Opioid Addiction

Over the past 20 years, millions of people have struggled with addiction to opioids. This is one of the biggest health crises in the United States.

Fortunately, there are well-understood treatment options, including medication-assisted treatment (MAT) with buprenorphine, naltrexone, or methadone, behavioral therapy, and aftercare programs.

What Is Opioid Addiction?

Opioid use disorder begins with the decision to use drugs like heroin, Vicodin, or OxyContin. But with continued use, opioids change chemical levels deep within the brain. When this happens, people can no longer control how much opioids they take or how often they use them. 

Key Facts About Opioid Addiction & Abuse

• In 2021, 80,411 overdose deaths were attributed to opioids. [2]
• More than 2.1 million people in the United States have opioid use disorders. [1]
• Overdose deaths are the leading cause of injury-related death in the United States. Most of those deaths involve opioids. [3]
• By June 2021, synthetic opioids (like fentanyl) were involved in 87% of opioid deaths. [4]
• Opioids can lead to physical dependence in as little as four to six weeks. If you have dependence, you’ll feel sick between doses and if you try to quit. [4]
• While prescription painkillers grab opioid headlines, researchers say heroin is often the first opioid people use. [5]

Causes of Opioid Addiction 

Using opioids is the major cause of opioid addiction. But some risk factors can increase the chance you’ll develop a problematic relationship with drugs. These are some of the risk factors for opioid addiction:

Biological Factors 

Researchers say as much as half of a person’s risk of addiction depends on genes. [6] Your genes could make opioids more rewarding or powerful for your brain cells. When that happens, an addiction could develop quicker than it might otherwise. 

Environmental Factors 

Some neighborhoods are deep in the grip of opioid addiction. Drugs are easy to buy, and almost everyone is using them. Living in a place like this could make it easy for you to use drugs for the first time. And it could make sustaining an addiction easier too. 

Social Factors

If you know people who use opioids, the behavior becomes normalized. Your peers might pressure you to use opioids, or they might offer pills for you to try when you’re feeling stressed or upset. 

Psychological Factors 

Opioids boost feelings of euphoria and relaxation. For some people, those feelings are hard to attain naturally. Long-standing depression or anxiety could make you more likely to start using opioids and to become addicted to them. 

Physical Factors 

Opioid painkillers are often prescribed for pain. Many people who start using these drugs to ease discomfort develop an addiction in time. 

Researchers say about 80% of people who use heroin first misused prescription opioids. They never intended to develop an addiction, but their medication exposure made drug abuse possible. [5]

Most Commonly Abused Opioids 

Multiple types of opioids exist. They all work in the same manner, and all of them can cause an opioid addiction in time. These are the versions experts say are most commonly abused: 

Heroin

Heroin is an illicit opioid made from the sap of the poppy flower. In many parts of the country, heroin is the cheapest opioid available, so it’s widely used. Heroin addiction is particularly dangerous, as needle-based diseases (like HIV and hepatitis) can lead to life-threatening complications.

Fentanyl

Fentanyl is a man-made opioid, and it’s one of the strongest versions available. Since it’s so powerful, it’s easy to smuggle into the country. 

A tiny amount can make a large quantity of drug products, leading to fentanyl addiction. But since it’s so strong, fentanyl can cause an overdose in even small amounts. 

Oxycodone

Oxycodone is a prescription painkiller (or opioid). It’s found in brand-name drugs like OxyContin, and it’s often sold on the black market by dealers. Oxycodone addiction is particularly dangerous as people buying pills from dealers may get another drug (like fentanyl) instead and overdose. 

OxyContin 

When people discuss the prescription opioid epidemic, they’re often referring to OxyContin. This prescription painkiller was once easy to crush and inject. Newer formulations make abuse harder, but OxyContin addiction still exists and is very dangerous. 

Dilaudid

Dilaudid is the brand-name version of the opioid hydromorphone. It’s designed for severe pain and can seem attractive to people who no longer get high when using weaker drugs like OxyContin. Buying Dilaudid from dealers can be dangerous, as the product you buy may contain something stronger (like fentanyl) instead. This could lead to fatal overdose. 

Hydrocodone

Hydrocodone is a prescription painkiller often sold under the brand names Vicodin or Lortab. Some people are introduced to hydrocodone during cold and flu season, as it’s sometimes combined into cough medication. Addiction to hydrocodone can develop quickly, even in people who never intended to abuse drugs. 

Codeine 

Codeine is a prescription painkiller in the opioid class. It’s considered less potent than other opioids like oxycodone, but it can still be misused. 

Codeine is particularly dangerous when mixed with other drugs, including alcohol. Codeine addiction can be treated effectively with MAT. 

