Oxycodone is the most commonly abused opioid in America. More than 12 million people use opioid drugs recreationally in the U.S.A.

Oxycodone was the leading cause of drug-related deaths in America until 2012, when heroin and fentanyl became more widely abused. Oxycodone overdose can cause spinal cord infarction in high doses as well as ischemic damage to the brain, due to prolonged hypoxia from suppressed breathing.

Most common side effects of oxycodone include reduced sensitivity to pain, euphoria, relaxation, and respiratory depression. Other side effects of oxycodone include constipation, nausea, tiredness, dizziness, itching, dry mouth, and sweating. 

Most side effects generally decrease in intensity over time, although constipation is likely to continue throughout use. Oxycodone in combination with naloxone in timed-release tablets have been created to deter abuse and reduce “opioid-induced constipation.” 

There is a high risk of severe withdrawal symptoms if a patient abruptly discontinues taking oxycodone. In a medical context, if the drug has been taken over an extended period of time, it is to be withdrawn gradually. People who abuse oxycodone at higher than prescribed doses are at risk of severe withdrawal symptoms

Symptoms of oxycodone withdrawal may include anxiety, panic attack, nausea, insomnia, muscle weakness, fevers, and other flu-like symptoms. Withdrawal symptoms have also been reported in newborns whose mothers had been taking oxycodone orally or injecting it during pregnancy.

In high doses and in people not tolerant to opioids, oxycodone can cause shallow breathing, slowed heart rate, clammy skin, pauses in breathing, low blood pressure, constricted pupils, circulatory collapse, respiratory arrest and death. Opioids were responsible for 49,000 of the 72,000 overdose deaths in the U.S. in 2017.

Oxycodone, sold under brand names such as Roxicodone and OxyContin (the extended release form) is a strong, semi-synthetic opioid used medically for treatment of moderate to severe pain. It is highly addictive, usually taken by mouth, and is available in immediate-release and controlled-release formulations. Onset of pain relief begins within fifteen minutes and lasts up to six hours with the immediate-release tablets. 

The reformulated OxyContin has caused some recreational users to switch to fentanyl, which is cheaper and not as difficult to find (and far more dangerous). In the United Kingdom, oxycodone is available by injection. When taken by mouth, oxycodone has roughly one and a half times the effect of the equivalent amount of morphine. 

Oxycodone was first made in Germany in 1916 from thebaine, an opiate alkaloid. In 2020, oxycodone was the 54th most commonly prescribed medication in the United States with over 12 million prescriptions.


Methamphetamine is a central nervous system stimulant used as a recreational drug and rarely as a second-line treatment for attention deficit hyperactivity disorder and obesity. It is seldom prescribed over concerns involving human neurotoxicity and potential for recreational abuse as an aphrodisiac and euphoriant. 

The highest degree of illegal methamphetamine use occurs in parts of Asia and Oceania, as well as the United States, where it has been classified as a schedule II controlled substance. Levomethamphetamine is available in the United States as an over-the-counter drug for use as an inhaled nasal decongestant. 

Recreationally, methamphetamine’s ability to increase energy has been reported to lift mood and increase sexual desire to such an extent that users are able to engage in sexual activity continuously for extensive periods during binges. At high doses, methamphetamine can induce psychosis, the breakdown of skeletal muscle, seizures and brain bleeding. Chronic high-dose intake can precipitate unpredictable mood swings, stimulant psychosis and violent behavior. 

Methamphetamine is very addictive and there is a high likelihood that withdrawal symptoms will occur when methamphetamine use ceases. Withdrawal from methamphetamine use may lead to a post-acute-withdrawal syndrome, which can persist for months beyond the typical withdrawal period. 

Methamphetamine is neurotoxic at high doses and has been shown to have a higher toxicity toward serotonergic neurons than amphetamine. Methamphetamine neurotoxicity causes deleterious changes in brain structure and function, such as reductions in gray matter volume.

A moderate overdose of methamphetamine may induce symptoms such as abnormal heart rhythm, confusion, difficult or painful urination, high or low blood pressure, high body temperature, over-active or over-responsive reflexes, muscle aches, rapid breathing, tremor, and an inability to pass urine. 

A large overdose may produce symptoms such as adrenergic storm, methamphetamine psychosis, substantially reduced or no urine output, cardiogenic shock, circulatory collapse, pulmonary hypertension, kidney failure, rapid muscle breakdown and serotonin syndrome. A methamphetamine overdose will likely also result in brain damage owing to dopaminergic and serotonergic neurotoxicity. Death from methamphetamine poisoning is often preceded by convulsions and coma.

A Cochrane Collaboration review on treatment for amphetamine and methamphetamine-induced psychosis states that about 5–15% of users fail to recover completely. The same review asserts that antipsychotic medications can aid in the resolution of acute amphetamine psychosis symptoms. 


