Article
Opioid Addiction – Signs, Withdrawal, & Recovery
What Are Opioids?
Opioids are a class of drugs that relieve pain but also carry a high risk of addiction. They include prescription painkillers like oxycodone and hydrocodone, as well as illegal drugs like heroin and synthetic opioids like fentanyl.
The National Institute on Drug Abuse (NIDA) defines them this way: “Opioids are a class of natural, semi-synthetic, and synthetic drugs. These include both prescription medications used to treat pain and illegal drugs like heroin. Opioids are addictive. Use of opioids either by themselves or in combination with other drugs is a major driver of the drug overdose crisis in the United States”.
Natural Opioids
Opioids have been used for a very long time, but most of them have been derived from nature. Examples of natural opioids include:
- Morphine
- Thebaine
- Codeine
- Opium
All four of these substances come from poppy seeds.
Semi-Synthetic Opioids
Semi-synthetic opioids are made in laboratories using natural opioids and special chemical processes. They include:
- Heroin
- Hydrocodone
- Oxycodone
- Oxymorphone
Synthetic Opioids
Synthetic opioids are not derived from nature and are often many times stronger than natural opioids, increasing both their impact on the brain and body and their potential to be addictive. For instance, fentanyl can be up to 100 times stronger than morphine. Examples of synthetic opioids include:
- Fentanyl
- Tramadol
- Methadone
Regardless of legal status or whether they’re natural, semi-synthetic, or synthetic, these drugs work by binding to opioid receptors in the brain, reducing the perception of pain and creating feelings of euphoria.
How Do Opioids Affect the Brain?
Opioids bind to receptors in the brain’s reward system, triggering the release of dopamine. This surge of dopamine reinforces opioid use by creating intense pleasure and relaxation. Over time, repeated opioid use alters brain function, leading to dependence, tolerance, and addiction.
It’s similar to how alcohol works in the brain in terms of affecting the built-in reward systems. Like opioids, alcohol triggers the release of dopamine. The stronger the surge of this hormone, the stronger the urge to repeat the action that triggered it. Repeated triggering creates habits, like alcohol addiction or opioid addiction.
Note that opioids do more than just relieve pain and induce relaxation and euphoria. They also:
- Affect your breathing.
- Affect your ability to deal with stress.
- Affect the communication of nerve cells to the brain.
The general idea of opioid use is that they “make you feel good”, but that isn’t entirely accurate. After all, “good” is pretty subjective. So, how do opioids actually make people feel? Some terms used to describe the situation include:
- Pain-free
- Intensely happy or euphoric
- Relaxed
- Drowsy
- High
A Look at Opioids in the Body
When opioids are taken (orally, intravenously, nasally, etc.) they enter the bloodstream. The speed of entry depends on a few factors, including the type of opioid and its strength, along with the delivery method. Oral intake (e.g., pills or tablets) releases opioids more slowly into the body than intravenous injection does.
Once in the bloodstream, they travel throughout the body, but most importantly they move to the brain and spinal cord. There, they bind to receptors in the brain designed for the body’s own naturally occurring molecules (e.g. endorphins and enkephalins).
What Is Opioid Addiction?
Opioid addiction, or opioid use disorder (OUD), is a chronic brain disease known for compulsive opioid use even in the face of harmful consequences. It involves physical dependence, psychological cravings, and difficulty quitting without professional help.
According to the Centers for Disease Control (CDC), opioid use disorder “is a problematic pattern of opioid use that causes significant impairment or distress. OUD is a treatable, chronic disease that can affect anyone – regardless of race, gender, income level, or social class.”
Given that opioid addiction can affect anyone at all, it’s important to recognize the signs and symptoms of OUD.
What Are the Signs and Symptoms of Opioid Addiction?
Signs and symptoms of opioid addiction can be physical, mental, and behavioral and include cravings, risky opioid use, withdrawal symptoms when not using opioids, increasing tolerance, and continued use of opioids despite negative consequences.
While most people fighting opioid addiction will show at least some of the signs and symptoms discussed below, understand that they’ll vary considerably from one person to another. There’s also the fact that many people attempt to hide their symptoms, which can make it very challenging to notice them.
Signs of opioid addiction include:
- Strong physical and emotional cravings for opioids can be overwhelming even when the person understands the negative outcomes of using them
- Risky use of opioids, such as while driving or engaged in an activity that requires significant mental focus, or in situations that put the user in danger
- Withdrawal symptoms when not using opioids, like sweating, increased cravings, tremors, and more
- Developing a tolerance and needing higher doses to achieve the same level of sensation, can increase the risk of overdose
- Using opioids in larger amounts or for longer than intended
- Unsuccessful attempts to cut back or quit
- Spending excessive amounts of time obtaining, using, or recovering from opioid use
- Neglecting responsibilities and social activities in favor of using opioids, including activities the person previously enjoyed like hobbies
- Continuing opioid use despite negative consequences
- Financial, legal, and relationship problems due to opioid use (job loss, relationship damage, etc.)