Lean 

Lean is the slang term for a homemade drink consisting of codeine-laden cough syrup, candy, and carbonation. People who drink lean report euphoria and dissociative symptoms. Lean is particularly prevalent on college campuses, but younger people use the drink too. 

Lortab

Lortab is a prescription painkiller containing an opioid (hydrocodone) and acetaminophen. People use Lortab to ease pain or control a cough. 

Even when taken as prescribed, a Lortab addiction can develop. When it does, people may take more of the drug than their doctors intend. 

Morphine

Morphine is one of the oldest and best understood painkillers in the opioid class. Doctors have used morphine-based products for decades to help people in pain. 

But morphine addiction often follows a legitimate prescription for the drug. When it does, people must buy more from dealers or switch to an illicit drug like heroin. 

Percocet

Percocet is a painkiller containing an opioid (oxycodone) and acetaminophen. The combination could reduce inflammation and ease pain. 

But Percocet addiction can develop due to the presence of oxycodone. Acetaminophen is toxic at high doses, so sustained abuse can lead to severe health issues. 

Tramadol 

Tramadol is an opioid medication often prescribed for pain that hasn’t responded to other drugs. Tramadol comes in extended-release formulations that can be crushed and injected for a quick high. Tramadol addiction can follow. 

Demerol

Demerol is an opioid sold under the generic name meperidine. It’s available in pill and injectable forms, and it can be quite helpful for people with severe pain from conditions like cancer. When abused, it can lead to addiction or overdose death.

Sufentanil

Sufentanil, sold under the brand name Dsuvia, is an opioid. This medication derives from fentanyl and is incredibly powerful. 

Sufentanil addiction can be successfully treated with MAT, ensuring that people don’t overdose and die from taking too much of this drug. 

Recognizing Opioid Addiction & Abuse

If you take an opioid substance regularly and wonder if you struggle with addiction, consider these questions:[7]

1. Do you often think about the drug? 
2. Have you tried to stop taking the opioid before and could not? 
3. Have you taken the narcotic just to feel normal?
4. Have you taken the drug, or taken more than a prescribed dose of the drug, to relax, especially after becoming stressed or upset? 
5. Do you worry about running out of the drug? 
6. Have you stolen prescription opioids or money to buy opioids? 
7. Have you ever experienced an opioid overdose?
8. Do you experience withdrawal symptoms, like anxiety, muscle pain, exhaustion, and intense cravings, when you try to quit?

Symptoms of Opioid Addiction 

Opioids can change almost every part of your life. Symptoms can be gathered into the following categories: 

Physical 

Opioids are sedatives, so people who take them can seem very relaxed and sleepy when they’re high. If people use opioids via needle, you may notice track marks on the arms and legs, or the person may wear long sleeves and long pants to cover up those signs. 

Mental 

People with opioid addictions may experience anxiety and distress, especially when their doses wear off. They may be preoccupied with plans about getting more drugs, and they may resist talking to others while they’re planning. 

Behavioral 

People with opioid addictions often withdraw from their friends and families. They carve out alone time to buy, use, and recover from the drug. They may stop going to work or attending classes due to drug use. 

Comparing Symptoms of Opioid Use Disorder by Type

Why Are Opioids So Addictive?

Researchers once thought that opioid painkillers were effective long-term therapies. We now know that’s not true. Instead, opioids are prescription medications that latch to three types of receptors in the brain and cause long-lasting changes, leading to addictive behaviors. 

Opioids latch to delta, kappa, and mu receptors in the brain. Once attached, they encourage these receptors to release dopamine, which is a chemical associated with euphoria. 

In time, the brain won’t release dopamine without drugs. People with addictions keep using drugs just to feel normal. It’s often an effort to not feel physically ill or depressed. 

What Are the Stages of Opioid Addiction?

Opioid addictions often progress in stages. Understanding what they are is important, as you can stop their progression. 

Stage 1: Tolerance 

At the tolerance stage, people who take opioids need bigger doses to experience the high they crave. This stage stems from brain cell damage caused by opioids. 

Stage 2: Dependence 

As drug use continues, brain cells no longer function properly without opioids. People may feel withdrawal symptoms, such as nausea and diarrhea, between doses. 

Stage 3: Abuse 

As dependence deepens, people may feel physically unable to quit using drugs, even if they want to do so. They begin to change their lives to perpetuate drug use, such as quitting their jobs or leaving their families. 

Stage 4: Addiction & Opioid Use Disorder 

Addiction is a physical and mental disorder. As drug use deepens, people may use such high doses that they could experience life-threatening complications. Signs of opioid overdose include unconsciousness and shallow breathing. 

Health Impact of Opioid Addiction

While we often discuss opioids as mental health disorders, physical issues are common too. They can be split into short-term and long-term impacts. 