Cocaine addiction is a biopsychosocial disorder characterized by persistent cocaine use despite adverse consequences, and withdrawal symptoms upon discontinuation. The Diagnostic and Statistical Manual of Mental Disorders classifies cocaine abuse as a “stimulant use disorder”. 

Cocaine use causes euphoria and high amounts of energy, as well as mood swings, paranoia, insomnia, psychosis, high blood pressure, a fast heart rate, panic attacks, seizures, cognitive impairments and drastic changes in personality. Overdose may result in cardiovascular and brain damage, constricting blood vessels, stroke and constricting arteries, causing heart attack.

The symptoms of cocaine withdrawal are dysphoria, depression, anxiety, decreased libido, psychological and physical weakness, pain, and compulsive cravings. Cocaine is a powerful stimulant known to make users feel energetic, happy, and talkative. 

Many people who habitually use cocaine develop a condition not unlike amphetamine psychosis, the symptoms of which include paranoia, confusion and the feeling of insects crawling under the skin, also known as “coke bugs.” 

Differing ingestion techniques come with their own symptoms. Snorting coke can cause a loss of sense of smell, nose bleeds, problems swallowing and an inflamed, runny nose. Smoking cocaine causes lung damage and injecting it puts users at risk of contracting infectious diseases. Heavy users report thoughts of suicide, unusual weight loss and trouble maintaining relationships.

When used habitually, because of its highly addictive nature, coke can change brain structure and function. Circuits within the brain structure that play a part in stress levels become more sensitive. When cocaine is absent, this increases an individual’s feelings of displeasure and negative mood swings. 

Additional withdrawal symptoms are exhaustion, hypersomnia, increased appetite, restlessness, irritability, lethargy, emotional lability, poor concentration, and bowel issues. In 2019, the CDC reported over 16,000 deaths from cocaine overdose in the US alone.

A study consisting of over one thousand US residents who had used cocaine within the previous 24 months for the first time was conducted. It was found that the risk of becoming dependent on cocaine within two years of first use was 5–6%. The risk of becoming dependent within 10 years of first use increased to 15–16%. 

Among recent-onset users individual rates of dependency were higher for smoking (3.4 times) and much higher for injecting. Women were 3.3 times more likely to become dependent, compared with men. Users who started at ages 12 or 13 were four times as likely to become dependent compared to those who started between ages 18 and 20.


Fentanyl contamination in cocaine, methamphetamine, ketamine, MDMA, and certain “prescription” drugs is common. Fentanyl is often found in heroin as well as illegally manufactured opioids and benzodiazepines. Naloxone, sold under the brand name Narcan, can completely reverse an opioid overdose. Fentanyl poses an very high overdose risk, due in part to having an extremely unpredictable fatal dosage when mixed with other drugs.

A kilogram of heroin laced with fentanyl may sell for more than $100,000, but the fentanyl itself may be produced far more cheaply (about $6,000 per kilogram); this provides incentive for drug dealers to cut high amounts of it into their product. As of 2018, fentanyl was the most common opioid in overdose drug deaths, surpassing heroin. 

There were 81,230 drug overdose deaths during the 12 months from May 2019 to May 2020, the highest number of overdoses for a 12-month interval ever recorded for the U.S. In 2021, the Public Health Agency of Canada noted that 87% of accidental opioid toxicity deaths involved fentanyl. Deaths involving synthetic opioids such as fentanyl increased by a marked 22% in 2021, according to the CDC data. 

In the past, media outlets have reported stories about police officers being hospitalized after contact with powdered fentanyl, or after brushing it from their clothing. Transdermal (via the skin) and inhalative exposure to fentanyl is extremely unlikely to cause overdose (except in cases of prolonged exposure with large quantities) and first responders are at minimal risk of fentanyl poisoning through accidental contact. The effects being reported (rapid heartbeat, hyperventilation and chills) were more commonly associated with a panic attack.

A 2021 paper expressed concern that these physical fears over fentanyl may inhibit effective emergency response to overdoses by causing responding officers to spend time on unnecessary precautions, and that such media coverage could perpetuate social stigmas that people who use drugs are dangerous to be around. 

The CDC recommends the following; the need to expand distribution and use of naloxone and overdose prevention education locally; to expand access and availability of treatment for substance use disorders; to intervene early with individuals at highest risk for overdose; and to improve detection of overdose outbreaks, in order to facilitate a more effective response. 

An effective social media campaign has been put into motion by the United States DEA called “One Pill Can Kill” with the goal of spreading awareness about the prevalence of counterfeit pills, and to show the difference between counterfeit pills and real prescription pills. It also offers resources for help with drug addiction and rehabilitation.