Office of Workers' Compensation Programs (OWCP)

Prescription opioids such as oxycodone, hydrocodone, morphine, and fentanyl, among others, are powerful medications that have pain-reducing benefits but also may lead to misuse, addiction, overdose, and even death. Various factors will increase an individual's risk of misuse, addiction or overdose while taking opioids. These risk factors include:

Opioid Dose, Duration, and Formulations

  • High Dose. The higher the opioid dose the higher the risk for misuse and overdose death. Higher doses, >100 morphine milligram equivalents (MME), have over two times the risk relative to lower doses. Even low doses (such as 20-50 MME) can present a risk.
  • Prolonged Duration. Prolonged use is associated with significant risk of addiction. Physical dependence and addiction to opioids may occur in as little as a few days. As many as one in four people receiving prescription opioids long term in a primary care setting struggles with opioid addiction.
  • Extended Release and Long Acting Formulations. There are greater risks of overdose and death associated with extended-release and long-acting opioid formulations versus immediate release formulations.

Healthcare Conditions and Individual Characteristics

Individuals with certain healthcare conditions or characteristics may be more sensitive to opioid effects, which may also lead to overdose. These conditions and characteristics include:

  • Older adults (65 years and older)
  • Respiratory conditions (Sleep Apnea, Asthma, or Chronic Obstructive Pulmonary Disease)
  • Wasting syndrome (Cachexia)
  • Impaired energy or strength (Debilitated Patients)

Some individuals with certain healthcare conditions or characteristics are at higher risk of misuse, which may lead to overdose. These include:

  • Younger adults (18-25 years old)
  • Mental Health Disorders (Depression, Anxiety, Post-traumatic Stress Disorder)
  • History of alcohol or substance abuse

As opioids have highly-addictive properties, they pose a substantial risk of addiction and overuse.

Concomitant Use of Other Medications or Other Agents

Unless advised by your health care provider, certain medications should be avoided when taking opioids due to increased risk of severe drowsiness, decreased awareness, breathing problems, coma, or death. These medications include:

  • Benzodiazepines (alprazolam, lorazepam, or diazepam)
  • Sedative/hypnotic agents (zolpidem or eszopiclone)
  • Muscle relaxants (carisoprodol, chlorzoxazone, or methocarbamol)
  • Antipsychotics (haloperidol, quetiapine, or risperidone)
  • Other central nervous system depressants (alcohol or street drugs)

Opioids may interact with other medications that may increase your risk of overdose, arrhythmias, or seizures. It is best to check with your healthcare provider and pharmacist and read information from the Food and Drug Administration (FDA) before taking other medications in conjunction with opioids.

If you have been taking opioids and feel you need help, talk to your doctor. OWCP stands ready to assist its injured federal workers with coordination and authorization of any necessary treatment to reduce the harms and risks of opioids. You may also wish to visit the Substance Abuse and Mental Health Services Administration (SAMSHA) website for additional information regarding treatment, or contact SAMHSA's National Helpline at 1-800-662-HELP.

Need Help? If you or someone you know needs help dealing with opioid abuse please visit or call 1-800-662-HELP (4357)