frequently asked questions

What’s the difference between dependence and substance use disorder? 

Physical dependence means the body has adapted to a drug and needs it to function normally — stopping suddenly causes withdrawal. Substance use disorder goes further: it’s a chronic brain disorder involving compulsive use despite harmful consequences. Someone can become physically dependent on an opioid taken exactly as prescribed without ever developing substance use disorder. 

Why are opioids so addictive? 

Opioids trigger a release of dopamine in the brain — the chemical associated with pleasure and reward. Over time, the brain adjusts to the drug’s presence, requiring more to achieve the same effect (tolerance) and functioning poorly without it. This rewiring is why opioid use disorder is classified as a disease, not a moral failure or a lack of willpower.

What is fentanyl, and why is it so dangerous? 

Fentanyl is a synthetic opioid that is roughly 50 to 100 times more potent than morphine. It’s used medically for severe pain, but illicitly manufactured fentanyl is now found in many street drugs — including counterfeit pills that look like legitimate prescriptions. Because even a tiny amount can cause an overdose, and because it’s often present without the user’s knowledge, fentanyl has driven a dramatic rise in overdose deaths nationwide.

Can someone overdose on a prescription opioid? 

Yes. Prescription opioids carry the same overdose risk as illicit ones — the drug doesn’t know how it was obtained. Risk is especially high when someone takes more than prescribed, combines opioids with alcohol or benzodiazepines (like Xanax or Valium), or uses a prescription that wasn’t prescribed to them. People who have stopped using and then relapse are also at elevated risk, because their tolerance has dropped.

What is naloxone, and should I carry it even if I don’t use opioids? 

Naloxone (brand name Narcan) is a medication that rapidly reverses an opioid overdose. It has no effect if opioids aren’t present in someone’s system, so it’s safe to administer even if you’re not sure what caused someone to lose consciousness. Having it on hand — like knowing CPR — is a reasonable precaution for anyone, not just people who use drugs. It’s available without a prescription at most pharmacies in Washington State, and free by mail through the People’s Harm Reduction Alliance at phra.org/naloxone. View more ways to get naloxone locally.

What if someone I care about is using opioids but won’t accept help? 

This is one of the hardest situations families face. You can’t force someone into recovery, but you can stay connected, reduce shame and stigma in how you talk about it, learn the warning signs of overdose, and keep naloxone accessible. An intervention — formal or informal — may be appropriate. The Washington Recovery Helpline (1-866-789-1511) offers free guidance for families navigating this. View more about helping others.

How is opioid use disorder treated?

Treatment options range from detox and inpatient residential care to outpatient programs, medication-assisted treatment, and mental health support. Because substance use disorder and mental health conditions often go hand-in-hand, the most effective treatment tends to address both. Whatcom County has multiple providers offering a range of these services. View local treatment resources.