By Melanie Warner Spencer
The opioid crisis is in our neighborhoods, our schools and inside homes that look a lot like yours and mine. It doesn’t discriminate and affects the most “together,” “wealthy” and “successful” people and families you know. It is not a crisis for other people in other places and knowing what to do about it — even just the basics — is the difference between keeping or losing someone you love.
Here are 10 things worth knowing before you need to.
1. Opioids Are Not Just a Street Drug Problem
Opioids are a class of drugs that includes both commonly prescribed pain medications — oxycodone, hydrocodone, morphine, codeine — and illicit substances like heroin. The crisis didn’t materialize in an alley. It took root in waiting rooms and pharmacies and well-meaning prescriptions for bad backs and post-surgical pain. In the early days of the epidemic, Alabama became well-known for high rates of opioid prescriptions, leading the nation with a rate of 143.8 prescriptions per 100 people in 2012. Prescription rates have since dropped 50 percent, to 71.4 per 100 residents in 2023 — but the state’s dispensing rate is still twice the national average, ranking it second in the country behind only Arkansas. The medicine cabinet has always been part of this story.
2. Alabama by the Numbers
From 2015 through 2021, Alabama recorded 6,307 overdose deaths. At its worst, Alabama had the highest rate of opioid prescription in the country — 143.8 prescriptions per 100 people at its 2012 peak, compared to 81.3 prescriptions per 100 people nationwide. The state has made progress — for the first time since 2017, Alabama experienced a notable decline in substance-related overdose deaths, a 30 percent decrease from April 2024 to April 2025 based on provisional CDC data. But progress doesn’t always mean victory, and furthermore, there is a gap in the data. According to the 2024 Automated Reports and Consolidated Ordering System (a data collection system where manufacturers and distributors report transactions to the DEA), the total distributed volume of opioid prescriptions in Alabama is increasing. So while there are fewer prescriptions per 100 people the volume of prescription sizes are growing. Moreover, law enforcement and treatment professionals agree that methamphetamine and fentanyl pose the greatest drug threats in Alabama — and fentanyl incidents have increased at an alarming rate in recent years. In Mobile County, those are people we went to school with, people we sit next to at church and people we see at our kid’s ball games.
3. Addiction Is a Disease — and It Can Happen Faster Than You Think
A 2024 Mayo Clinic report found that after just five days of taking an opioid medication, the chances increase that a patient will still be taking opioids a year after beginning what was meant to be a short-term course. Five days. That is less time than it takes most people to recover from the surgery or injury for which the opioids were prescribed.
Opioids work by flooding the brain’s reward centers, and the slide from therapeutic use to physical dependence is not a moral failure — it is a neurological process that can happen to anyone. Young adults aged 18 to 25 face particularly elevated risks, with opioid use disorder rates double the national average, and over 80 percent not receiving the treatment they need. The stigma that surrounds addiction — the idea that people who struggle simply lack the will to stop — is not only wrong, it’s deadly. It keeps people from seeking help until it is too late.
4. Fentanyl Changed Everything
If the overprescription era opened the door to this crisis, fentanyl broke it off its hinges. Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine, making fatal and nonfatal overdoses far more likely than with heroin and other prescription opioids. A lethal dose of fentanyl is two milligrams. Two milligrams — roughly 10 to 15 grains of table salt. The numbers in Alabama tell the full arc of the catastrophe: fentanyl-related overdose deaths in Alabama went from 121 in 2018, to 193 in 2019, to 428 in 2020, with 830 deaths in 2021 and 835 in 2022. Fentanyl now accounts for 66 percent of all overdose deaths in Alabama.
5. You May Encounter Fentanyl Without Knowing It
This is perhaps the most urgent thing to understand about the present moment.
Fentanyl has spread throughout the entire illicit drug supply — including drugs that have historically had nothing to do with opioids. Counterfeit pills containing fentanyl are difficult to distinguish from authentic prescription pills, creating a false sense of security for people using them and complicating toxicology analysis. Think fake Percocet and fake Xanax and cocaine and methamphetamine laced with fentanyl. Methamphetamine and fentanyl are almost tied as the drugs of greatest threat in Alabama, and fentanyl has been encountered in the form of counterfeit pills as well as mixed in with multiple other substances.
The person who believes they are taking a recreational painkiller — or who has never in their life considered themselves anywhere near the opioid crisis — may be holding a pill that could stop their breathing within minutes. This is the reality of the current drug supply.
6. Know What an Overdose Looks Like
An overdose can look, to the untrained eye, like someone who has simply fallen into a very deep sleep. Key symptoms of an overdose include slow or stopped breathing, unresponsiveness, pale or clammy skin, and blue lips or fingernails. Pinpoint pupils — tiny, even in low light — are another telltale sign, as are gurgling or choking sounds and a limp, unresponsive body.
It has been estimated that roughly 40 percent of fatal overdoses occur while someone else is present. Someone who might have called for help. If you are ever in doubt, rouse the person, call their name, try to wake them. If they will not respond, don’t wait. Treat it like an overdose. You may be right.
7. Narcan Works and Anyone in Mobile Can Get It
Naloxone — sold most commonly under the brand name Narcan — is an opioid antagonist that reverses an overdose by blocking opioid receptors and restoring normal breathing. It requires no medical training to administer and is available in nasal spray form. Since March 2023, it has been available over the counter at most pharmacies without a prescription. Most pharmacies throughout Mobile carry naloxone, though it is recommended to call ahead before going.
