Trusted medical advice from the
American Academy of Family Physicians.

Opioid Addiction

What is opioid addiction?

An opioid addiction is a powerful urge to use certain medicines called opioids. But what are opioids? And what is an addiction?

Opioids are medicines that are often prescribed by a doctor to help relieve pain. An addiction is a strong craving to do something. In this case, it’s a strong craving to use opioids. Addiction is a disease that affects your brain and behavior. At first, you have control over your choice to use opioids. But if you don’t follow your doctor’s instructions for the medicine, its effect eventually makes you want to keep using it. Over time, your brain actually changes so that you develop a powerful urge to take the opioids.

Opioids are prescribed to treat many issues, including:

  • Toothaches and dental procedures
  • Injuries
  • Surgeries
  • Chronic conditions such as cancer

Some prescription cough medicines also contain opioids.

Opioids work by lowering the number of pain signals your body sends to your brain. They also change how your brain responds to pain. When used correctly, opioids are safe. But when people misuse the medicine (opioid use disorder), they can become addicted. People can also become addicted to opioids by using the drug illegally.

Some opioid drugs include:

  • Opium
  • Codeine
  • Fentanyl
  • Heroin
  • Hydrocodone and oxycodone
  • Hydromorphone and oxymorphone
  • Methadone
  • Morphine
  • Tramadol

Symptoms of opioid addiction

An opioid addiction is also called substance abuse. The signs and symptoms of substance abuse can be physical, behavioral, and psychological. One clear sign of addiction is not being able to stop using opioids. Another sign is if a person is not able to stop using more than the amount prescribed by their doctor.

Other signs and symptoms of opioid abuse include:

  • Shallow or slow breathing rate
  • Physical agitation
  • Poor decision making
  • Abandoning responsibilities
  • Mood swings
  • Irritability
  • Depression
  • Lowered motivation
  • Anxiety attacks

You might have an opioid addiction if you crave the drug or if you feel you can’t control the urge to take the drug. You may also be addicted if you keep using the drug without your doctor’s consent, even if the drug is causing trouble for you. The trouble may be with your health, with money, with work or school, with the law, or with your relationships with family or friends. Your friends and family may be aware of your addiction problem before you are. They may notice the changes in your behavior.

If you take too many opioids, you may experience an opioid overdose. This is a very serious medical condition. Symptoms include:

  • Unresponsiveness (can’t wake up)
  • Slow, irregular breathing, or not breathing at all
  • Slow, erratic pulse, or no pulse
  • Vomiting
  • Loss of consciousness (passing out)
  • Small pupils in their eyes

An opioid overdose requires immediate emergency medical treatment. If you suspect someone has overdosed, call 9-1-1 right away. In some states, a prescription nasal spray called naloxone (Narcan) is available to keep on hand in case of an overdose. Talk to your doctor to see if you might need this medicine.

What causes opioid addiction?

Opioid drugs alter your brain by creating artificial endorphins. Besides blocking pain, these endorphins make you feel good. Too much opioid use can cause your brain to rely on these artificial endorphins. Once your brain does this, it can even stop producing its own endorphins. The longer you use opioids, the more likely this is to happen. You also will need more opioids over time because of drug tolerance.

Drug tolerance is when your body, over time, gets used to the effects of a drug. As this happens, you may need to take a higher dose of the drug to get the same effect. When you take opioids over time, you need a higher dose to get the same pain relief.

If you stop using an opioid for a period of time, your tolerance will begin to fade. If you need to begin taking it again, you most likely will not need your former higher dose. That can be too much for the body to take. If you stop taking a medication, and then resume, talk to your doctor about dosage.

What is drug dependence?

Drug dependence is when the way your body works changes because you have taken a drug for a long time. These changes cause you to have withdrawal symptoms when you stop using the drug. Withdrawal symptoms can be mild or severe, and may include:

  • Sweating
  • Nausea or vomiting
  • Chills
  • Diarrhea
  • Shaking
  • Pain
  • Depression
  • Insomnia
  • Fatigue

If you have been taking a prescription opioid for a long time, work with your doctor. They can help you avoid withdrawal symptoms by gradually lowering your dose over time until you no longer need the medicine.

What is the difference between drug tolerance, dependence, and addiction?

Drug tolerance and dependence are a normal part of taking any opioid drug for a long time. You can be tolerant to, or dependent on, a drug and not yet be addicted to it.

Addiction, however, is not normal. It is a disease. You are addicted to a drug when it seems that neither your body nor your mind can function without the drug. Addiction causes you to obsessively seek out the drug, even when the drug use causes behavior, health, or relationship problems.

