Few people might imagine themselves becoming addicted to opioids after being prescribed these powerful drugs for pain. And, yet, that's exactly how it begins in many cases.
"Most commonly, opioid addiction arises from legitimate prescriptions after an injury or surgery. This often begins the cascade of exposure, sensitization, addiction, and abuse," Asif Ilyas, MD, MBA, president of the Philadelphia-based Rothman Orthopaedic Institute Foundation for Opioid Research & Education, tells Health.
What is opioid addiction?
Opioid addiction is a complex, chronic disease that causes a person to compulsively seek out and use opioids, even when those drugs are no longer medically necessary, says the US National Library of Medicine (NLM).
People with "a problematic pattern of opioid use" leading to problems and distress in their lives may receive a diagnosis of "opioid use disorder," notes the American Psychiatric Association. That diagnosis includes opioid dependence and opioid addiction, "with addiction representing the most severe form of the disorder," per a review published by the NLM.
How addictive are opioids? The answer: extremely. A person's odds of still being on opioids one year later increases five days into use, reports the Mayo Clinic.
According to the National Institute of Drug Abuse (NIDA), prescription opioids include:
Heroin is also an opioid, though an illegal one.
What causes opioid addiction?
Opioid addiction is complex. A combination of factors—genetic, environmental, and lifestyle—play a role, according to the NLM.
Opioids act on parts of the brain and nervous system that regulate pain, says NIDA. With long-term use, a person may become dependent on these drugs, leading to physical and psychological withdrawal symptoms, explains NLM.
According to the Mayo Clinic, it's not possible to predict who might become dependent on opioids—anyone can develop an addiction.
While researchers have examined variations in genes that may be involved in addiction, the NLM says it's unclear how such changes affect the body's response to opioids. Other risk factors, per the NLM, include:
- History of substance abuse
- Childhood abuse or neglect
- Impulsivity or sensation-seeking personality traits
- Living in a rural area
- Associating with people who abuse opioids or other substances
- Easy access to opioids
Angela L. Robinson, LPCMH, NCC, the clinical director at NorthNode Group Counseling in Dover, Delaware, points to another factor: "When a person is in pain, and the weight of their responsibilities is hanging over their heads and their livelihoods are on the line, it can lead a person to take the drugs chronically out of addiction, but also desperation. They might know there is a problem but are trying to keep up with life as normal."
What are the signs and symptoms of opioid addiction?
There are many different signs of opioid addiction to look out for in yourself or your loved ones. According to Sarah Fletcher, LPC, LAC, chief clinical officer at Sandstone Care, which has locations in Colorado, Maryland, and Virginia, opioid addiction symptoms include:
- Regular use. They take opioids for at least 10 out of 30 days.
- Hazardous use. They take substances in a way that has put them or someone they know at risk for safety.
- Interpersonal problems. Their opioid use has caused discord within their personal friendships and family relationships.
- Worried loved ones. Others that they know have expressed verbal concern about the amount or frequency of their use.
- Neglected responsibilities. They have given up hobbies or responsibilities in order to use substances instead. Also, they miss work or school obligations in order to use substances or due to being under the influence of substances.
- Withdrawal symptoms. They notice that withdrawal symptoms present when they discontinue using. These signs may include sweats, headaches, hopelessness, agitation, and more.
- Higher tolerance. They need larger amounts of substances in order to receive the same effect.
- Failed attempts to quit. They have made attempts to discontinue substances, and they have been unsuccessful.
- Cravings. When they are not using opioids, they become preoccupied with ways to use or think about using them.
What is the treatment for opioid addiction?
Due to stigma and frustration, people may try to quit opioids on their own. However, while it may be possible, it is highly ill-advised. The severity of withdrawal symptoms—fatigue, dizziness, aggression, among others—can make quitting without support challenging and potentially even lead to a stronger relapse, says Fletcher.
"Breaking the stigma around substance use and mental health disorders is important," Fletcher tells Health. "We must encourage folks who have questions or who are struggling to reach out by removing pressure and judgment."
Anyone who is interested in stopping opioid use should reach out to a medical professional. Robinson recommends getting "a treatment plan put together by an addiction specialist in an intensive outpatient program. You will get medication to help ease and control the experience, and go to behavioral counseling."
Methadone and buprenorphine, by acting on opioid receptors in the brain, can decrease cravings and withdrawal symptoms, says the NLM. A specialist can help someone taper their opioid intake, Instead of quitting use immediately.
Another medication, naltrexone, blocks opioid receptors and reduces cravings. A person can start using it seven to 10 days after they last took opioids, says the Substance Abuse and Mental Health Services Administration (SAMHSA).
Therapy is another option for people to pursue, whether it be individual, group, or family, says the NLM. Solo sessions may involve cognitive behavioral therapy, motivational enhancement therapy, or contingency management. Therapy can help to change a person's attitude towards opioids and to have them continue other treatments, such as medicine.
"Everyone should consider therapy in order to learn what the best coping skills are for their own bodies and mind," says Robinson.
Preventing opioid addiction
Experts agree: The most important steps to prevent opioid addiction are awareness and education. This includes ensuring patients are fully informed before beginning opioid use and exploring other, less addictive medications when possible.
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