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Opioid Addiction: Definition, Symptoms, Types, Causes, Effects, and Treatment

Opioid addiction is characterized as a powerful, compulsive urge to use opioid drugs, even when they are no longer medically required despite negative consequences. Opioids encompass a class of drugs derived from the opium poppy plant as well as synthetic analogs. The disorder involves changes in the brain and persistent behavior patterns, resulting in significant personal and societal harm.

Symptoms of opioid addiction include intense cravings for opioids, inability to control or reduce use, withdrawal symptoms when not using, and continued use despite negative consequences. Physical signs might also include drowsiness, weight loss, and frequent flu-like symptoms.

There are several types of opioids, including prescription medications like oxycodone, hydrocodone, and morphine, as well as illicit drugs such as heroin. Synthetic opioids, like fentanyl, are particularly dangerous due to their high potency.

The causes of opioid addiction can include genetic predisposition, environmental factors, previous substance abuse, and often, initial medical use with prescription painkillers. The brain’s reward system is altered by opioids, reinforcing drug-taking behavior.

The effects of opioid addiction are devastating and wide-ranging, impacting physical health, mental health, relationships, and employment. Health effects can include respiratory depression, infectious diseases, and overdose. Opioid addiction can lead to social isolation and financial problems.

In 2021, the number of people who died from a drug overdose was over six times higher than in 1999. According to the 2024 CDC report titled “Understanding the Opioid Overdose Epidemic,” over 75% of the nearly 107,000 drug overdose deaths in 2022 involved an opioid, translating to at least 224 opioid overdose deaths each day. This alarming statistic underscores the severe impact of opioids on society and highlights the urgent need for comprehensive substance use disorder treatment strategies to manage the opioid epidemic.

Treatment for opioid addiction is multifaceted, often involving medication-assisted treatment (MAT) which includes drugs like methadone, buprenorphine, or naltrexone. Behavioral therapies and support from recovery groups are also critical. Comprehensive treatment plans are tailored to meet the individual’s needs.

What is Opioid Addiction?

what is opioid addiction

Opioid addiction, or Opioid Use Disorder (OUD), is a chronic disorder characterized by a problematic pattern of opioid use that causes significant problems or distress where opioids are continued to be used despite the consequences. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5-TR), a diagnosis of OUD requires at least two specific symptoms occurring within a 12-month period, such as a persistent desire or unsuccessful efforts to cut down opioid use and continued use despite social or interpersonal problems caused by opioids.

Opioids, including prescription medications and illicit substances, interact with opioid receptors in the brain to reduce pain perception but can also lead to euphoria, increasing the risk of addiction. The use of these substances, despite the knowledge of harmful consequences, is driven by cravings and withdrawal symptoms that compel continued use.

Effective treatments involve medications like methadone and buprenorphine, coupled with counseling and behavioral therapies. Understanding and addressing this disorder requires a comprehensive approach due to its complex nature and the significant risks it poses to individuals and society. This information is outlined in the publication “Psychiatry.org – Opioid Use Disorder” by the American Psychiatric Association, accessed on May 10, 2024.

What is the difference between opioids and opiates?

Opioids are a class of drugs that include both naturally derived and synthetic substances used for pain relief and other medical purposes. In 2017, the opioid crisis was declared a public health emergency in the U.S., claiming over 187 lives per day and Over 560,000 people in the U.S. have died from overdoses involving opioids since the epidemic began according to the Federal Communications Commission, Connect2HealthFCC program. Opioids work by binding to specific receptors in the brain and body, reducing pain and producing euphoria. Medically, they are prescribed for pain relief, anesthesia, cough suppression, diarrhea suppression, and the treatment of opioid use disorder. Commonly known opioids include prescription drugs such as hydrocodone (Vicodin), oxycodone (OxyContin), and synthetic opioids like fentanyl.

Opiates are a subset of opioids that are naturally derived from the opium poppy plant. They are extracted and refined from natural plant matter, specifically poppy sap and fibers. Opiates are also used medically for pain relief, anesthesia, and other similar purposes. Examples of opiates include opium, morphine, codeine, and heroin. These substances are utilized in both medical and illicit contexts, often leading to substance use disorders.