How is opioid addiction diagnosed?

Your doctor or a medical health professional can diagnose opioid use disorder and opioid addiction. Diagnosis will include a medical assessment. It also often includes testing for mental health disorders.

Can opioid addiction be prevented or avoided?

Many people are able to use opioids safely without becoming addicted to them. But their potential for addiction is high. This is especially true if you use them for long-term pain management.

In general, you are more likely to avoid addiction if you can use opioid drugs no longer than a week. Research shows that using them for more than a month can make you dependent on them.

Opioid addiction treatment

Opioid addiction is a chronic illness and should be treated the same as other chronic illnesses. Like those, it should continually be managed and monitored. You should feel comfortable discussing treatment with your family doctor, who is properly trained for this treatment.

Treatment for opioid addiction is different for each person. The main goal of treatment is to help you stop using the drug. Treatment also can help you avoid using it again in the future.

When you stop using opioids, your body will react. You will have a number of symptoms that may include nausea and vomiting, abdominal pain, and anxiety. This reaction is called withdrawal.

Your doctor can prescribe certain medicines to help relieve your withdrawal symptoms. They also will help control your cravings. These medicines include methadone (often used to treat heroin addiction), buprenorphine, and naltrexone.

Methadone and buprenorphine help reduce withdrawal symptoms by targeting the same centers in the brain that opioids target. Only they do not make you feel high. They help restore balance to your brain and allow it to heal. According to National Institutes of Health (NIH), you may safely take the medicines long term, even for a lifetime. You should not quit them without first telling your doctor.

Naltrexone is another medicine your doctor may prescribe. This medicine doesn’t help you stop taking opioids. It is to help you prevent from relapsing. Relapsing means to start taking opioids again. This medicine is different from methadone and buprenorphine because it does not help with cravings or withdrawal. Instead, according to NIH, it prevents you from feeling the high you would normally feel when you take opioids.

You may also need help with your mental or emotional addition to opioids. Behavioral treatments can help you learn how to manage depression. These treatments also help you avoid opioids, deal with cravings, and heal damaged relationships. Some behavioral treatments include individual counseling, group or family counseling, and cognitive therapy. Ask your doctor for a recommendation.

Medications

Methadone

 

Buprenorphine

 

Naltrexone
Types

 

 

Tablet, liquid 

 

Sublingual (under-the-tongue) tablet, buccal film (small patch that adheres to inner cheek), long-acting injection (shot) 

 

Tablet, Intramuscular injection (shot) 

 

 

 

Use Daily · Daily for tablet 

· Every 4 weeks for injection

· Daily for tablet 

· Every 4 weeks for injection

How to get medication At an opioid treatment program Can be prescribed by your primary care doctor Can be prescribed by any medical provider
Craving reduction +++ ++ +
Possible Side Effects Sleepiness 

Constipation

Heart problems (such as heart disease)

Interactions with other drugs (there are medicines that you should not use with methadone)

Overdose if combined with certain other medicines

Headache 

Nausea

Constipation

 

Injection site reactions 

Headache

Insomnia

 

Considerations Must be seen daily at first May need to be seen 1 to 2 times per week at first, then may move to monthly visits Must completely withdraw from opioids before starting treatment (usually 7 to 14 days). 

May be seen monthly for injections

Table adapted with permission from Coffa and Snyder, 2019. Source for formulations Kampman, K. et al. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opiod Use (2015). Source for pregnant patient treatment: Coffa and Snyder, 2019.

Living with opioid addiction

The first step toward recovery is recognizing that you have a problem with opioids. If you think you are addicted to them, know that there is help for you. The first step in breaking addiction is realizing that you control your own behavior.

The following steps will help you fight your addiction:

  • Commit to quitting. Take control of your behavior and commit to fighting your addictions.
  • Get help from your doctor. They can be your biggest ally, even if you’re trying to quit a drug they prescribed. Your doctor may be able to prescribe medicine that will help ease your cravings for the addictive drug. Talking with your doctor or a counselor about your problems and your drug use can be helpful, too.
  • Get support. Certain organizations are dedicated to helping people who have addictions. They want you to succeed and will give you the tools and support you need to quit and move on with your life. Ask your family and friends for support, too.

Questions to ask your doctor

  • How can I prevent getting addicted to opioids?
  • Is the medicine I’m taking addictive?
  • How do I know if I’m addicted to an opioid?
  • What should I do if I think I’m addicted to an opioid?
  • How do I know if a friend of family member is addicted to an opioid?
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