Opioid Addiction: Signs, Risk Factors, and Treatment Options

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The class of opioid drugs include illicit opioids like heroin and prescription painkillers, such as morphine, Vicodin, Percocet, OxyContin, tramadol, and fentanyl. They work by binding to opioid receptors, which are responsible for regulating pain, stress, temperature, respiration, endocrine activity, gastrointestinal activity, mood, and motivation. Opioids alleviate pain and can create a sense of relaxation as well as feelings of euphoria. Because of these desirable effects, opioids are highly addictive, and many people who begin taking them for medical reasons end up misusing them and developing an opioid addiction.^1,2

Signs and Symptoms of Opioid Addiction

Opioids are highly addictive because of the intense feelings of euphoria and pain-relief they produce. Prescription opioids are classified as a Schedule II drug, which means it has a high potential for misuse, dependence, and addiction, while heroin is a Schedule I controlled substance since it has no accepted medical use.³

Opioid tolerance develops quickly, leading you to take increasingly higher doses of the drug to experience the same effects. Tolerance can then speed up the development of physiological dependence, which occurs when your body requires the presence of an opioid to function normally. Both tolerance and dependence play a major role in contributing to the development of an opioid addiction.⁴

Diagnostic Criteria for Opioid Use Disorder

Opioid use disorder is a condition characterized by repeated, compulsive opioid use despite negative consequences. It is the formal term for an opioid addiction.⁵

Common signs of opioid use disorder include:⁵

Experiencing strong cravings for opioids
Failing to quit or control opioid use despite efforts to do so
Taking higher or more frequent doses of opioids than intended
Continuing use despite physical or psychological problems caused or worsened by use
Continuing use despite negative effects on relationships, work, school, etc.
Using opioids in physically hazardous situations, such as while driving
Spending a great deal of time obtaining and using opioids as well as recovering from their effects
Neglecting important hobbies or recreational activities in favor of opioid use
Developing a tolerance
Experiencing opioid withdrawal symptoms when you suddenly stop taking them

Opioid Withdrawal

When you abruptly quit or reduce opioid use, you may experience a myriad of unpleasant or distressing withdrawal symptoms, such as:⁵

Nausea and vomiting
Depression
Anxiety
Restlessness
Muscle aches
Runny nose or teary eyes
Dilated pupils
Goose bumps
Profound sweating
Diarrhea
Fever
Insomnia
Excessive yawning

If you or someone you know may be addicted to opioids, get help today by calling 800-681-1058 (Who Answers?) .

Learn more about opiate withdrawal.

Signs of Opioid Abuse and Addiction

Some signs that someone you know may be misusing opioids include:⁵

Initial euphoria followed by apathy
Depressed mood
Drowsiness (being “on the nod”)
Slurred speech
Impaired memory or attention
Pupillary constriction
Impaired judgment

Other signs of opioid addiction are specific to the individual’s method of administration, such as injecting or snorting. If your loved one is injecting opioids, you may notice the following:⁵

Collapsed veins
Puncture marks
Track lines
Peripheral edema
Cellulitis
Abscesses
Circular scars

Additionally, people who inject opioids or other drugs are at an increased risk of contracting HIV or hepatitis C, as well as bacterial endocarditis, an infection of the heart lining.⁵

Meanwhile, snorting opioids can lead to other harmful effects, such as:⁵

Nose bleeds
Irritation of the nasal mucosa
Perforation of the nasal septum

Taking an opioid like morphine, oxycodone, or heroin over a long period can cause nerve damage in the brain that prevents cells from producing endorphins. This can create an inability to manage pain as a result, which can lead you to take even more of the drug to achieve the same effect.⁶

Who is at Risk of an Opioid Addiction?

If you have issues with severe, chronic pain, your physician may prescribe an opioid as a part of your treatment. Anyone who takes an opioid for the treatment of pain is at risk of developing an opioid addiction. The risk of addiction increases significantly when you misuse the medication by taking higher or more frequent doses than prescribed, mixing it with other substances, or using it in a way other than directed (e.g., injecting or snorting).¹⁰

Other risk factors for opioid misuse and addiction may include:¹¹

Poverty
Unemployment
Personal/Family history of substance abuse
Young age
History of criminal activity or legal problems, including DUIs
Regular contact with high-risk people or high-risk environments
Problems with past employers, family members, and friends
Risk-taking or thrill-seeking behavior
Heavy tobacco use
History of severe depression or anxiety
Stressful situations
Prior drug or alcohol rehabilitation

How to Treat an Opioid Addiction

Medical Detox for Opioid Withdrawal

The first step on the continuum of opioid addiction treatment is often medical detox, in which you receive 24/7 medical care to manage your opioid withdrawal symptoms and cravings. Medical detox often takes place in a hospital setting, giving you access to a team of medical professionals who can keep you safe and comfortable throughout withdrawal. They will administer an opioid withdrawal medication, such as methadone or buprenorphine, which alleviates withdrawal symptoms and cravings. They’ll also provide supportive care, such as intravenous fluids or symptomatic medications for symptoms that aren’t managed by withdrawal medications.

