Opiate & Opioid Addiction

Opiates and opioids are used for legitimate medical purposes, such as pain relief. Over time, however, they can cause addiction and many other serious consequences.

Opiates and opioids are terms for narcotics that are generally used interchangeably. While these drugs are prescribed to relieve acute pain, prolonged use can lead to abuse, addiction, tolerance and physical dependence. Opioid addiction is a disease that has destroyed the lives and families of millions. While there is no cure for opioid addiction, this disease can be treated in drug addiction rehabilitation.

Common opioids include prescription painkillers such as:

• Hydromorphone (Dilaudid)
• Oxycodone
• Hydrocodone 
• Fentanyl
• Heroin

To understand opioid addiction fully, it’s important to know why these drugs are so addictive and why they’re used in medicine.

What Is Opioid Addiction?

Opioid addiction is a complex phenomenon in which a person is physically and sometimes psychologically dependent on an opioid, but they find it hard to quit even though they know it is harmful. Opioid addiction is characterized by a person showing two or more of the following symptoms:

• Taking more opioids or for a longer time than intended
• Previous unsuccessful attempts to quit opioids
• Spending a lot of time obtaining or taking opioids
• Cravings for opioids
• Inability to fulfill life responsibilities due to opioids
• Interpersonal problems caused by opioids
• Giving up other activities because of opioids
• Taking opioids even when it is hazardous to do so
• Taking opioids even though you know doing so is harmful to you
• Needing more opioids to achieve the same effects as before
• Withdrawal symptoms when you stop taking opioids

Causes of Opioid Addiction

When a person takes an opioid, the drug enters the brain and creates a flood of feel-good chemicals. Because the high is unlike any naturally-occurring rush of dopamine or endorphins, the only way a person can experience it again is by using the drug again.

After repeated use, however, the brain will reduce its ability to create these chemicals naturally. As a result, a person may only be able to experience these feelings again when they use opioids. This is one of the main reasons opioids are highly addictive.

There are several steps to developing an opioid addiction. These include:

• Tolerance: When a person has to use increasingly larger doses of opioids to experience the same high
• Physical dependence: When the body enters withdrawal if the person stops taking the drug
• Psychological addiction: Mental cravings for opioids set in, leading to addictive behaviors.

Tolerance and dependence can occur independently of addiction, but they often exist together as the physical and psychological effects of opioids increase.

Opiate and Opioid Types

Although even medical experts use the terms opiate and opioid interchangeably, there are some slight differences between the two. The word “opioid” is an umbrella term in that all opiates are opioids, but the reverse isn’t always true. Opiates are naturally formed from the poppy plant. In contrast, opioids can be either naturally formed or manufactured. While some opioids are entirely synthetic, others are only semi-synthetic:

Opioids and opiates are prescribed mainly to treat moderate to severe pain. In many cases, opioids are prescribed following surgery or a medical procedure. In a recent study by The Recovery Village, participants reported using these common legal opioid drugs, some using more than one:

• Oxycodone: A semi-synthetic opioid that 68% reported using. Common brand names are Percocet (a combination drug containing oxycodone) and OxyContin.
• Hydrocodone: Of study participants, 56% reported using this semi-synthetic opioid, included in drugs like Lortab and Vicodin.
• Morphine: This is a highly addictive, naturally occurring opiate that 37% reported using.
• Codeine: This less powerful but still addictive opiate is primarily used as a cough suppressant. Codeine is typically prescribed as a combination medication, and 31% reported using this substance.
• Fentanyl: Fentanyl is a highly addictive synthetic opioid. It is commonly prescribed as a transdermal patch but is also sold illegally. About 26% of participants reported using fentanyl.

Signs and Symptoms of Opioid Abuse

When a person is abusing or addicted to opiates, they often prioritize obtaining their drug of choice and getting high above all other things. As a result, opiate abuse and addiction have many visible signs. If you suspect a friend or family member may be using opiates, you should begin to see changes in multiple aspects of their life.

Financial Signs of Opioid Abuse

Over time, people abusing any substance will begin to face financial hardships as they need more of the drug to satisfy their addiction. Almost half (45%) of all current and former opioid users report significant financial impacts from opioid use. The person may have struggles like:

• Falling behind on bills
• Needing to borrow money or take out new loans
• Selling or pawning possessions
• Stealing money or possessions from others

Professional Signs of Opioid Abuse

As addiction and physical dependence take hold, people will struggle to maintain their roles and responsibilities at work, school or home. Of survey participants who used opioids, 1 in 3 reported an impact on their career or job (37%). Signs of opioid abuse include:

• Coming in late to work or school
• Missing work or school completely
• Being unprepared or failing to meet deadlines
• Decreased performance or productivity

Legal Signs of Opioid Abuse

Of the opioid users surveyed, 16% had experienced a legal issue because of their opioid use. A person addicted to opioids could have multiple encounters with law enforcement, leading to:

