Some of the initial signs and symptoms of painkiller abuse can be as simple as not taking medicines as they’re prescribed. Of course, if someone is taking medications they’re not prescribed, this is already a sign of abuse, even if they’re taking minimal amounts. Generally, when someone starts to abuse prescription pain medications, they’ll take a higher dose than what’s prescribed, particularly as they start to build a tolerance. They also may look for alternate ways to take the drug, such as crushing it up or pairing it with alcohol, which would heighten the effects. Physical and other behavioral signs may also be present, many of which are similar to what you would see when someone is abusing any other kind of drug.

Signs of Painkiller Abuse

Changes in physical appearance that could indicate the abuse of painkillers include pupils that are dilated or constricted, changes in weight, and bloodshot or glazed eyes.  With painkillers, people who are abusing them will most often seem very drowsy, or they could nod off without realizing it.

Some general signs of painkiller intoxication and abuse may include:

  • Drowsiness
  • Poor concentration
  • Memory problems
  • Constipation
  • Slower breathing rate
  • Slower reactions and movements
  • Apathy
  • Mood swings
  • Depression

There are also a variety of lifestyle changes that may occur and indicate painkiller abuse. These can include:

  • People who are abusing painkillers may have less money, or they may try to do things like stealing or illegal activities to get more money to pay for the drugs.
  • There is a sense of preoccupation that almost always occurs when someone is using prescription painkillers or any other drug that they’re abusing. They’re more concerned with maintaining their addiction than other areas of their life, so their social interactions and work can start to suffer.
  • Drug users may acquire a new group of friends who are also using drugs.
  • In general school and work are usually neglected if a person is abusing drugs.
  • Individuals who are taking painkillers may exhibit angry outbursts or a general change in attitude. They may also appear anxious or as if they’re keeping secrets or not being forthcoming. There can be an overall sense of irritability as well.
  • It’s not uncommon for people who are abusing prescription painkillers to become very aggressive toward individuals who try to talk to them about the drugs, or who they perceive as trying to control their actions.
  • The user’s grooming habits can start to decline, and they can lose interest in their physical appearance.
  • Users will often ask to borrow money from family members, or they may turn to stealing to support their habit.
  • If someone the user knows has a prescription for painkillers, they may go missing.
  • Sleep patterns often change and can include sleeping during the day and staying up at night.

People who are abusing painkillers may also start to make excuses. They can make excuses as to why they’re using painkillers, as well as why their behavior is changing. There can also be excuses as to why they’re unable to stop using the drugs, or they can start trying to convince the people around them they’ll stop using them, but they aren’t able to.

Physical Symptoms & Side Effects of Painkiller Abuse

There is always the risk of physical side effects that can come with the use of any painkiller, including OTC medicines, but the risks are exceptionally high with prescription painkillers. Narcotic painkillers are responsible for a significant number of deaths each year, not even including accidental overdoses.

Opioids, which is what narcotic painkillers are, interact the brain’s opioid receptors, and this prevents the release of a chemical called GABA. GABA is responsible for controlling the release of dopamine and other neurotransmitters, so when it’s impacted, it causes dopamine to flood into the brain, which is what creates the high prescription drug users feel.

Physical symptoms can include relaxation of the iris and the muscles, but it also slows reaction times and makes it harder to control your movements. Lethargy and paranoia may be seen with abuse, as well as respiratory depression.

Other side effects in the short-term can include constipation or diarrhea, nausea, and vomiting. Muscle spasms may occur as well. People who are abusing prescription painkillers may start to experience more pain and side effects like headaches and muscle aches.

Depression and anxiety may occur as the result of using painkillers, as can paranoia, confusion, disorientation, distorted perception of reality and feelings of anger or hostility. More serious side effects of opioids can include liver damage and brain damage.

Addiction itself can be a very serious side effect of using painkillers. For some people, because of the effect of opiates on the brain, addiction may occur in less than three days. Driving while using opiates can be dangerous because of impacted reaction times.

Long-Term Health Effects of Painkiller Abuse

The effects of painkiller abuse can be apparent in the short-term or the long-term, and the consequences can be deadly. Long-term effects of painkiller abuse can be physical, psychological and social.

Some of the long-term physical effects of painkiller abuse include:

  • Liver and/or kidney disease or failure
  • Lowered immunity
  • Gastrointestinal problems
  • Cardiovascular issues
  • Impaired mental function
  • Collapse of the respiratory system
  • Death resulting from toxicity or overdose

Opiates can have severe effects on the digestive system, and when people are long-term abusers, they may rely on laxatives for bowel movements. They may also have damage to the anus because of this.

There is also something called narcotic bowel disorder, which is the result of the impact the drugs have on the bowel system. The slowdown can lead to nausea, vomiting, bloating and distention of the abdomen.