Inpatient and Outpatient Rehab

Once you complete opioid detox, the next step is to transition into a rehab program. Opioid addiction treatment occurs in either an inpatient or outpatient setting. Inpatient treatment involves residing at the treatment center for the entire program. You receive around-the-clock treatment and care, with little to no exposure to triggers. Inpatient provides more structure and intensiveness, which many people find beneficial.

Conversely, outpatient opioid addiction treatment offers more flexibility and less scheduling conflicts. You live at home while attending therapy and counseling during the day. The time commitment for outpatient ranges from just a few hours per week to several hours per day. If your opioid addiction is more severe but you are unable to attend inpatient, you may want to opt for a partial hospitalization program (PHP) or intensive outpatient program (IOP).

Ultimately the right treatment setting for you depends on your opioid addiction, other substance use, mental health condition, physical health, priorities, schedule, and more.

Medications

During treatment, the treatment team may include an opioid addiction treatment medication, known as medication-assisted treatment (MAT).

Medications for opioid addiction recovery may include:¹²

Naltrexone: Naltrexone binds to opioid receptors in the brain and blocks the sedative and euphoric effects of opioids, which reduces cravings.
Methadone: Methadone is a full opioid agonist that eases opioid cravings. Although it’s an opioid, it doesn’t cause a euphoric high.
Suboxone (buprenorphine/naloxone): Buprenorphine is a partial opioid agonist, which alleviates opioid cravings without producing a high, and naloxone is an opioid antagonist, which reduces the risk of diversion and misuse.

Opioid Addiction Therapies

Opioid addiction treatment programs may vary depending on treatment philosophy and approach. For example, some rehabs integrate holistic treatment modalities while others may take a faith-based approach. But all quality opioid rehabs should utilize evidence-based therapies and approaches, such as:

Individual therapy: This involves meeting with a therapist one on one to help you understand the reasons behind your opioid misuse and to overcome your struggles. This is an opportunity to work on developing trust in another person and learning to speak openly about yourself and begin developing new, healthier coping skills.
Group therapy: Group therapy is an important part of treatment. It can help to know someone else is experiencing similar issues and that you are not alone. Overcoming the isolation that is typically part of opioid addiction is a key factor in recovery. This provides peer support, which is essential. Group therapy allows you to express your emotions and receive feedback that helps you learn new coping skills and to develop new, healthy relationships.
Family therapy: A person’s family is their support system and relationship issues may need to be addressed. Family therapy can help people work out their differences and develop healthier connections. Support from your family helps you become more open to your loved ones and provide healing and closure.

For help finding an opioid rehab, contact 800-681-1058 (Who Answers?) to explore rehab options in your area.

Resources

Johns Hopkins Medicine. (2018, February 28). Opioid addiction.
U.S. Department of Health and Human Services. (2020, August 30). Opioids.
United States Drug Enforcement Administration (2018, June 10). Drug scheduling.
National Institute on Drug Abuse. (2019, August 8). Opioid overdose crisis.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Centers for Disease Control and Prevention. (2020, December 21). Opioid overdose.
Niesters, M., Overdyk, F., Smith, T., Aarts, L., & Dahan, A. (2013). Opioid-induced respiratory depression in paediatrics: a review of case reports. British Journal of Anaesthesia 110 (2):175-182.
Sullivan, M., Edlund, M., Fan, M., DeVries, A., Braden, J., & Martin, B. (2010). Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and Medicaid insurance plans: the TROUP Study. Pain 150(2): 332–339.
Centers for Disease Control and Prevention. (2020). Preventing an opioid overdose.
World Health Organization. (2020). Opioid overdose.
Mayo Clinic. (2018). How opioid addiction occurs.
National Institute on Drug Abuse. (2021). Medications to Treat Opioid Use Disorder Research Report Overview.