• Being arrested or jailed
• Incurring fines
• Starting probation
• Losing their license to drive

Social Signs of Opioid Abuse

When asked about their social lives, 46% of opioid survey respondents reported that opioids affected their relationships with loved ones. As the drug becomes a person’s main motivator, other aspects of life will be pushed to the background, leading to issues like:

• Spending less time with established friends and family
• Spending more time with a new group of friends
• Isolating and staying away from others
• Being more irritable, secretive or confrontational with others
• Canceling plans or frequently being late

Factors That Influence Opioid Addiction Risk

Some people will experience the signs of addiction very quickly, while others using the drug similarly will not. It seems that several risk factors increase the occurrence of opioid addiction. They include:

• Using substances over the long term
• Beginning to use substances from a young age
• Poverty
• Unemployment or poor work history
• Substance abuse among family members
• Stressful or traumatic life experiences
• Chaotic or dangerous environment

A person who experiences more risk factors will be in increased danger of developing an opioid use disorder or addiction, but not having these added risk factors does not exclude a person from possibly gaining an opioid addiction.

Short-Term Effects of Opioid Addiction

Opiate abuse can start to rewire the brain over time and elicit changes in behavior, psychology and physiology. As a result, you may notice physical and psychological changes in a person struggling with opiate or opioid abuse.

Initial physical symptoms of opioid addiction are:

• Dry mouth
• Constipation
• Feeling lightheaded
• Feeling euphoric and overly elated
• Constricted pupils
• Lack of coordination
• Sleeping too much
• Nausea and vomiting

Dangerous symptoms and side effects of opioid use can occur during any use. More severe symptoms may progress as use continues.

Severe symptoms include:

• Slowed heartbeat
• Slowed or shallow breathing
• Dizziness/drowsiness
• Low blood pressure

Psychological symptoms of opiate abuse are:

• Confusion
• Loss of appetite
• Irritability
• Mood swings
• Depression

Opiate abusers are also at an increased risk for certain health concerns, including HIV and hepatitis, due to injecting opiates intravenously. All opiate users also regularly risk experiencing an overdose, which is a medical emergency that can easily turn lethal if not treated immediately.

Long-Term Health Effects of Opioid Addiction

The longer a person abuses opioids, the more at risk they are for causing serious and sometimes permanent damage. Long-term health effects of opioid abuse include damage to body parts such as the brain, heart, central nervous system and other major organs. Opiate abuse can affect pregnancy and cause adverse health effects in fetuses and newborn babies.

The Recovery Village recently asked current and former opioid users what long-term effects they experienced because of their opioid use, misuse and abuse.

Among this group, reported long-term opioid and opiate use effects included:

• A weakened immune system (38%)
• Gastrointestinal issues, such as constipation and bowel obstruction (43%)
• Respiratory depression (18%)
• Bloodborne infections and illnesses (25%)
• Vein collapse (19%)
• Coma (8%)
• Skin abscesses (22%)
• Sexual dysfunction/impotence (20%)
• Brain damage and loss of cognitive abilities (16%)
• Dental problems (26%)
• Depression (42%)

Pregnant women who are addicted to opiates not only put their bodies at risk, but they also put their babies at risk for addiction in utero and after they are born. About 14% of those surveyed about opioid use reported pregnancy and/or neonatal complications. 

Prenatal opiate exposure risks:

• Preterm birth
• Low birth weight
• Neonatal abstinence syndrome, including tremors, convulsions and respiratory distress
• Infant opiate addiction
• Newborn withdrawal
• HIV-positive infants
• Hepatitis-positive infants

How Opioids Affect the Brain?

Opioids can impact the brain both over the short and long term. The consequences of opioid use can, therefore, vary depending on how long you take the drug:

• Over the short term, opioids trigger the brain’s reward system while blocking pain signals at the level of the spinal cord. Opioids also have a depressant effect, which can lead to slowed breathing, a major cause of overdose.
• Over the long term, your brain gets acclimated to the presence of the opioid, requiring higher and higher doses. In addition, you may become more sensitive to pain, develop mental health issues like depression, and increase the risk for falls and fractures from sedation and dizziness.

Opioid Overdose

An opioid overdose is an unfortunately common consequence of opioid addiction. Between February 2022 and January 2023, more than 79,000 Americans died from an opioid overdose. An opioid overdose can occur when:

• You take too much of an opioid.
• You take an opioid more often than you should.
• You mix the opioid with other substances, including benzodiazepines or alcohol.

Opioid overdose symptoms include:

• Pale or clammy skin
• Purple or blue fingers or nails
• Limp muscles
• Vomiting or gurgling noises
• Unresponsiveness
• Slowed or stopped breathing or heart

Opioid Withdrawal Detox & Withdrawal Timeline

Your opioid detox and withdrawal timeline depends heavily on the type of opioid you take. If you take a long-acting opioid like OxyContin, your timeline will be longer than a person who takes a short-acting opioid like heroin. 