The list above includes some of the most common signs of opioid addiction. However, it’s important to know the symptoms of use to watch for. The list below includes symptoms of active use of opioids, as well as symptoms of addiction:
- Changes in sleeping, eating, and bathing habits
- Unexplained weight loss
- Decreased libido
- Frequent flu-like symptoms
- Changes in exercise habits
- Isolation from friends and family members
- Changes in hygiene habits
- Increasing financial difficulties
- Stealing from work, friends, and/or family members
Who Is Most at Risk of Opioid Addiction?
Anyone can suffer from opioid addiction but, some populations are groups are more at risk, including veterans, Native Americans, and Alaska Natives.
These groups are at greater risk for several reasons. One of those is that they often have existing mental health conditions like depression or PTSD. Second, many have limited access to healthcare, limited economic opportunities, and live in or are part of disadvantaged communities.
What Are the Dangers of Opioid Addiction?
Opioid addiction poses serious health risks, including risk of overdose and death, as well as long-term health complications.
Overdose
An opioid overdose happens when excessive opioid use suppresses breathing, leading to unconsciousness and potential death. Signs include slow or stopped breathing, blue lips, and unresponsiveness. Naloxone (Narcan) can reverse an overdose if it’s administered in time.
According to the National Institute on Drug Abuse:
- Almost 74,000 overdose deaths were attributed to synthetic opioids (other than methadone) just in 2022.
- Almost 108,000 people died from drug-involved overdoses in the US in 2022.
- 81,806 people died in 2022 from opioid-involved overdoses, an increase from 49,860 in 2019.
- Over 16,000 people died from overdosing on prescription opioids in 2022.
- Heroin-related deaths decreased to 5,871 in 2022, but the number of deaths involving heroin and fentanyl increased by almost 80%.
Health Complications
Long-term opioid use increases the risk of infections (HIV, hepatitis C), heart problems, lung conditions, and mental health disorders like depression and anxiety.
- Infections: The CDC noted a dramatic increase in blood-borne infections, including HIV and viral hepatitis, related to opioid use disorder. In most cases, the increased risk came from using contaminated equipment, as well as spending time in unsanitary conditions, and the general population being less likely to be vaccinated.
- Heart Problems: A large study following 50,000 individuals found that those who had received opioid prescriptions were more likely to develop cardiovascular disease and that higher opioid doses were associated with a higher risk of cardiovascular disease.
- Lung Conditions: Opioids have a pronounced effect on the pulmonary system. Misuse of opioids can suppress breathing and lead to hypoxia and suffocation (a primary cause of death in overdose cases). Opioids also make asthma symptoms worse, and individuals with existing lung conditions are more likely to die from opioid overdoses. Studies have also shown a connection between opioid use and both pneumonia and COPD.
- Mental Health: Opioids alter brain chemistry, which can lead to the development of mental health disorders, as well as amplify existing mental health disorders. Some of the most common mental health impacts seen in opioid addiction include: ADHD, bipolar disorder, depression, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD).
Opioid addiction poses serious risks. However, quitting opioids without assistance can also be dangerous so it is important to seek medical support to manage withdrawal symptoms.
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What Is Opioid Withdrawal?
Opioid withdrawal happens when someone reduces their opioid use or stops entirely, causing flu-like symptoms, intense discomfort, anxiety, and other symptoms.
Because opioid withdrawal can be severe, it’s important to know the symptoms, the timeline of progression, and the importance of medical supervision and support.
Symptoms of Opioid Withdrawal
Common withdrawal symptoms include:
- Anxiety and restlessness
- Insomnia
- Muscle aches and chills
- Runny nose and sweating
- Nausea, vomiting, and diarrhea
- Generalized pain
- Fever
- Intense cravings
- Elevated heart rate
- Elevated blood pressure
- Dilated pupils
Timeline
Opioid withdrawal symptoms typically begin within 6 to 12 hours for short-acting opioids and 24 to 48 hours for long-acting opioids. Physical symptoms peak within two to three days and gradually subside over a week. However, psychological symptoms can last much longer and sleep disruption and mood symptoms can last for several months.
Medical Supervision
Medical supervision during withdrawal helps manage symptoms safely and reduces the risk of complications. Physical withdrawal symptoms can be very uncomfortable. However, the psychological symptoms are even more concerning, including the potential for severe psychiatric symptoms.
How Can You Overcome Opioid Addiction?
Overcoming opioid addiction requires an effective strategy that includes medication-assisted treatment (MAT), therapy, and support groups.
