Opiate Addiction: Symptoms, Treatment and Resources

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.

Opiate drugs affect the same brain receptors and have the same effects on the central nervous system. Opiates are derived naturally, but opioids are manufactured. 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 oxycodone, Dilaudid, hydrocodone and fentanyl, as well as the illicit drug heroin. Opioid addiction is a large contributor to overdose deaths in the United States. In 2021 alone, there were 80,411 opioid overdose 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.

How Opiate Addiction Happens

Opiates are highly addictive. The drug enters the brain from the bloodstream and creates a rush of artificial endorphins and dopamine. These neurotransmitters are responsible for feelings of reward, pleasure and satisfaction, and the opiate’s effect on them creates a rush of euphoria. Because the high is unlike any naturally occurring flood of dopamine or endorphins, the only way a person can reexperience it is by using again.

After repeated use, however, the brain is less able to naturally create dopamine and endorphins. As a result, a person may only be able to experience these feelings again when they use opiates. Because of the desirable feelings the drug causes in the brain, and because someone may no longer feel pleasure naturally, they may crave an opiate high. People choose to abuse opiates to continue feeling that high and to lessen their pain. This is one of the main reasons opiates are highly addictive.

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

• Tolerance: When a person must use increasingly larger doses of opiates to experience the same high
• Physical dependence: When the body enters withdrawal if the person stops taking the drug
• Psychological addiction: When mental cravings for opiates 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 opiates increase.

Can You Get Addicted to Opiates if You Use Them as Prescribed?

According to a recent poll conducted by The Recovery Village, nearly 64% of respondents attributed the main driving factor behind the opiate crisis in the United States to overprescribing.

Experts concur with the poll results. Research supports the idea that opiate overprescribing is a pervasive issue and plays a significant role in fueling opioid addiction. Many instances involve doctors prescribing more opioids than necessary, leading to an excess supply of pills. When patients have an abundance of pills, there is a higher likelihood of taking them for longer durations than required, thus escalating the risk of addiction.

Even medications prescribed for acute pain have the potential to be taken long-term, as evidenced by around 6% of individuals continuing to use opiates 90 days after minor or major surgeries. Such prolonged usage significantly elevates the risk of addiction. Moreover, a considerable portion of individuals — up to 26% — prescribed opioids for chronic, non-cancer-related pain eventually become dependent on these drugs. This highlights the grave consequences of prolonged opioid use and its potential to lead to addiction.

Which Opiates Are Most Addictive?

Heroin is one of the most addictive drugs in the world, as it acts quickly on the brain, triggering a surge in feel-good chemicals in the brain’s reward system. As a Schedule I illicit narcotic, it is a highly potent opiate that can be extremely difficult to quit. Many people who become addicted to heroin start with prescription opioids. Prescription opioids are often prescribed for legitimate reasons, such as pain relief after surgery. However, some people can become addicted to prescription opioids and then turn to heroin because it is cheaper and easier to obtain.

Codeine is another addictive opiate. It is a prescription medication used to treat pain and coughing. Codeine is less well-known than other opiates, but it can still be addictive. That said, many forms of codeine are Schedule III narcotics, meaning they have less of an addictive potential than opioids like heroin, fentanyl or oxycodone.

It is important to remember that all opiates are addictive. This means that they all have the potential to cause dependence and abuse. If you are taking an opiate, it is important to be aware of the risks and to use the medication as prescribed by your doctor.

Which Opiates Are Most Commonly Abused?

• Vicodin (hydrocodone/acetaminophen): Vicodin is one of the most frequently abused opiates. It is prescribed to manage severe pain, often after surgery or injury. Unfortunately, even when initially prescribed by a doctor, Vicodin can quickly become a substance of abuse. Not only is its ingredient hydrocodone the most abused opioid in the U.S., but it is also the most misused prescription drug in the country.
• Oxycodone: The active ingredient in OxyContin and the drug that helped kick off the opioid epidemic, oxycodone is the second-most commonly abused opioid in the country. Like Vicodin, it is prescribed to manage severe pain.
• Heroin: Heroin is an illegal, synthesized form of morphine that can be injected, smoked or snorted. The drug becomes particularly dangerous when mixed with other substances.
• Morphine: Another commonly abused opiate is morphine — a substance extracted from poppy plants. It is often used in medical settings and administered orally or intravenously.
• Codeine: Codeine, chemically similar to morphine, is another frequently abused opiate. Like many other prescription opioids, it is often used to relieve pain.
• Fentanyl: Fentanyl has seen a significant increase in abuse in recent years, making it one of the most commonly abused opioids. Similar to heroin, fentanyl acts rapidly as a sedative and powerful pain reliever.
• Hydrocodone: Hydrocodone is an opiate used both as a pain reliever and cough suppressant. It can also be subject to abuse.