The primary difference between opioids and opiates lies in their origin and production. Opiates are directly derived from natural sources, specifically the opium poppy plant, and include drugs like morphine and heroin. In contrast, opioids encompass both natural opiates and synthetic drugs created in laboratories. While opiates are purely natural, most opioids are synthetic or semi-synthetic, designed to mimic the effects of natural opiates. This distinction affects their classification and the way they are produced and used medically and illicitly. The ongoing opioid crisis, exacerbated by the COVID-19 pandemic, underscores the importance of addressing both categories through comprehensive health interventions, including the use of broadband-enabled telehealth solutions.

What Are The Different Types Of Opioids?

Opioids, as described by Dr. Ananya Mandal in her publication “Opioid Types” from New Medical Life Sciences (June 2023), can be classified based on their origin, structure, and how they are produced. The different types of opioids include:

  1. Naturally Occurring Opioids: These opioids are alkaloids found in the resin of the opium poppy, such as morphine, codeine, and thebaine. They are directly extracted from natural sources. Additionally, natural opioids like those from the Kratom plant (Mitragyna speciosa) and the psychoactive compound Salvinorin A from Salvia divinorum also fall into this category.
  2. Endogenous Opioids: These are opioids naturally produced in the body and include enkephalins, dynorphins, endorphins, and endomorphins, which play crucial roles in pain regulation and mood control.
  3. Semisynthetic Opioids: Created in the lab from natural opioids, this class includes drugs such as hydrocodone, oxycodone, hydromorphone, oxymorphone, and heroin (diacetylmorphine), among others. They are often used medically for pain relief and in some cases, for addiction treatment.
  4. Synthetic Opioids: These are fully synthesized in the laboratory and include medications used for pain relief, drug dependence treatment, and anesthesia. Examples include methadone, fentanyl, pethidine, and dextropropoxyphene.
  5. Opioid-like Agents: Although chemically distinct from traditional opioids, agents like tramadol and tapentadol affect the μ-opioid receptor and also interact with the noradrenergic and serotonergic systems to alleviate pain.

In terms of chemical classification according to the Drug Enforcement Agency (DEA):

  • Phenanthrenes or typical opioids include drugs like morphine and oxycodone.
  • Benzomorphans, such as pentazocine.
  • Phenylpiperidines, which include potent agents like fentanyl.
  • Diphenylheptanes, which encompass drugs like methadone.

What are the Symptoms of Opioid Addiction?

The symptoms of Opioid Use Disorder (OUD) are detailed comprehensively in the publication “Psychiatry.org – Opioid Use Disorder” by the American Psychiatric Association. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5-TR), OUD is characterized by a problematic pattern of opioid use that leads to significant impairment or distress. Individuals with this disorder exhibit several behavioral, psychological, and physiological symptoms which must include at least two of the following criteria within a 12-month period:

  1. Taking larger amounts or over a longer period than intended: This occurs when individuals consume opioids in greater quantities or for a longer duration than they initially planned or desired.
  2. Persistent desire or unsuccessful efforts to cut down or control opioid use: Despite attempts to decrease or control their opioid use, individuals find themselves unable to do so.
  3. Spending a great deal of time obtaining, using, or recovering from the effects of opioids: A significant amount of time is spent in activities necessary to obtain opioids, use opioids, or recover from their effects.
  4. Craving, or a strong desire or urge to use opioids: Individuals experience intense desires or urges to use opioids, which can dominate their thoughts.
  5. Problems fulfilling obligations at work, school, or home: Opioid use can lead to failure in meeting responsibilities at work, school, or home due to the effects or aftereffects of use.
  6. Continued opioid use despite having recurring social or interpersonal problems: This includes continuing to use opioids despite the negative consequences it may have on relationships and social interactions.
  7. Giving up or reducing activities because of opioid use: Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  8. Using opioids in physically hazardous situations: This includes using opioids in situations where it is physically dangerous to do so, such as driving or operating machinery.
  9. Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids: Individuals continue to use opioids even though they know it is worsening their physical or psychological health.
  10. Tolerance: This is defined as needing increasingly larger amounts of opioids to achieve the desired effect or a significantly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal symptoms: This includes experiencing physiological withdrawal symptoms when not using opioids, or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Heroin

Picture of heroin with description of different types including black tar liquid packages, brown powder heroin and white powder heroin along with Street Terms for Heroin identification

Heroin is an illegal, highly addictive opioid derived from morphine. It is typically sold as a white or brown powder or as a black, sticky substance known as “black tar heroin.” Heroin is not manufactured for medical use and is considered a Schedule I controlled substance in the United States due to its high potential for abuse and no accepted medical use.

