Medically reviewed: 02/25/2019
Last updated: 12/6/2021
Author: Dr. Michael E. Wolf
Reading Time: 7 minutes
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
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
- Muscle aches
- Runny nose or teary eyes
- Dilated pupils
- Goose bumps
- Profound sweating
- Excessive yawning
Call our 24/7 helpline at (800) 662-HELP (4357) if you are worried you or someone you know may be addicted to opioids. Our caring and compassionate treatment support advisors can help you get the treatment you need.
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
- 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
- Personal/Family history of substance misuse
- 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.
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, call our confidential helpline at (800) 662-HELP (4357) to speak to a rehab support specialist about options in your area.
- 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.