Medication-Assisted Treatment (MAT)
MAT combines medications with therapy to help manage cravings and withdrawal symptoms. Common medications include:
- Methadone: Reduces cravings and withdrawal symptoms.
- Buprenorphine: Partially activates opioid receptors to ease withdrawal.
- Naltrexone: Blocks opioids from binding to receptors, preventing their effects.
Psychotherapy can help individuals talk through their withdrawal symptoms. It can help them change how they think, learn new coping techniques, address their reactions to their addiction and the causes of addiction, and build their self-confidence, all of which are important for successfully quitting opioids.
Therapy
Therapies like cognitive-behavioral therapy (CBT) and motivational interviewing help individuals develop coping strategies and increase motivation to continue in treatment. These types of therapies usually play a role in MAT, but they can also be used in situations where medication might not be necessary to help the person learn the skills necessary to avoid relapse. Many therapies are helpful for people struggling with substance use disorders including Acceptance and Commitment Therapy (ACT) which helps move people toward their goals by examining their values and helping them behave in ways that are consistent with their values. Mentalization Based Therapy (MBT) helps people reflect on their mental states and be more aware of their own needs and desires and the needs and desires of others, so they can more successfully navigate interpersonal challenges.
Some therapies treat co-occurring conditions like PTSD and trauma such as Cognitive Processing Therapy (CPT) which is a structured form of cognitive-behavioral therapy (CBT) specifically designed to treat post-traumatic stress disorder (PTSD) and related conditions. It helps individuals process and reframe traumatic experiences by addressing maladaptive thoughts and beliefs, and reducing symptoms like anxiety, depression, and intrusive memories. Some people with trauma benefit from Somatic Experiencing which is a treatment that helps people identify and cope with physical sensations in their body that occur as a result of trauma. This bottom-up approach is helpful for people who may struggle with top-down or cognitive therapies.
It’s important for a trained mental health professional to do a full evaluation of all the drivers of Opioid use disorder and to put together a treatment plan that addresses both the physiological aspects of the addiction as well as the psychological aspects of the use including providing skills and strategies to manage triggers and cravings and targeted therapies to assist with co-occurring disorders to create a holistic treatment plan.
Support Groups
Groups like Narcotics Anonymous (NA) and SMART Recovery offer peer support, accountability, and shared experiences to improve chances of recovery.
What Is the Role of Support Groups in Opioid Addiction Recovery?
Support groups offer encouragement, accountability, and a sense of community. They provide a safe space to share struggles and successes, reducing isolation and increasing motivation. Group members can share, but many initially get a lot of value simply from listening to others’ stories and realizing that they are not alone.
Narcotics Anonymous (NA) is closely aligned with Alcoholics Anonymous (AA).
If you like the 12-step nature of Narcotics Anonymous but have a dual diagnosis, Dual Recovery Anonymous (DRA) might be the better choice.
On the other side of the spectrum, there’s SMART Recovery, which stands for self-management and recovery training. It focuses on peer support, CBT, and motivational psychology.
There is also LifeRing Secular Recovery. Where NA has religious connotations, LifeRing takes a secular approach to opioid addiction recovery.
How Can You Prevent Opioid Addiction?
Preventing opioid addiction involves responsible medication use, risk awareness, and community support. It also means dealing with underlying causes that might drive someone to use opioids, such as trauma or PTSD.
Prescription Opioid Use
- Follow prescription instructions carefully. Don’t take more than prescribed. Only take the medication if you genuinely need it.
- Store medications securely. Don’t leave them out and openly accessible. Keep them somewhere out of sight and don’t talk about your prescription.
- Dispose of unused opioids properly. Most pharmacies offer a simple way to dispose of unused opioids. Never flush them down the toilet or put them in the trash.
Risk Factors
- A family history of addiction increases your risk for opioid addiction. If you have a family history of addiction, ask your doctor about alternatives to opioids.
- Mental health conditions like depression and anxiety can increase your risk for addiction. Speak to your doctor about any mental health conditions before taking opioids.
- Exposure to trauma is another major risk factor and is one of the largest reasons people turn to opioids (both legal and illegal).
Support and Education
- Open communication with healthcare providers about the challenges you face can help you avoid addiction. Discuss your mental health, your family’s history, traumatic events in your past, and any previous drug or alcohol use.
- Learn more about opioid risks. The more you understand, the easier it will be to use any prescription opioids correctly and avoid using illegal ones.
- Create a support network. You’re not alone. Friends and family can be there to support you through tough times. Counselors, therapists, and support groups add their strength to help you become more resilient.
Conclusion
Opioid addiction is a serious but treatable condition. Recovery is possible with the right support and treatment. If you or someone you know is struggling with opioid addiction, seek help today.
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