Heroin addiction involves a powerful physical and psychological dependence on the drug, characterized by intense cravings, compulsive drug-seeking behavior, and significant withdrawal symptoms. Addiction can develop rapidly with heroin use.

Heroin withdrawal symptoms include severe muscle and bone pain, sleep disturbances, diarrhea, vomiting, cold flashes, and intense cravings. Withdrawal can begin within a few hours after the last dose and may persist for days to weeks. Treatment options for heroin addiction include medical detoxification, replacement therapies such as methadone or buprenorphine, and comprehensive addiction treatment programs including counseling and behavioral therapies.

Fentanyl

Fentanyl is a synthetic opioid that is 50-100 times more potent than morphine. It is used for severe pain management, particularly in cancer patients. Fentanyl is manufactured by pharmaceutical companies in various forms, including patches and lozenges. It is highly addictive and has a high potential for abuse and overdose.

Fentanyl addiction involves a strong physical and psychological dependence on the drug, with significant cravings and withdrawal symptoms. Individuals addicted to fentanyl may use increasingly larger doses to achieve the desired effects, leading to a high risk of overdose.

Fentanyl withdrawal symptoms include severe muscle and bone pain, sleep disturbances, diarrhea, vomiting, and intense cravings. Medical detoxification and gradual tapering are essential due to the potency of the drug. Withdrawal symptoms can begin within hours of the last dose and may persist for weeks. Treatment options for Fentanyl use disorder include medical detox, replacement therapies like methadone or buprenorphine, and supportive therapies including counseling and behavioral therapy.

Morphine

Morphine is a natural opiate used to treat severe pain. It is derived from the opium poppy and produced by various pharmaceutical companies. Morphine is highly addictive, leading to both physical and psychological dependence.

Morphine addiction involves compulsive drug-seeking behavior and use despite negative consequences, with significant cravings and withdrawal symptoms. Individuals addicted to morphine may engage in risky behaviors to obtain the drug and may experience severe disruptions in their personal and professional lives.

Morphine withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended. Symptoms of morphine addiction withdrawal can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Hydrocodone

Hydrocodone is a semi-synthetic opioid derived from codeine, used to treat moderate to severe pain. It is manufactured by pharmaceutical companies in various formulations, including combination products with acetaminophen. Hydrocodone is highly addictive, leading to physical and psychological dependence.

Hydrocodone addiction involves compulsive use, significant cravings, and withdrawal symptoms when not using the drug. Individuals may misuse hydrocodone to achieve euphoria or to alleviate withdrawal symptoms from other opioids.

Hydrocodone withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is essential for safely discontinuing the drug. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Methadone

Methadone is a synthetic opioid that is primarily used for pain relief and as part of drug addiction detoxification and maintenance programs. Developed in Germany during World War II, methadone was introduced into the United States in 1947. It is manufactured by various pharmaceutical companies under different brand names. Methadone is highly addictive and can lead to dependency if not used under strict medical supervision.

Methadone addiction occurs when a person becomes dependent on the drug, requiring it to feel normal and experiencing cravings when not using it. This addiction can develop even when methadone is taken as prescribed. Individuals addicted to methadone may find it challenging to function without the drug and might engage in behaviors aimed at obtaining it.

Methadone withdrawal symptoms include anxiety, muscle aches, insomnia, sweating, and nausea. Withdrawal can begin within 24-36 hours after the last dose. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Methadone can take several days to weeks to fully leave the body due to its long half-life. Treatment options include supervised tapering, replacement with other medications like buprenorphine, and supportive therapies such as counseling and behavioral therapy.

Oxycodone

Oxycodone is a semi-synthetic opioid derived from thebaine, an alkaloid found in the opium poppy. It is used to treat moderate to severe pain and is produced by pharmaceutical companies in various forms, including OxyContin. Oxycodone is highly addictive and can lead to physical and psychological dependence.

Oxycodone addiction involves compulsive use despite harmful consequences and is characterized by intense cravings and withdrawal symptoms. Individuals addicted to oxycodone often prioritize the drug over other aspects of their life, leading to significant personal and professional issues.

