Signs and Symptoms of Opioid Dependence

The National Institute of Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

According to the Centers for Disease Control and Prevention (CDC), deaths in the United States from prescription opioids, such as oxycodone, hydrocodone, and methadone, have quintupled since 1999.

This article will discuss:

Signs and Symptoms of Opioid Dependence 5
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What Are Opioids and Why Are They Abused?

Opioids are a group of drugs derived from the poppy plant or chemically synthesized in a laboratory setting. This class of drugs includes both legal and illegal opioids. Legally prescribed opioids include morphine, codeine, and oxycodone. Illegal opioids include heroin.

Opioids are used to help individuals cope with pain. They bind to natural opioid receptors in the brain, mimicking specific chemicals that are related to sensations of pain relief, pleasure, and reward.

When used as prescribed, legal opioids are one of the most effective forms of pain relief, especially if the pain is severe or other attempts to relieve the pain have been unsuccessful. In addition to relieving pain, opioids can cause euphoria, making them the most abused types of substances currently available.

When opioids are abused, the route of intended administration is often altered. For example, when prescription pain pills are ground up, the powder can be snorted, smoked, or mixed with water and injected. These methods increase the speed of absorption, creating a “rush” or a strong, fast acting effect of positive sensations. Even when taken as prescribed, the potential for opioid abuse and addiction is high and treatment may be required.

It’s important to recognize the signs and symptoms of opioid addiction. If you notice any of these symptoms in family or friends, help is available.


How Opioid Abuse Impacts Your Body

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine and morphine.

Opioid abuse can cause body-wide symptoms, and too much of the drug can affect different body systems. For example:

  • In the stomach and intestines, opioid use and abuse can cause constipation, cramping, and discomfort in the abdomen. It can also cause vomiting and prolonged nausea.
  • In the heart and lungs, opioids cause low blood pressure, which can lead to paleness in the face, clammy skin, and purple or blue fingernails and lips.
  • In the nervous system, opioids can cause an inability to feel pain. They can also produce a state of calm or euphoria, change body temperature, and cause the pupils to constrict.

Early Signs of Potential Abuse

  • Taking someone else’s medication, even for a legitimate purpose such as to relieve pain
  • Craving or a strong desire to use the substance/medication
  • Using in contradiction to prescribing guidelines (e.g., combining the substance/medication with alcohol or other drugs)

Social Indications of Opioid Abuse

Often, people struggling with opioid use disorder start behaving differently. Here are some social indications to look for:

  • Changes in behavior or mood
  • Financial problems
  • Making bad or reckless decisions
  • New “friends” who are a negative influence
  • Missing school or work
  • Suspension from school or job loss due to an opioid-related incident

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The Three C’s – Recognizing Prescription Opioid Abuse

According to NIDA, the “Three C’s” can be helpful in identifying abuse and/or addiction among patients who are regularly prescribed opioid painkillers. The Three C’s are:

Loss of Control
• Often claims their prescription opioids have been lost or stolen
• Requests early refills of prescription painkillers
• Seeks opioids from other doctors or sources
• Opioid withdrawal symptoms noted at doctor’s appointments
Craving Opioids
• Recurring requests for increases in opioid dosage or frequency of administration
• Reports increasing pain, despite the lack of disease progression
• Dismissive of non-opioid treatments
Continued Abuse Despite Negative Consequences
• Over-sedation/somnolence
• Decreases in activity,
• Decreases in ability to function and/or maintain relationships


Signs of Opioid Abuse

  • Taking a substance in larger or longer amounts than intended: Prescription painkillers are meant to be a short-term fix; extended use can signal trouble.
  • Unsuccessful efforts to curb or control substance use: Even if a person wants to quit, this can be harder for some individuals. What’s more, genetic, environmental, and psychological factors put some people at an elevated risk for opioid addiction.
  • Excess time spent obtaining, using, or recovering from opioids: People who are addicted to opioids spend a lot of time and money seeking drugs. If they’re unable to find their drug of choice, they look for replacement substances instead. For example, buying prescription pain pills off the street can be expensive. When the money runs out, many people turn to heroin because it is cheaper.
  • Craving or strong urge to use the substance: The fact that opioids have negative consequences is of little concern when someone is addicted. Addiction drives the brain to seek more opioids, regardless of the outcome.
  • Consistent failure to fulfill work, home, or school obligations: Opioid abuse tends to disrupt sleep patterns and cause sedation, effects that can negatively impact life duties and responsibilities. This is one of the first noticeable red flags others might notice.
  • Continued opioid use despite social or personal problems: Personality changes like irritability and abrasiveness may indicate someone is struggling with an opioid addiction. Arguments with family, friends, or coworkers are common during active addiction. This is especially true when confronted about their drug use.
  • Withdrawal from social, occupational, or recreational activities: Opioid addiction causes a decline in function, prompting many people to withdraw from society and embrace isolation. Skipping out on activities that used to bring pleasure or failing to show up for group outings isn’t uncommon.
  • Recurrent opioid abuse in dangerous situations: Acting recklessly under the influence of opioids is a common side effect. Examples can include recklessness driving, operating heavy machinery, or even having unsafe sex.
  • Continued opioid abuse despite existing psychological issues: Sadly, opioid abuse can exacerbate mental health conditions such as depression and bipolar disorder – a population that is already vulnerable to addiction.
  • Taking more to achieve the same level of intoxication: Continued opioid use slows endorphin production, prompting higher, more frequent dosages to obtain the same high.
  • Opioid withdrawal symptoms are evident: Diarrhea, sweating, moodiness, dilated pupils, watery eyes, cramping and/or abdominal pain, increased heart rate, excessive yawning, goose bumps, insomnia, or tremor, among other things, can occur in the absence of opioids. The pain and discomfort inspires continued opioid abuse as a way to counteract the withdrawal symptoms.