Opiate and opioid drugs affect the same brain receptors and have the same effects on the central nervous system. Opiates are derived naturally, but opioids are man-made. However, while the term “opiates” only describes natural drugs, “opioids” is used as an umbrella term for both natural opiates and synthetic opioids.
While opioids are prescribed to relieve acute pain, prolonged use can lead to abuse, addiction, tolerance and physical dependence. Common opioids include prescription painkillers such as Dilaudid, oxycodone, hydrocodone and fentanyl, as well as the illicit drug heroin. Opioid addiction is a large contributor to overdose deaths in the United States. In 2019, there were 70,630 fatal overdoses, and opioids were responsible for 70.6% of these deaths. 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.
To fully understand opioid addiction, it’s important to understand why these drugs are so addictive and why they’re used in medicine.
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How Opioid Addiction Happens
Opiates are highly addictive drugs, making addiction a very real possibility. When a person takes an opioid or opiate, the drug enters the brain through the bloodstream and creates a flood of artificial endorphins and dopamine. These are neurotransmitters responsible for feelings of reward, pleasure and satisfaction, and the opioid’s effect on them creates a rush of euphoria. 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 dopamine and endorphins naturally. As a result, a person may only be able to experience these feelings again when they use opioids. Because of the strong and desirable feelings that flood the brain, and because they may no longer feel pleasure naturally, they may crave an opioid high. People choose to abuse opioids to lessen their pain and continue experiencing these euphoric feelings on demand. 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 would enter 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 independent of addiction, but they often exist together as the physical and psychological effects of opioids increase.
- What are opiates?
Opiates are derived from the opium plant and used to treat pain. These substances carry a high risk of addiction for anyone who takes them for a prolonged period, even if they are used as prescribed.
For almost as long as they have existed, opiates have been used for both medicinal and recreational purposes. The Sumerians first cultivated the opium poppy plant (Papaver somniferum) in 3,400 B.C. They referred to it as the “joy plant,” and the wonder drug was soon passed around the world as merchants learned of its multiple uses. Opium was used not only to relieve pain but to induce sleep and relieve bowel issues. Opiates are also frequently used to treat coughs.
- What are opioids?
While there is no major difference in their effectiveness, opioids are synthetic or partly synthetic drugs that act similarly to naturally-made opiates. With opioids, the active ingredients are synthesized by chemical processes.
However, because they are similar in how they affect the body and brain, the terms opiate and opioid are often used interchangeably. Now, when people say “opioid,” they are usually referring to any substance that is naturally or synthetically derived from the poppy.
All of these drugs can be abused and cause addiction to develop, even if they are prescription medications. Even when used as prescribed, tolerance and physical dependence are common and expected consequences of opioids.
- What are common street names for opiates/opioids?
People who abuse these drugs frequently refer to opioids using slang words and phrases to evade police attention. Some of the street names for a variety of opiates and opioids include:
- Nose drops
- Black tar
- China white
- Chinese H
- White dynamite
- What do opiates look like?
Opiates can range in appearance. Drugs like oxycodone and hydrocodone come in pill form. Many opioids are combination drugs that are formulated with acetaminophen or aspirin, so different pill colors can denote different drug strengths. These combinations may be pink, blue, peach or yellow.
Opiates are usually swallowed as pills to treat pain. However, if someone is misusing opioids, they may use an unapproved route of administration to feel the effects faster. These methods include:
- Chewing the drug in order to increase absorption
- Crushing and snorting pills for faster entry into the bloodstream
- Dissolving crushed pills in water and injecting them intravenously
- Smoking opioids, like in the case of smoking the gel in fentanyl patches
- Misusing opioid intravenous solutions (morphine, hydrocodone and fentanyl are manufactured as intravenous solutions for use in hospitals)
People who struggle with opioid addiction may store their pills in traditional orange pill bottles or hide them in mint tins or candy jars. If the person crushes pills and snorts them, they may keep the powder in small bags, foil pouches or twisted pieces of cling wrap.
More than half (57%) of current and former opioid users began their opioid addiction with a legitimate prescription. These people may have had surgery or an illness in which they were prescribed an opioid painkiller, resulting in addiction. For many people, prescription painkiller use leads to heroin addiction. In many cases, people who are in treatment for heroin addiction resorted to using heroin because prescription pills were more expensive and harder to obtain. Among those surveyed by The Recovery Village, one in three opioid users started with a legitimate prescription and transitioned to heroin or misusing prescription opioids.
Heroin is derived from morphine and is typically sold in powder form. The drug varies in color from white to brown. Besides powder form, heroin can also be found as granules and brown, crystalline pieces called “rocks.”
- What is an opioid overdose?
Opioid overdoses are extremely dangerous events that affect thousands each year. Overdoses occur when the amount or potency of opioids overwhelm the body, leading to a slow down of the heart and lungs. Among the current and former opioid users surveyed, 48% had gone to the hospital for an opioid-related emergency, and 37% overdosed without getting to medical care in time.
Though they survived these dangerous situations, many more did not: overdoses involving opioids led to nearly 50,000 deaths in 2019.
Some of the most common signs and symptoms of opioid overdose include:
- Nausea and vomiting
- Trouble speaking
- Weak or slowed heartbeat
- Clammy skin
- Purple or blue fingernails and lips
- Losing consciousness
Drug overdose can be fatal. If you suspect someone is experiencing an overdose, call 911 immediately. Do NOT be afraid to seek help. If you do not have access to a phone, contact Web Poison Control Services for online assistance.
- Why does long-term use of prescription opioids lead to addiction for many?
A study published in the journal Pharmacoepidemiology & Drug Safety (PDS) examined trends in prescription opioid use in the United States from 1999 through 2000, and from 2013 through 2014, and results were compared. Specifically, this study looked at long-term opioid use, which was defined as the use of prescription opioids for 90 days or longer.