Short-acting opioid withdrawal timeline:

• Symptoms begin within 12 hours of the last dose
• Symptoms peak within 24–48 hours of the last dose
• Symptoms resolve within three to five days after the last dose

Short-acting opioid withdrawal timeline:

• Symptoms begin within 30 hours of the last dose
• Symptoms peak within three to eight days after the last dose
• Symptoms resolve within 10 days of the last dose, although it may take longer in some cases

After withdrawal is, you may notice persistently lingering symptoms like anxiety, depression and insomnia over the next few weeks to months. This is normal, and these symptoms resolve with continued abstinence.

Withdrawal symptoms stay generally consistent throughout the withdrawal period, no matter how long it lasts. Medication-assisted treatment (MAT) can be prescribed if medically appropriate to ease and prevent withdrawal symptoms, but there is no shortcut through detox and the withdrawal process itself. Withdrawal symptoms include:

• Muscle aches
• Sleeping problems
• Runny nose and eyes
• Sweating
• Yawning
• Enlarged pupils 
• Abdominal cramps
• Diarrhea
• Goosebumps
• Nausea and vomiting
• Agitation
• Anxiety

Diagnosing Opioid Addiction

To determine if someone is being negatively impacted by opioids, mental health and addiction professionals will work with them to evaluate if they have an opioid use disorder, the clinical term for opioid addiction. As a recognized psychological condition in the DSM-5, opioid use disorder involves ongoing substance use that results in:

• Opioids being used in large amounts for long periods
• Repeated, unsuccessful attempts to reduce or end opioid use
• Excessive time, energy, effort and money spent using and recovering from use
• Cravings and strong urges to use
• Struggling to meet expectations at home, work or school
• Continuing to use opioids despite conflict with loved ones
• Quitting fun or important activities to spend more time using
• Using opioids in dangerous situations, like driving
• Needing to take more of the opioid to produce the desired effect
• Feeling ill or uncomfortable when the drug is not present

To be diagnosed with an opioid use disorder, a person only needs to show two of the signs and symptoms listed. Having more could indicate a more significant and problematic condition.

Treatment and Resources for Opioid & Opiate Addiction

Treatment for opioid and opiate use disorders should be tailored to the unique symptoms and needs of the individual. Fortunately, a full continuum of care is available to people in need. Some of the best and most impactful treatment options include:

Inpatient/Residential Care

People struggling significantly with their addiction to and dependence on opioids may require a period of inpatient or residential care. These are the most intensive and regulated forms of treatment where the individual lives at the treatment center.

Inpatient treatment often occurs at a rehab treatment facility or a hospital. Both are staffed by treatment experts around the clock to best meet the needs of those affected by opioids.

Outpatient Services

Outpatient treatment generally refers to all services that allow the person to live at home while attending treatment and receiving services at the treatment center. Multiple outpatient levels of care exist, and treatments can range anywhere from 30 hours each week to one hour each month. The treatment team will work to coordinate the amount of care that fits the patient’s needs.

Detoxification

Available at the inpatient/residential or outpatient levels of care, medical detoxification (detox) is often the first step in recovery. As opioids leave the body, they create uncomfortable and distressing mental and physical withdrawal symptoms, so professional detox services work to increase comfort, ease the process and aid recovery.

Therapy

Also available at all levels of care, individual and group therapy help patients better understand themselves and their addictions. A range of therapy options can help identify the underlying factors leading to addiction and discover ways to avoid relapse in the future.

Medication Services

Many people with opioid use disorders will utilize medication-assisted treatment (MAT) to reduce withdrawal symptoms and encourage recovery. Patients can receive prescriptions for medication that interacts with the opioid system in the brain to block or trigger the release of neurotransmitters.

Options for MAT include:

• Methadone
• Buprenorphine (Suboxone)
• Naltrexone

Prescribers may also prescribe medications to address co-occurring mental health disorders that could encourage substance use.

Support Groups

Support groups like SMART Recovery or 12-step programs are not meant to replace professional treatment options. Instead, they are intended to extend or complement therapy and medication. With their focus on fellowship and understanding, support groups are great options for many during and after treatment.

Outlook for Opioid Addiction

Recovery from opioid addiction is a lifelong process. Relapse is a common and expected part of the disorder: 4 in 5 opioid users report relapsing after starting their recovery. Experts agree that seeking professional treatment that matches a person’s situation and staying in that treatment for the appropriate amount of time can significantly increase periods of sustained recovery. People who do not seek professional treatment or who do not finish treatment are at a much higher risk of future relapse. Thankfully, among the opioid rehab patients surveyed, 87% report completing their first treatment program thoroughly.

How The Recovery Village Helps Opiate & Opioid Addiction

At The Recovery Village, we believe in going beyond offering simple medical detox and rehab options. Instead, we support you every step of your recovery, offering a full continuum of care from medical detox to rehab to aftercare. We are invested in your success on your road to recovery. There is no better time to seek treatment than now — contact us today to learn more.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more