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Signs & Symptoms of Opioid Addiction | What to Look For

Opioid addiction is often recognizable to friends and family from the psychological, physical, behavioral, or social changes that a person experiences when they use opioids heavily. While these signs may be hidden in the early stages, they usually become impossible to hide as addiction deepens.

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Psychological symptoms of opioid addiction may include cravings for the drug of choice, preoccupation with opioids or getting high, difficulty controlling the use of opioids, and continued opioid use despite the negative consequences they experience.[1] 

Physical signs of being under the influence of opioids may include constricted pupils, drowsiness, and slurred speech. Long-term use of opioids can cause physical issues like weight loss, heart problems, and respiratory issues.[1]

Behavioral or social symptoms of ongoing opioid abuse and addiction may include secrecy around the use of drugs, neglected responsibilities, deceptive behavior, and changes in social circles.[1]

If you or someone you love is living with an addiction to opioids, treatment can help. Comprehensive opioid addiction treatment can control opioid withdrawal symptoms and cravings while you build a better life in recovery.

Psychological Signs of Opioid Addiction

Psychological signs of opioid addiction include the following:[1,2]

  • A strong desire or urge to use opioids
  • Obsession with getting more opioids and staying high
  • Irritability, anxiety, and depression, especially when without opioids
  • Feeling like opioids are necessary to cope with daily life or to feel normal
  • Impaired ability to make rational choices and avoid risky behaviors
  • Difficulties with memory, attention, concentration, and problem-solving abilities
  • Emotional highs and lows, sometimes accompanied with heightened sensitivity or emotional numbness

Physical Symptoms of Opioid Addiction 

Over time, opioid misuse has substantial effects on the body. Physical signs of opioid addiction include the following:[1,2]

  • Need for higher doses of opioids over time to achieve the desired effect
  • Withdrawal symptoms when without opioids, which may include nausea, vomiting, diarrhea, muscle aches, sweating, insomnia, and restlessness
  • Constipation and other gastrointestinal difficulties
  • Central nervous system depression and slow, shallow breathing, which may be life-threatening
  • Infections at injection site if using needles
  • Infection of the heart or other heart problems

Behavioral & Social Signs of Opioid Addiction

As opioid misuse continues, it’s hard to hide behavioral and social changes, such as the following:[1,2]

  • Failure to fulfill work, school, or family obligations due to drug use
  • Decreased participation in activities that were once enjoyable or important
  • Isolating from family, friends, and social activities in order to get high instead
  • “Doctor shopping” (seeking prescriptions from multiple doctors) or engaging in other deceptive behaviors to get more opioids
  • Financial problems due to spending a significant amount of money on opioids and an inability to maintain a job
  • Strained relationships with family, friends, and romantic partners due to drug use and associated behaviors
  • Risky activities, such as driving under the influence, sharing needles, or participating in illegal activities to obtain opioids

What Are the Signs That Someone Is Addicted to Opioids?

While everyone is different, there are some common signs that someone is addicted to opioids. Look for the following:[1,3,4]

Emotional Distance

Noticeable fluctuations in mood, such as increased irritability, sadness, anxiety, or anger, can indicate a number of potential problems. However, when combined with opioid use, mood swings may correlate with whether or not the person is high or if they are without their drug of choice. This can indicate an opioid use disorder (OUD).

Social Shifts

Withdrawal from social activities, close relationships, goals, and hobbies can indicate a shift in focus to getting and staying high.

Physical Changes

Weight loss without any other cause, a decline in personal hygiene, and a shift away from caring about how they appear can indicate a problem when opioid use is a concern.

Financial Challenges

Maintaining a job is difficult when dealing with an OUD, and opioids are expensive on the street. The combination of these issues can mean that someone living with addiction may always be out of money, frequently asking to borrow money, or stealing to cover their expenses.

Performance & Engagement

A decline in work or academic performance, a lack of motivation, difficulty focusing, and decreased productivity can signify a problem with opioids. 

Sleep Patterns

Changes in sleeping habits, including sleeping significantly more or less or sleeping at odd times, can indicate that one’s sleep schedule is being dictated by opioid use and not their natural rhythms. 

Uncharacteristic Behavior

Engaging in risky or impulsive acts, exhibiting secrecy, or shying away from things that used to be important can indicate a problem with opioid misuse.

Health Effects of Opioid Addiction

Ongoing opioid abuse and addiction can bring about both short-term and long-term health issues. Overdose is always a risk, and this can be fatal.[5]

Short-Term Health Effects

These are some of the potential health problems associated with opioid addiction in the short term:[1,6-8]

Respiratory Issues

Opioids can suppress the respiratory system, leading to reduced oxygen intake and potentially creating respiratory distress or failure.