The Euphoric Effect of Opiates

When people take opiates, they experience an intense rush of pleasure or euphoria. This feeling can be addictive to many people, as the brain learns to associate taking opiates with feeling good.

Opiates act by stimulating the release of the natural neurotransmitter dopamine. Dopamine is responsible for regulating pleasure, and when it is released in large amounts, it can create a feeling of euphoria. When someone takes an opiate, it floods the brain with dopamine, which is why they experience such a strong feeling of pleasure.

The artificial feel-good impact is often intense. When you take opiates, the endorphins are released at a much higher level than they would be naturally. Opiates provide a level of pleasure that is difficult to replicate naturally, so it’s easy for our brains to crave more and more.

Over time, the pleasure centers of the brain stop eliciting as strong of a response to opioids. This is because the brain starts to adapt to the increased levels of dopamine, and it takes more and more of the drug to achieve the same feeling of pleasure. Physical tolerance develops, and eventually, opiate addiction ensues.

How Do Opiates Affect the Nervous System?

When an individual consumes opiates, their nervous system undergoes rapid and profound changes. During the initial encounters with opiates, particularly substances like heroin, users often describe an intense euphoric surge that surpasses any previous experiences. The reason behind these sensations lies in how opiates interact with the nervous system.

Opiates bind to opioid receptors found on the neurons responsible for controlling dopamine release. This interaction triggers an artificially intense release of dopamine, approximately tenfold higher than the natural amount. The body becomes conditioned to seek opiates repeatedly as it craves the heightened dopamine response. With continued usage, the body adapts and develops a tolerance, requiring increasingly higher doses of opiates to achieve the same initial effects.

Common Opioids and Opiates

Opioid pain medications are primarily prescribed to treat moderate to severe pain, typically after a medical procedure or surgery. In a recent study by The Recovery Village, participants reported using several common legal opioid drugs, some using multiple:

• Oxycodone: 68% reported using this semi-synthetic opioid. Common brand names include Percocet (a combination drug containing oxycodone and acetaminophen) and OxyContin.
• Hydrocodone: a semi-synthetic drug that 56% reported using. It is included in drugs like Vicodin and Lortab.
• Morphine: 37% reported using this highly addictive, naturally occurring substance found in the opium plant.
• Codeine: a less powerful but still addictive substance, codeine is primarily used as a cough suppressant and pain reliever. Codeine is typically prescribed as a combination medication. 31% reported using this substance.
• Fentanyl: a highly addictive, synthetic opiate that 26% reported using. While fentanyl is commonly prescribed as a transdermal patch, it is also sold illegally.

Common Signs of Opiate Addiction

When someone is abusing or addicted to opiates, they may prioritize obtaining drugs and getting high above all else. Opiate abuse and addiction have several visible signs. If you suspect a family member or a friend is using opiates, you may begin to see changes across their life.

Financial Signs of Opiate Abuse

Over time, substance abuse often leads to financial hardships. Perhaps when opiate use begins, the person has a valid prescription, so the cost is low. However, a person will need more of the drug as their tolerance and addiction build.

A person buying opiates could end up spending a lot of money. They may show signs of significant financial 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 opiate users report significant financial impacts because of their opiate use. 

Professional Signs of Opiate 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 opiates 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, including:

• 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 Opiate Abuse

People are often willing to break the law to get and use opiates. 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 opiate users surveyed, 16% had experienced a legal issue because of their opioid use. 

Social Signs of Opiate Abuse

The effects of opiate abuse could have a major impact on a person’s social functioning. The drug can become their main motivator, pushing positive aspects of life to the background. This can lead to a host of social changes:

• 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

When asked about their social lives, 46% of opioid survey respondents reported that opioids affected their relationships with loved ones, and 35% said it affected their abilities as parents. 

Short-Term Effects of Opiate 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 several psychological and physical changes in a person struggling with opioid or opiate abuse.