Oxycodone withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is essential for safely discontinuing the drug. Withdrawal symptoms typically start within hours of the last dose and can last for several days to weeks. Treatment options include medically supervised detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Codeine

Codeine is a natural opiate used to treat mild to moderate pain and to relieve cough. It is derived from the opium poppy and manufactured by various pharmaceutical companies. Codeine can be addictive, especially when used in higher doses or for prolonged periods.

Codeine addiction involves a physical and psychological dependence on the drug, characterized by cravings and withdrawal symptoms when not using it. Individuals may misuse codeine to experience euphoria or to alleviate withdrawal symptoms from other opioids.

Codeine withdrawal symptoms include restlessness, muscle aches, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detoxification, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Hydromorphone

Hydromorphone is a semi-synthetic opioid derived from morphine, used to treat severe pain. It is manufactured by various pharmaceutical companies under different brand names, including Dilaudid. Hydromorphone is highly addictive and can lead to both physical and psychological dependence.

Hydromorphone addiction involves a strong dependence on the drug, characterized by compulsive use and significant withdrawal symptoms. Individuals addicted to hydromorphone may find it challenging to function without the drug and might engage in behaviors aimed at obtaining it.

Hydromorphone withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Buprenorphine

Buprenorphine is a semi-synthetic opioid used to treat opioid addiction and moderate to severe pain. Various pharmaceutical companies produce Buprenorphine in formulations like Suboxone and Subutex. Buprenorphine has a lower potential for addiction compared to other opioids but can still be addictive.

Buprenorphine addiction involves dependence on the drug, characterized by cravings and withdrawal symptoms. Individuals addicted to buprenorphine may misuse it to achieve euphoria or to alleviate withdrawal symptoms from other opioids.

Buprenorphine withdrawal symptoms include anxiety, muscle aches, insomnia, sweating, and nausea. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Oxymorphone

Oxymorphone is a semi-synthetic opioid derived from thebaine, used to treat moderate to severe pain. Oxymorphone is manufactured by Endo Pharmaceuticals and is available under brand names like Opana. Oxymorphone is highly addictive, leading to physical and psychological dependence.

Oxymorphone addiction involves a strong dependence on the drug, characterized by significant cravings and withdrawal symptoms. Individuals addicted to oxymorphone may engage in risky behaviors to obtain the drug and may experience severe disruptions in their personal and professional lives.

Oxymorphone withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Percocet

Percocet is a combination medication containing oxycodone and acetaminophen. It is used to treat moderate to severe pain. PERCOCET® is a Registered Trademark of Endo Pharmaceuticals Inc. in Chadds Ford, Pennsylvania and is commonly prescribed for short-term pain management. The oxycodone component of Percocet is highly addictive and can lead to physical and psychological dependence.

Percocet addiction occurs when an individual becomes dependent on the medication, experiencing cravings and withdrawal symptoms when not using it. Addiction can develop even when Percocet is taken as prescribed, particularly if used for an extended period.

Percocet withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is essential to minimize withdrawal symptoms. Withdrawal symptoms typically start within hours of the last dose and can last for several days to weeks. Treatment options include medically supervised detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Meperidine

Meperidine, also known by its brand name Demerol, is a synthetic opioid used to treat moderate to severe pain. It is manufactured by various pharmaceutical companies and was once widely used in medical settings, although its use has declined due to the availability of safer alternatives. Meperidine is highly addictive and can lead to physical and psychological dependence.

Meperidine addiction occurs when an individual becomes dependent on the drug, experiencing cravings and withdrawal symptoms when not using it. This addiction can develop even when meperidine is taken as prescribed.

Meperidine withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Tapentadol

Tapentadol is a synthetic opioid used to treat moderate to severe pain. It is manufactured by various pharmaceutical companies and is available under brand names such as Nucynta. Tapentadol has a dual mechanism of action, working as both an opioid receptor agonist and a norepinephrine reuptake inhibitor. Despite being considered less potent than some other opioids, tapentadol is still addictive and can lead to dependence.

Tapentadol addiction involves physical and psychological dependence on the drug, characterized by cravings and withdrawal symptoms when not using it. Individuals may misuse tapentadol to achieve euphoria or to alleviate withdrawal symptoms from other opioids.