NEXT Distro of Alabama provides naloxone, crisis support and harm reduction programs online and through the mail, connecting Alabama residents with local resources and mailing naloxone to those who cannot access it locally. VitAL Alabama also distributes free naloxone and fentanyl test strips across the state. Naloxone will not harm someone who is not experiencing an opioid overdose. It can be given safely to people of all ages. Think of it the way you’d think of a fire extinguisher. Keep it somewhere accessible; Hope you never need it; Be glad you have it if you do.
8. Narcan Buys Time. Call 911 Immediately.
This is critical: naloxone is a bridge, not the finish line. Naloxone usually takes effect in three to five minutes and lasts 60 to 90 minutes. Multiple doses may be required, as the duration of action of most opioids is greater than that of naloxone. Fentanyl, in particular, can outlast the medication — meaning a person who appears to recover may slip back into overdose as the Narcan wears off.
Give the Narcan. Call 911 immediately. Roll the person onto their side to prevent choking. Stay with them. Do not leave.
If concern about legal consequences is the thing holding anyone back: under Alabama’s Good Samaritan Law, signed into effect in 2015, a person cannot be prosecuted for any misdemeanor drug-related offense or underage alcohol offense if law enforcement learned of it only because that person was seeking help for someone else. To qualify, a person must act in good faith and reasonably believe that no one else has yet sought assistance, provide their real name when calling 911 and stay with the individual until first responders arrive. Make the call; A life is worth it.
9. Treatment Works and It Is Available
Recovery from opioid use disorder is not a long shot. It is, with the right support, the expected outcome. There are three FDA-approved medications for treatment: buprenorphine, methadone and naltrexone. All three are safe and effective. They reduce cravings, manage withdrawal and allow people to function and rebuild their lives — not by trading one addiction for another, as stigma would suggest, but by treating a disease of the brain the same way we treat any other chronic condition.
Alabama’s Department of Mental Health offers Medication-Assisted Treatment through certified Opioid Treatment Programs, with services available in Mobile County, among others. There are 21 certified OTP programs in the state. In Mobile specifically, New Season Treatment Center provides outpatient opioid addiction treatment and recovery for Mobile and surrounding areas, including Prichard, Chickasaw, Satsuma, Theodore,
Grand Bay and Spanish Fort. Behavioral Health Group also operates a Mobile
treatment center offering methadone, buprenorphine and Suboxone alongside counseling services. The Recovery Organization of Support Specialists (ROSS) provides a wide range of free services statewide, including a 24/7 helpline, six community recovery centers and opioid overdose prevention training. Help exists. The barrier is rarely availability — it is awareness, and stigma, and fear. All of which can be overcome.
10. This Requires All of Us
Over 71 percent of Alabamians who need substance use treatment do not receive it. That gap — between need and care — does not close on its own. It closes because communities decide to close it; Because people carry Narcan and know how to use it.; Because neighbors drop the judgment and pick up the phone; Because families have honest conversations before there is a crisis, not after.
For help, call SAMHSA’s free, confidential National Helpline at 1-800-662-4357, available 24 hours a day, 365 days a year. Call or text 988 for the Suicide and Crisis Lifeline, which also assists with substance use crises. For free naloxone in Alabama, visit vitalalabama.com or nextdistro.org, or call ahead to most Mobile-area pharmacies.
Sources
- Alabama Department of Mental Health — Understanding the Opioid Crisis: https://mh.alabama.gov/understanding-the-opioid-crisis/
- Alabama Opioid Overdose and Addiction Council — 2023 Annual Report: https://mh.alabama.gov/wp-content/uploads/2024/01/2023-Alabama-Opioid-Overdose-and-Addiction-Council-Report-to-the-Governor.pdf
- Alabama Opioid Overdose and Addiction Council — 2024 Annual Report: https://mh.alabama.gov/wp-content/uploads/2025/01/2024-Alabama-Opioid-Overdose-and-Addiction-Council-Annual-Report.pdf
- Alabama Opioid Overdose and Addiction Council — 2025 Annual Report: https://www.alabamapublichealth.gov/pharmacy/assets/council-report-2025.pdf
- Alabama Reflector — Alabama Sees Significant Drop in Overdose Deaths, CDC Data Shows: https://alabamareflector.com/2025/01/02/alabama-sees-significant-drop-in-overdose-deaths-cdc-data-shows/
- VitAL Alabama — Facts About Fentanyl:
https://vitalalabama.com/resources/helpful-information/opioids-and-overdose/facts-about-fentanyl/ - VitAL Alabama — Good Samaritan Law: https://vitalalabama.com/resources/helpful-information/opioids-and-overdose/good-samaritan-law/
- NOT ONE MORE Alabama — Narcan & Good Samaritan Law:
https://www.notonemorealabama.org/narcan–good-samaritan-law.html - World Forum for Mental Health — Alabama Drug and Alcohol Statistics:
https://www.wfmh.org/stats/alabama-drug-alcohol-statistics - Alabama Department of Mental Health — Substance Use Treatment Services: https://mh.alabama.gov/division-of-mental-health-substance-abuse-services/substance-abuse-treatment-services/
- New Season Treatment Center, Mobile: https://www.newseason.com/treatment-center-locations/alabama/mobile-metro-treatment-center/
- Gartlan Injury Law — Does Alabama Have a Good Samaritan Law?:
https://www.gartlaninjurylaw.com/blog/does-alabama-have-a-good-samaritan-law/ - Mayo Clinic — How Opioid Addiction Occurs: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
- SAMHSA — National Helpline: https://www.samhsa.gov/find-
help/helplines/national-helpline - Centers for Disease Control and Prevention — Drug Overdose Mortality: https://www.cdc.gov/nchs/state-stats/deaths/drug-overdose.html