Regarding the liver, this is the organ responsible for processing and breaking down drugs, so long-term narcotic use can put an intense amount of strain on it. The liver may then start storing toxins, which can be particularly true with drugs that contain acetaminophen as well as opioids.

A condition called rhabdomyolysis may occur, in which muscle tissue breaks down very quickly,  leading to complete immobilization for hours. Muscles can begin to disintegrate, which can then result in damage to other organs. Many people who use prescription painkillers for long periods of time may also need kidney dialysis or transplants.

When someone experiences problems with their kidneys, it can lead to kidney failure which can then contribute to a heart attack or other damage to their heart.

With long-term use, other side effects may also include hormonal dysfunction including reduced fertility and libido, immunosuppression, testosterone depletion, and abnormal pain sensitivity.

Painkillers can not only cause severe and even deadly physical symptoms in the short-term and the long-term. They’re also responsible for a variety of mental, emotional and psychological symptoms. In the short-term when using painkillers people can become angry, hostile, withdrawn or confused. These problems can continue in the long-term and become more pervasive.

For people who are long-term painkiller abusers, their personality or character can change indefinitely as a result. Painkillers have such a profound effect on the brain’s systems and neurotransmitters that it may be difficult to reverse these impacts, and it can lead to overall decay of mental function.

Other long-term psychological symptoms may include:

  • Frequent mood swings
  • Behavior extremes
  • Depression
  • Anxiety
  • Confusion
  • Paranoia and increases in fear
  • Problems with reality perception
  • Feelings of low self-esteem
  • Rage and hostility
  • Isolate from loved ones
  • Broken relationships

Painkillers are a very harmful addiction to have, and the side effect can impact nearly every aspect of the person’s body, mind, and life. With long-term use, there’s hardly any area of the user’s life that would be unaffected by their drug abuse, which is why it’s so important to recognize the signs and symptoms early on and seek methods of treatment. Essentially, long-term use of painkillers and prescription narcotics can lead to a complete breakdown of many of the body’s systems and organs, as well as mental function.


Anson, Pat. “Sharp Rise in Suboxone Emergency Room Visits.” National Pain Report, 31 Jan. 2013, Accessed 27 Feb. 2017.

Blum, Kenneth, et al. “Withdrawal from Buprenorphine/Naloxone and Maintenance with a Natural Dopaminergic Agonist: A Cautionary Note.” PubMed Central, National Institutes of Health, 22 Nov. 2013, Accessed 2 Feb. 2017.

“Buprenorphine Sublingual and Buccal (Opioid Dependence).” MedlinePlus, U.S. National Library of Medicine, 16 Sept. 2016, Accessed 2 Feb. 2017.

“Buprenorphine.” DEA Diversion Control Division, U.S. Drug Enforcement Agency, July 2013, Accessed 2 Feb. 2017.

“The DAWN Report: Emergency Department Visits Involving Buprenorphine.” Substance Abuse and Mental Health Services Administration, 29 Jan. 2013, Accessed 2 Feb. 2017.

“Is Buprenorphine Addictive?” The National Alliance of Advocates for Buprenorphine Treatment, Accessed 2 Feb. 2017.

Mental Health Daily. “How Long Does Suboxone Stay In Your System?” Mental Health Daily, Accessed 27 Feb. 2017.

National Center for Biotechnology Information. “Buprenorphine.” The PubChem Open Chemistry Database, Accessed 27 Feb. 2017.

National Center for Biotechnology Information. “Naloxone.” The PubChem Open Chemistry Database, Accessed 27 Feb. 2017.

“Opioids.” Substance Abuse and Mental Health Services Administration, 23 Feb. 2016, Accessed 2 Feb. 2017.

Schuman-Olivier, Z., et al. “Benzodiazepine Use During Buprenorphine Treatment for Opioid Dependence: Clinical and Safety Outcomes.” National Center for Biotechnology Information, National Institutes of Health, 1 Oct. 2013, Accessed 2 Feb. 2017.

Sontag, Deborah. “Addiction Treatment With a Dark Side.” The New York Times, 16 Nov. 2013, Accessed 2 Feb. 2017.

“Suboxone Dosing Guide.” The National Alliance of Advocates for Buprenorphine Treatment, . Accessed 2 Feb. 2017.

“Suboxone: The New Drug Epidemic?” National Pain Report, 23 Sept. 2013, Accessed 2 Feb. 2017.

“SUBOXONE® (Buprenorphine and Naloxone) Sublingual Film (CIII).”, Indivior Inc., Dec. 2016, Accessed 2 Feb. 2017.

“What Exactly is Buprenorphine?” The National Alliance of Advocates for Buprenorphine Treatment, . Accessed 2 Feb. 2017.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with 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 providers.