Short-Term Impact

The short-term impact of opioids typically involves intoxication. Signs include the following:[1]

• Confusion
• Drowsiness
• Memory loss 
• Nodding in and out of sleep 
• Slurred speech 

Long-Term Impact

The long-term impact of opioids typically involves significant illness and disease. Signs include the following:

• Infections: Needle-based opioid abuse can inject diseases (like HIV and hepatitis) beneath the skin. Additives and contaminants can also lead to abscesses. 
• Constipation: Opioids slow food’s movement through the body, leading to intense constipation and pain. 
• Withdrawal symptoms: People may experience nausea, diarrhea, vomiting, and shaking when they try to quit or reduce their doses.
• Overdose: As opioid addiction deepens, people may use very large drug doses. They could use enough to slow breathing and heart rates to life-threatening levels. 
• Heart problems: Opioids can change the speed of your heartbeat. And some contaminants can damage the heart muscle even more. 

Evidence-Based Treatment for Opioid Use Disorder

Opioid addictions are serious, and they can be life-threatening. Treatment for opioid addiction is very effective and can help you to build a new life. Your program may involve three stages:

Medical Detox 

Medical detox is the process of ending the body’s tolerance to and dependence on intoxicating substances. 

During medical detox, doctors use medications to ease your transition from intoxication to sobriety. Your doctor can help you understand what to expect during detox, but know that you’ll likely feel slightly uncomfortable but not deeply sick during this stage. 

For opioid detox, MAT with one of two substances is common.

• Buprenorphine: This partial opioid agonist has revolutionized outpatient treatment for opioid addiction. This means that it can produce pain relief and mild intoxication, but these effects are less intense than with full opioid agonists, like heroin. For people who are physically dependent on opioids, taking a partial opioid agonist can suppress cravings without causing euphoria.
  
  More doctors can prescribe buprenorphine for outpatient use, without as much oversight as other types of MAT. The doctor will still oversee how much buprenorphine the individual takes and help them taper the dose down until their body no longer relies on opioids to feel normal. [9]
  
• Methadone: One of the first medications offered as MAT for opioid addiction, methadone is a full opioid agonist, but it remains in the body for hours longer than other substances like heroin or oxycodone. This means that it offers relief from cravings, allowing the individual to focus on therapy and other forms of rehabilitation treatment. [8]
  
  Since methadone can be addictive, it is administered at dedicated clinics with staff oversight. Doses will be slowly tapered over weeks or months until the person no longer struggles with intense drug cravings.

Sometimes, naltrexone is also used as part of MAT. After someone has gone through detox, if they relapse while they take naltrexone, they will not experience the same effects from opioids. This can help them stop seeking the positive effects of opioids.

Rehabilitation 

Behavioral health treatment is the next step in opioid treatment. In some cases, the person may detox and then enter rehabilitation treatment. In other cases, slow detox with MAT and rehabilitation therapy will overlap. 

The focus of rehabilitation is behavioral therapy, which is based on talk therapy. This can be group therapy, individual therapy, or both. These therapies help the individual understand potential causes of their addiction, the signs associated with addiction and withdrawal, and how to manage cravings or stress that might lead to a relapse.

You can access therapy in residential rehab, in which you move out of your home to get care. You can also use outpatient treatment, in which you stay home but get care in appointments. 

Aftercare

It is increasingly common for people who leave a rehabilitation program to maintain some level of connection to the recovery community as a form of aftercare. This includes the following:

• Going to support groups
• Attending individual therapy
• Pursuing complementary treatments like yoga or art therapy

Developing an aftercare plan might be one of the final steps in a rehabilitation program. This might include making a list of loved ones to contact in the event of a relapse, a daily schedule to remain focused on long-term health goals, and a list of important appointments like job interviews or doctors’ visits.

Support Resources for Opioid Addiction

Opioid addiction can be isolating. But there are several organizations that offer both education and support for people with an opioid use disorder. They include the following:

1. Narcotics Anonymous: Connect with others in recovery from opioid use disorder in free meetings. These are held all over the world as well as online. 
2. Nar-Anon Family Group: Join these meetings and bring your family along to learn more about how to support you. 
3. LifeRing Secular Recovery: Many support group models have a religious bent. LifeRing is different and allows people to recover without leaning on the idea of a higher power. 
4. U.S. Department of Health and Human Services: Find treatment services, and learn more about how addictions work and are treated. 
5. National Institute on Drug Abuse: Read the latest research on how addictions work and how experts believe they should be treated. 

Frequently Asked Questions About Opioid Addiction

We’ve compiled some of the most frequently asked questions about opioid addictions and how they are treated. 

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More