Initial physical symptoms of opiate addiction are:

• Dry mouth
• Constipation
• Lightheadedness
• Feelings of euphoria and elation
• Constricted pupils
• Lack of coordination
• Sleeping too much
• Nausea and vomiting

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

Severe symptoms include:

• Slowed heartbeat
• Slowed or shallow breathing
• Blue or purple lips, nails or skin
• Dizziness/drowsiness
• Low blood pressure

If you see someone experiencing one of these severe symptoms of opioid abuse, they could be overdosing. Call 911 immediately and give naloxone if available.

Psychological symptoms of opiate abuse are:

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

Opiate users 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 Opiate Addiction

The longer someone abuses opiates, the higher the risk of serious and sometimes permanent damage. Long-term health effects of opiate abuse include damage 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 opiates 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’ve been taking will no longer suffice. 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 include:

• 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). Research is still not fully clear as to how prenatal opiate exposure affects children, but pregnant mothers should avoid opiate abuse and get help for their addiction before and during pregnancy.

Factors That Influence Opiate Addiction Risk

Some people will experience the signs of addiction very quickly, while others using the drug similarly will not. Several risk factors can increase the occurrence of opiate addiction. These 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. However, not having these added risk factors does not exclude a person from possibly gaining an opiate addiction.

Diagnosing Opiate Addiction

To determine whether someone is being negatively impacted by opiates, mental health and addiction professionals will work with the person. They will evaluate whether the person has an opioid use disorder — the clinical term for opiate addiction. As a recognized psychological condition in the DSM-5, opioid use disorder involves ongoing substance use that results in:

• Opiates 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 opiates 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.

Opiate Addiction Withdrawal

When a person stops taking opiates, they may experience withdrawal symptoms. These symptoms can be physical and psychological, and they can range from mild to severe. The severity of the symptoms depends on a number of factors, including the type of opiate used, the dose taken and the length of time the person has been taking the drug.

Some common physical withdrawal symptoms include:

• Nausea and vomiting
• Diarrhea
• Muscle cramps
• Chills
• Sweating
• Increased heart rate
• High blood pressure
• Pupil dilation
• Runny nose
• Tearing

Some common psychological withdrawal symptoms include:

• Anxiety
• Insomnia
• Irritability
• Depression
• Fatigue
• Restlessness
• Cravings

In some cases, withdrawal symptoms can be life-threatening. If you or someone you know is experiencing withdrawal symptoms, it is important to seek medical attention.

There are a number of treatment options available for opiate withdrawal. These include medication-assisted treatment (MAT), counseling and support groups. MAT involves the use of medications to help manage withdrawal symptoms and reduce cravings. Counseling can help people understand their addiction and develop coping mechanisms. Support groups can provide people with support from others going through the same thing.

The Recovery Village’s accredited treatment facilities offer a comprehensive program for opiate addiction treatment. The program includes MAT, counseling and support groups. The Recovery Village’s staff is experienced in helping people overcome opiate addiction and achieve long-term recovery.

Treatment and Resources for Opiate Addiction

Treatment for 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 opiates 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 opiates.

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 a week to one hour each month. The treatment team will work to coordinate the amount of care that fits the client’s needs.

Detoxification

Available at the inpatient/residential or outpatient levels of care, detoxification (detox) is often the first step in recovery. As opiates leave the body, they create uncomfortable and distressing mental and physical withdrawal symptoms. Professional detox services work to increase comfort, ease the process and aid recovery. During detox, patients will often taper off opiates to mitigate the severity of withdrawal symptoms.

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 uncover ways to avoid relapse in the future.

Medication Services

Many people with opiate 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 be 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.

Is It Possible to Just Withdraw from Opiates at Home?

Some people attempt to self-treat opiate withdrawal with at-home remedies, such as vitamins, herbal supplements, diet changes and exercise. However, at-home opiate withdrawal without medical support is not recommended due to its low effectiveness and high likelihood of relapse. There is also very little scientific evidence that natural opiate withdrawal remedies work.

If you or someone you know is struggling with opiate addiction, it is important to seek professional help. There are many effective treatment options available, including MAT, counseling and support groups. With the right help, you can overcome addiction and live a healthy and fulfilling life.

Outlook for Opiate Addiction

Recovery from opiate 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 opiate rehab patients surveyed, 87% report finishing their first treatment program completely.

Find the Help that You or Your Loved One Needs for Opiate Addiction

With the stigma still surrounding opiate 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 opiates 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 opiate 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.

Editor – Heather Lomax

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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