdose symptoms include agitation, hallucinations, psychosis, lethargy, seizures, heart rhythm abnormalities, high blood pressure, and increased body temperature.
    • Overdose can lead to stroke, heart attack, or organ problems caused by overheating and can result in death.

    Types of Stimulants

    • Illicit Stimulants


      • cocaine
      • crack
      • methamphetamine
      • “crystal meth”
    • Prescription Stimulants


      • Ritalin
      • Adderall
      • Concerta
      • Dexedrine
  • Lesson 5: Sedatives/Tranquilizers

    What are Sedatives and Tranquilizers?

    Sedatives and tranquilizer drugs—also known as central nervous system depressants—decrease brain activity. They are generally prescribed to treat anxiety, panic attacks, and sleep disorders. These can cause drowsiness, slurred speech, confusion, dizziness, low blood pressure, and slowed breathing.

    What are the Risks?

    Using central nervous system depressants can lead to physical dependence and when stopped may have serious withdrawal symptoms. Because they cause drowsiness and interfere with muscle coordination, these drugs may present a safety risk when driving, operating machinery or doing other potentially dangerous activities. They have also been used as “date rape” drugs [Go to Resource]. Combining these drugs with alcohol and/or opioids can further slow heart rate and breathing, which can lead to death.

    Types of Sedatives/Tranquilizers

    • Prescription Sedatives


      • benzodiazepines (Xanax; Valium)
      • sleep medications (Ambien; Lunesta
      • barbiturates
  • Lesson 6: Alcohol

    What is Risky Alcohol Use?

    The National Institute on Alcohol Abuse and Alcoholism defines “risky use” as consuming more than 4 drinks on any day or 14 drinks per week for men, or more than 3 drinks on any day or 7 drinks per week for women. “Binge drinking” is considered 5 or more drinks on one occasion for men and 4 or more drinks on one occasion for women.

    What are the Risks?

    • Drinking alcohol is associated with short- and long-term health risks, including motor vehicle crashes, alcohol poisoning, liver disease, high blood pressure, and various cancers (for example, breast cancer).[5]
    • For some health problems, there is no known safe level of alcohol consumption.[6,7]
    • Drinking more than 14 drinks per week for men or more than 7 drinks per week for women significantly increases the risk for short- and long-term harm.[5]
    • Binge drinking and heavy alcohol use (binge drinking on 5 or more days in the past month) can lead to heart damage, liver problems, inflammation of the pancreas, and increased risk of developing cancer of the mouth, esophagus, throat, liver, and breast.[8]

    What is a Standard Drink?
    [Go To Resource]

  • Lesson 7: New Psychoactive Substances

    What are Psychoactive Substances/Synthetic Drugs?

    New psychoactive substances, like “synthetic marijuana,” are chemically similar to the mind-altering compound in marijuana, but these chemicals are man-made, unregulated, unpredictable, and potentially very dangerous. Bath salts[9], another new psychoactive substance, are chemicals created as inexpensive substitutes for illegal stimulants like cocaine [Go to Resource].

    What are the Risks?

    These dangerous substances can produce paranoia, hallucinations, panic attacks, and extreme agitation and violent behavior [Go to Resource].

    Types of Psychoactive Substances

    • Unregulated


      • bath salts
      • K2/Spice