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The class of opioid drugs includes illicit opioids like heroin1 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 use disorder.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 they have 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 a person 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 the 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 use disorder.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 clinical term for an opioid addiction. According to SAMHSA's 2024 National Survey on Drug Use and Health, approximately 4.8 million people aged 12 or older in the United States had an opioid use disorder in the past year.5
Common signs of opioid use disorder include:6
- 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 suddenly stopping use
Opioid Withdrawal
When you abruptly quit or reduce opioid use, you may experience a range of unpleasant or distressing withdrawal symptoms, such as:6
- Nausea and vomiting
- Depression
- Anxiety
- Restlessness
- Muscle aches
- Runny nose or teary eyes
- Dilated pupils
- Goose bumps
- Profound sweating
- Diarrhea
- Fever
- Insomnia
- Excessive yawning
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Signs of Opioid Abuse and Addiction
Some signs that someone you know may be misusing opioids include:6
- 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:6
- 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.6
Meanwhile, snorting opioids can lead to other harmful effects, such as:6
- 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 changes in brain chemistry that reduce the brain's ability to produce endorphins naturally. This can create an increasing inability to manage pain, which may lead a person to take even more of the drug to achieve the same effect.7
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Who is at Risk of an Opioid Addiction?
If you have issues with severe, chronic pain, your physician may prescribe an opioid as part of your treatment. Anyone who takes an opioid for the treatment of pain is at risk of developing an opioid use disorder. The risk increases significantly when a person misuses 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 (for example, injecting or snorting).8
Other risk factors for opioid misuse and addiction may include:9
- Poverty
- Unemployment
- Personal or family history of substance use disorder
- 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 circumstances
- Prior substance use treatment
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 a person receives 24/7 medical care to manage opioid withdrawal symptoms and cravings. Medical detox often takes place in a hospital setting, giving access to a team of medical professionals who can help keep a patient safe and comfortable throughout withdrawal. They will administer an opioid withdrawal medication, such as methadone or buprenorphine, which alleviates withdrawal symptoms and cravings. They will also provide supportive care, such as intravenous fluids or symptomatic medications for symptoms that are not 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 fewer 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 consider a partial hospitalization program (PHP) or intensive outpatient program (IOP).
Ultimately, the right treatment setting for you depends on your opioid use history, other substance use, mental health conditions, physical health, priorities, schedule, and other factors.
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Medications
During treatment, the care team may incorporate medication for opioid use disorder (MOUD), also known as medication-assisted treatment (MAT).
Medications for opioid addiction recovery may include:10
- 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 is an opioid, it does not cause a euphoric high when taken as prescribed.
- 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. 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 understand the reasons behind opioid misuse and to work through underlying struggles. This is an opportunity to develop trust, learn to communicate openly, and build healthier coping skills.
- Group therapy: Group therapy is an important part of treatment. Knowing that others are experiencing similar challenges can reduce isolation, which is commonly part of opioid addiction. Group settings provide peer support, a space to express emotions, and feedback that helps develop new coping skills and healthier relationships.
- Family therapy: A person's family is their support system, and relationship issues may need to be addressed in treatment. Family therapy can help people work out differences and develop healthier connections, providing healing and a foundation for ongoing recovery support.
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Resources
- Johns Hopkins Medicine. Opioid addiction. Published February 28, 2018. https://www.hopkinsmedicine.org/opioids/signs-of-opioid-abuse.html. Accessed July 2025.
- U.S. Department of Health and Human Services. Opioids. Updated August 30, 2020. https://www.hhs.gov/opioids/prevention/index.html. Accessed July 2025.
- United States Drug Enforcement Administration. Drug scheduling. Published June 10, 2018. https://www.dea.gov/drug-scheduling. Accessed July 2025.
- National Institute on Drug Abuse. Opioid overdose crisis. Published August 8, 2019. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis. Accessed July 2025. [Note: drugabuse.gov now redirects to nida.nih.gov; URL requires manual update.]
- Substance Abuse and Mental Health Services Administration. Release of the 2024 National Survey on Drug Use and Health. Published 2025. https://www.samhsa.gov/blog/release-2024-nsduh-leveraging-latest-substance-use-mental-health-data-make-america-healthy-again. Accessed July 2025.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.
- Centers for Disease Control and Prevention. Opioid overdose. Updated December 21, 2020. https://www.cdc.gov/drugoverdose/pubs/featured-topics/treatment-recovery.html. Accessed July 2025. [Note: URL may be deprecated; manual redirect check required.]
- World Health Organization. Opioid overdose. Published 2020. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose. Accessed July 2025.
- Mayo Clinic. How opioid addiction occurs. Published 2018. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372. Accessed July 2025.
- National Institute on Drug Abuse. Medications to treat opioid use disorder research report overview. Published 2021. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview. Accessed July 2025. [Note: drugabuse.gov now redirects to nida.nih.gov; URL requires manual update.]