In 1999-2000, 4.1% of adults were taking prescription opioid medications, and from 2013 through 2014, 6.8% of US adults were taking prescription opioids. The increase was mostly driven by an increase in the long-term use of prescription opioids, which increased from 1.8% of adults to 5.4%. Long-term use of opioids correlates with many negative health consequences.
Long-term use of opioids is associated with worse physical health, a higher incidence of benzodiazepine use, and higher rates of heroin addiction. Therefore, the study concludes, it is essential that doctors carefully weigh the risks and benefits of long-term opioid use in their patients before prescribing it.
A CDC study from 2017 reported that the sharpest increase in the likelihood of long-term dependency on prescription opioids came just five days after the initial prescription. Another spike in dependency was seen after one month. In general, however, the longer a prescription, the greater the risk of long-term addiction.
Long-term opioid use was also associated with other types of addictions. For example, the study published in PDS found a higher risk of alcohol abuse and heroin abuse among people who had been prescribed opioids for long periods. A 2016 study published in Addiction Science & Clinical Practice reported that alcohol misuse among people in medication-assisted addiction treatment for opioid use disorder was common and was associated with a greater risk of death.
Common Opioids and Opiates
Opioid pain medications 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: 56% reported using this semi-synthetic opioid, included in drugs like Lortab and Vicodin.
- Morphine: a highly addictive, naturally occurring substance found in the opium plant that 37% reported using.
- Codeine, a less powerful but still addictive substance, is primarily used as a cough suppressant. Codeine is typically prescribed as a combination medication, and 31% reported using this substance.
- Fentanyl is a highly addictive opiate that is produced synthetically. Fentanyl is commonly prescribed as a transdermal patch but is also sold illegally. About 26% of participants reported using fentanyl.
Common Signs of Opioid Addiction
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 a number of 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. Perhaps when opioid use begins, the person has a valid prescription, so the cost is low. However, as a person’s tolerance and addiction build, they will need more of the drug to meet their demand.
A person buying opioids could end up spending tremendous amounts of money. They may display significant financial signs of abuse like:
- Falling behind on bills
- Needing to borrow money or take out new loans
- Selling or pawning possessions
- Stealing money or possessions from others
Almost half (45%) of all current and former opioid users report significant financial impacts because of their opioid use.
- Professional Signs of Opioid Abuse
As addiction and physical dependence take hold, a person will struggle to maintain their roles and responsibilities. One in three survey participants who used opioids reported an impact on their career or job (37%). Due to the demands of a workplace, signs of opioid abuse in a professional setting may emerge and include:
- Coming in late to work
- Missing work completely
- Being unprepared or failing to meet deadlines
- Decreased performance or productivity
Similar educational signs of opioid abuse may present for children, adolescents and young adults who are still in school.
- Legal Signs of Opioid Abuse
People are often willing to break the law to get and use opioids. A person addicted to opioids could have multiple encounters with law enforcement, leading to:
- Being arrested
- Incurring fines
- Starting probation
- Becoming incarcerated
- Losing their license to drive
Of the opioid users surveyed, 16% had experienced a legal issue because of their opioid use.
- Social Signs of Opioid Abuse
The effects of opioid abuse could have a major impact on a person’s social functioning. As the drug becomes their main motivator, positive aspects of life will be pushed to the background, which leads to a host of social changes 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
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 a variety of physical and psychological changes in a person struggling with opiate or opioid abuse.
Initial physical symptoms of opioid addiction are:
- Dry mouth
- 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 and serious symptoms may progress as use continues.
Severe symptoms include:
- Slowed heartbeat
- Slowed or shallow breathing
- Low blood pressure
Psychological symptoms of opiate abuse are:
- Loss of appetite
- Mood swings
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 and 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 damages to various parts of the body 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%)
It is important to remember that the intention of abusing opioids is to feel the “high” that comes with taking them. However, when a person gets used to the feeling or reaches a certain tolerance, the amount they have been taking will not suffice any longer. Gradually, the dosage will start to increase, resulting in severely damaging effects on the human body.
Pregnant women who are addicted to opiates not only put their own 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
As prenatally opiate-exposed children grow, preliminary reports show a prevalence of conduct issues and emotional disturbances in small children. There was also a greater risk for slow physical development and attention-deficit/hyperactivity disorder (ADHD). While the data is still fully unclear as to how prenatal opiate exposure affects children, it is best for pregnant mothers to avoid opiate abuse and get help for their addiction before and during pregnancy.
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
- 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.
Diagnosing Opioid Addiction
To determine if someone is being negatively impacted by opioids, mental health and addiction professionals will work with the person to evaluate if they have an opioid use disorder, the clinical term for an 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 of time
- 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 disorder.
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, there is a full continuum of care 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 in which 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 client’s needs.
Available at the inpatient/residential or outpatient levels of care, 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.
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 interact with the opioid system in the brain to block or trigger the release of neurotransmitters.
Options for MAT include:
- Buprenorphine (Suboxone)
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 as an extension or complement to 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: four out of five 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 finishing their first treatment program completely.
Find the Help that You or Your Loved One Needs for Opioid or Opiate Addiction
With the stigma still surrounding opioid addiction, many people avoid going to treatment and end up endangering themselves. At The Recovery Village, we believe there is no shame in having an addiction to opioids or any other substance. Addiction is a disease, and like any disease, it requires medical care and attention. With the right course of action, including detoxification, treatment plans, and supervision from qualified staff, you can put opioid addiction in the past and lead a happy and successful life. There is no better time to seek treatment than now — contact us today to learn more.
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- Medical Disclaimer
The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.