Opium is an important raw material for the legal manufacture of morphine, codeine and their derivatives as opioid pharmaceuticals. It is also the raw material for the illicit production of heroin. Morphine and codeine are responsible for both the medical and dependence-producing properties of opium are derived from its main constituents. These two substances, together with morphine-like substances of synthetic origin, have taken over opium's therapeutic role. Both the natural and the synthetic groups of narcotics include substances with varying degrees of desirable and undesirable effects, all of which are abused as prescription and non-prescription drugs to some degree.
Prescriptions for opioid painkillers rose markedly in the early 21st Century. Americans use 80 percent of the world's opioids. In 2015, more than one-third of American adults were prescribed an opioid drug. As reported in 2017, fifteen percent of seniors on Medicare were prescribed an opioid upon discharge following an acute hospitalization and 42 percent of them were still taking it three months later. Opioid overdoses have become the leading cause of death for Americans under the age of 50.
The number one most prescribed drug in the United States in 2010 was the combination of hydrocodone and acetaminophen with over 135 million prescriptions dispensed. Between 1999 and 2017, nearly 218,000 people died of an overdose of prescription opioids, including oxycodone, better known by its brand name OxyContin. According to 2017 estimates from the U.S. Department of Health and Human Services, more than 130 people died of an opioid overdose every day in America (and, for the first time in recorded history, Americans were more likely to die in an opioid overdose than a car crash). Fentanyl (an opioid) now outpaces heroin as the deadliest drug on Long Island, New York, where overdose deaths doubled between 2013 and 2014.
Politicians, pundits and drug regulators all weighed in on measures to prevent abuse and the deaths that resulted from illicit use. One result was that opioid prescriptions fell dramatically. At last count (2021), prescriptions for hydrocodone and acetaminophen were reduced to 30 million. That is down 100 million prescriptions in less than a decade (ClinCalc DrugStats Database). However deaths from opioid overdose rose were higher and rates still rose steadily; the percent change was 29.48% from 2019 to 2020 and 11.48% from 2020 to 2021. Among adolescents, fentanyl-involved fatalities increased from 253 to 884 (4.23 per 100000) in 2021. An explanation was that the illicit drug supply has increasingly become contaminated with illicitly manufactured fentanyls and other synthetic opioid and benzodiazepine analogues and added to counterfeit pills resembling prescription opioids, benzodiazepines, and other drugs.