Gastrointestinal Problems

Digestive side effects like nausea and frequent bouts of vomiting can occur with any amount of opioid use. Constipation and other gastrointestinal issues are common.

Increased Risk of Accidents

The impairing effects of opioids — including drowsiness, cognitive impairment, and slowed reflexes — raise the risk of accidents and injuries while under the influence.

Overdose

High doses of opioids or combining opioids with other substances can depress the central nervous system so much that the person stops breathing entirely. While opioid overdose may be reversible with quick administration of naloxone (Narcan), it is commonly fatal.

Long-Term Health Effects

With continued abuse, long-term health effects from opioid addiction set in. They may include the following:[1,9-14]

Chronic Pain

Prolonged opioid use can induce a paradoxical condition known as opioid-induced hyperalgesia, whereby individuals become more sensitive to pain when taking opioids. 

Organ Damage

Opioid addiction can contribute to organ damage over time. The liver may be affected, leading to hepatitis or even liver failure. Kidney damage and compromised immune function are also possible consequences.

Hormonal Disruptions

Opioids can disrupt the endocrine system, causing hormonal imbalances. Men may experience decreased testosterone levels, infertility, and sexual dysfunction, while women may encounter menstrual irregularities and fertility issues.

Increased Susceptibility to Infectious Diseases

Opioid addiction, particularly through injection drug use, heightens the risk of contracting infectious diseases like HIV/AIDS, hepatitis B, and hepatitis C due to needle sharing.

Mental Health Disorders

Opioid addiction often coexists with mental health disorders, such as depression, anxiety, and post-traumatic stress disorder (PTSD). Additionally, long-term opioid use can worsen existing mental health conditions or contribute to the development of new ones.

Societal & Intrapersonal Problems

Opioid addiction strains relationships, creates financial challenges, leads to legal complications, and diminishes overall quality of life.

Help for Opioid Addiction

With continued abuse, the effects of opioid addiction worsen. Even if you now feel like the signs and symptoms of your opioid addiction are manageable and potentially not obvious to those around you, they will spiral out of your control. However, there is hope.
Evidence-based addiction treatment that incorporates medications and therapy can help you to safely stop all opioid abuse. You’ll acquire tools to help you avoid relapse, and you’ll build skills that will serve you in recovery. Reach out for help now, so you can begin to build a better future today.

Updated January 12, 2024
Resources
  1. Opioid use disorder. Dydyk AM, Jain NK, Gupta M. StatPearls. Published 2022. Accessed December 22, 2023.
  2. Opioids: Recognizing the signs. New York State Department of Health. Published December 2017. Accessed December 22, 2023
  3. Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. International Journal of Preventive Medicine.
  4. Warning signs of substance and alcohol use disorder | Information for family and friends. Alcohol and Substance Abuse Program, Indian Health Service. Published 2023. Accessed December 22, 2023.
  5. Opioid overdose. World Health Organization. Published August 29, 2023. Accessed December 22, 2023.
  6. Opioid Addiction: Prevention, education, and treatment. College G. Gaston College.
  7. Opioid-induced respiratory depression in humans: A review of pharmacokinetic–pharmacodynamic modelling of reversal. Algera MH, Kamp J, van der Schrier R, et al. British Journal of Anaesthesia. 2019;122(6):e168-e179.
  8. Opioid-induced constipation: a narrative review of therapeutic options in clinical management. Lang-Illievich K, Bornemann-Cimenti H. The Korean Journal of Pain. 2019;32(2):69-78.
  9. A comprehensive review of opioid-induced hyperalgesia. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. Pain Physician. 2011;14(2):145-161.
  10. What do we know about opioids and the kidney? Mallappallil M, Sabu J, Friedman E, Salifu M. International Journal of Molecular Sciences. 2017;18(1):223.
  11. The neurobiology of opioid dependence: Implications for treatment. Kosten T, George T. Science & Practice Perspectives. 2002;1(1):13-20.
  12. The effect of opioid therapy on endocrine function. Brennan MJ. The American Journal of Medicine. 2013;126(3):S12-S18.
  13. Opioids and infectious diseases: A converging public health crisis. Schwetz TA, Calder T, Rosenthal E, Kattakuzhy S, Fauci AS. The Journal of Infectious Diseases. Published April 4, 2019.
  14. Comorbidity of opioid-related and anxiety-related symptoms and disorders. Langdon KJ, Dove K, Ramsey S. Current Opinion in Psychology. 2019;30:17-23.
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