Opioids are among the most addictive substances available today, making opioid use disorder one of the most complicated and dangerous addictions to navigate without professional assistance. Whether the opioid in question is a pain medication, heroin, or illicitly manufactured fentanyl, the neurological and physical consequences of opioid dependence require clinical support that is far beyond the ability to stop on one’s own.
If you are struggling with an addiction to opioids, please know that recovery is possible. But it takes the appropriate treatment, level of care, and support that addresses the full picture of what opioid use disorder does to a person.
What Are Opioids?
Opioids are a class of substances that bind to specific receptors in the brain and body, which can provide pain relief, euphoria, and sedation.[1] The most common examples are prescription drugs such as oxycodone, hydrocodone, morphine, and codeine; semi-synthetic drugs like heroin, and fully synthetic drugs like methadone and fentanyl. Opioids are prescribed widely for pain management and do have therapeutic value; however, the potential for developing an opioid use disorder is high, and the effects of opioid use disorder can have severe consequences.
Over the last two decades, the opioid epidemic has significantly impacted the United States. The Substance Abuse and Mental Health Services Association (SAMHSA) reported that approximately 6 million Americans met the criteria for opioid use disorder in 2022.[2] Nearly 80,000 fatal drug overdoses involving opioids occurred in 2022 alone, with the vast majority attributable to illicitly manufactured fentanyl, making opioids the leading cause of drug overdose death in the United States.[3]
The Most Addictive Opioids
Not all opioids carry equal addiction risk. There are many factors that influence the likelihood of addiction, such as potency, speed of action, and half-life.
The most addictive opioids include:
- Fentanyl — A synthetic opioid 50 to 100 times more potent than morphine, and now the leading cause of opioid overdose deaths. Fentanyl is frequently found in counterfeit pills and other illicitly manufactured drug products.
- Heroin — A semi-synthetic opioid derived from morphine with a rapid onset of action, particularly when injected. Dependence can develop within days to weeks of regular use.
- Oxycodone — A prescription opioid with a high potential for misuse that is closely associated with the start of the opioid epidemic. Extended-release oxycodone is among the most widely misused, with people crushing and snorting the drug instead of taking it as directed.
- Hydrocodone — One of the most frequently prescribed opioids in the United States and often the first opioid used prior to progressing to stronger and more addictive opioids.
- Methadone — An opioid used in medication-assisted treatment that carries significant addiction potential when misused outside of a supervised clinical context.
- Tramadol — Often perceived as a lower-risk opioid, tramadol still produces physical dependence with regular use and carries unique risks due to its additional serotonergic effects.
Signs of Opioid Dependence
Symptoms of opioid dependence can range from very mild to very severe. The sooner the signs of opioid dependence are identified, the greater the chances of successful treatment.
Behavioral Signs of Opioid Addiction
Signs of opioid use and dependence include:
- Using more opioids than intended or for longer than intended
- Unsuccessful attempts to reduce or control opioid use
- Spending significant time getting, using, or recovering from opioids
- Strong cravings
- Failing to fulfill responsibilities at work, school, or home due to opioid use
- Continuing to use opioids despite negative consequences
- Giving up important activities because of opioid use
- Using opioids in potentially dangerous situations
- Continuing to use opioids despite knowing they are worsening your mental or physical condition
- Building tolerance; needing more opioids to get the same effect as when first starting
Physical Signs of Opioid Use
Physical signs of opioid use may include:
- Constricted (pinpoint) pupils
- Drowsiness or nodding off
- Slowed breathing and speech
- Nausea and constipation
- Bruises or track marks at injection sites
- Significant weight loss
- Neglect of personal hygiene and grooming
- Experiencing withdrawal symptoms when reducing or stopping opioid use
Recognizing Opioid Dependence in a Loved One
Opioid use disorder usually develops over time, and those closest to the person are often unaware of how serious the problem has become until usage escalates.
Behavioral changes to watch for include increased secretiveness, unexplained financial difficulties, withdrawal from family and social relationships, extreme mood swings, and a pattern of feeling well only after taking medication or disappearing for periods of time. If prescription opioids are in the home, missing pills or repeated requests for new prescriptions may also be a sign.
How Opioid Dependence Develops
When someone takes opioids, the euphoric effect occurs because the drug binds to mu-opioid receptors in the brain and floods the brain’s reward system with dopamine.[4] Over time, with repeated use, the brain’s own opioid system begins to downregulate. Natural opioid production decreases, mu-opioid receptor sensitivity diminishes, and the body feels depressed and uncomfortable when not using.
The loss of control over how much and how often opioids are used is one of the major differences between physical dependence and a diagnosed opioid use disorder. Co-occurring mental health disorders, such as depression and anxiety, are very common in people with opioid use disorder and often complicate treatment and recovery when not addressed through integrated dual diagnosis treatment.[5]
How to Safely Detox From Opioids
Detoxing from opioids can be extremely uncomfortable to go through, which can increase the risk of relapse in early recovery.[6] In order to detox safely, a medically supervised detox with medication-assisted treatment is recommended
Opioid withdrawal symptoms typically start within 12 to 24 hours after the last dose of a short-acting opioid and within 36 to 48 hours for long-acting opioids.[7] Typical withdrawal symptoms include:
- Strong cravings for opioids
- Anxiety, agitation, and restlessness
- Muscle and body aches
- Nausea, vomiting, and diarrhea
- Sweating, chills, and goosebumps
- Insomnia
- Elevated heart rate and blood pressure
Though opioid detox is rarely fatal in healthy adults, strong withdrawal symptoms can make completing an unassisted detox extremely difficult. Most importantly, once a detox is completed, the user’s previous tolerance to opioids usually decreases dramatically. This becomes dangerous because a relapse after any period of abstinence carries a greatly raised risk of fatal overdose, as users often return to a regular dosage that they are no longer tolerant to.
Using evidence-based treatment with supervised detox with buprenorphine or methadone is the best way to detox from opioids, as both medications reduce the severity of withdrawal symptoms and help manage cravings throughout the recovery process.