Tapentadol withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is essential to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Dextropropoxyphene

Dextropropoxyphene is a synthetic opioid used to treat mild to moderate pain. It was once widely prescribed under various brand names, including Darvon. However, due to its high potential for overdose and limited effectiveness compared to other pain relievers, it has been withdrawn from the market in many countries, including the United States. Despite this, dextropropoxyphene is addictive and can lead to dependence.

Dextropropoxyphene addiction involves a physical and psychological dependence on the drug, characterized by cravings and withdrawal symptoms when not using it. Individuals may misuse dextropropoxyphene to achieve euphoria or to alleviate withdrawal symptoms from other opioids.

Dextropropoxyphene withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Oliceridine

Oliceridine is a synthetic opioid used to treat acute pain. It is manufactured by various pharmaceutical companies and is marketed under the brand name Olinvyk. Oliceridine is designed to provide effective pain relief with potentially fewer side effects compared to traditional opioids. However, it is still addictive and can lead to physical and psychological dependence.

Oliceridine addiction involves dependence on the drug, characterized by cravings and withdrawal symptoms when not using it. While designed to be safer, misuse of oliceridine can still lead to addiction and other serious health issues.

Oliceridine withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. Treatment options include medical detox, replacement therapies, and supportive treatments such as counseling and behavioral therapy.

Pethidine

Pethidine, also known as meperidine and sold under the brand name Demerol, is a synthetic opioid with a high potential for addiction. According to a 2012 case report by Bilge Burçak Annagür in the European Journal of General Medicine, pethidine is commonly used preoperatively and postoperatively to relieve pain. Although widely used in medical settings, its use has declined due to the availability of safer alternatives. Pethidine is highly addictive and can lead to both physical and psychological dependence.

Pethidine addiction occurs when an individual becomes dependent on the drug, experiencing cravings and withdrawal symptoms when not using it. Addiction can develop even when pethidine is taken as prescribed. A study by Solhi et al. (2016) found that morphine is more effective than pethidine for acute pain management in opioid-dependent patients. The study assessed pain severity using visual analog scale (VAS) scores and withdrawal symptoms using the Clinical Opioid Withdrawal Scale (COWS). Patients who received morphine reported better pain control with a VAS score of 4.11 ± 1.90 compared to those who received pethidine, who had a VAS score of 5.85 ± 2.08. Additionally, patients who received pethidine exhibited more pronounced withdrawal symptoms, with a COWS score of 4.80 ± 2.18 compared to those who received morphine, who had a COWS score of 1.98 ± 0.82.

A real-life example documented by Bilge Burçak Annagür in the 2012 case report highlights the high risk of pethidine addiction among healthcare workers. A nurse developed an addiction after being prescribed pethidine for postoperative pain. Her addiction led to severe personal and professional consequences, including job loss and eventual death from overdose. This case underscores the importance of closely monitoring patients for signs of addiction, especially when prescribing medications with high addiction potential.

Pethidine withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Gradual tapering under medical supervision is recommended to minimize withdrawal symptoms. Symptoms can start within hours of the last dose and may last for several days to weeks. The manifestations of pethidine addiction are similar to those of heroin, and all abstinent syndromes can be relieved by methadone or clonidine within three weeks, except for psychological cravings throughout the detoxification period.

Iatrogenic narcotic addiction of this kind is curable as long as the Pethidine user is highly and conscientiously motivated, coupled with rehabilitation measures after detoxification, according to Jiang Z. in Zhonghua Shen Jing Jing Shen Ke Za Zhi (1992). Medical supervision and comprehensive rehabilitation efforts are paramount for Demerol-dependent individuals to recover.

What are the Causes of Opioid Addiction?

causes of opioid addiction

The causes of opioid addiction are complex and multifaceted, with a combination of biological, psychological, and social factors contributing to the development of opioid use disorder. It is not fully understood why some individuals become addicted while others do not, but certain patterns and risk factors have been identified.

Biological Factors

  • Pleasurable effects and euphoria: Opioids are known to produce pain relief and, in some individuals, a sense of euphoria or heightened well-being. The experience of euphoria after taking opioids can serve as a warning sign of vulnerability to addiction. Even when opioids are used as prescribed by a doctor, the pleasurable effects may make some individuals more susceptible to developing an addiction.
  • Physiological effects: Studies indicate that even a single dose of opioids can have physiological effects that may increase vulnerability to opioid use disorder. These initial changes in the body’s response to opioids can create a predisposition to addiction, making individuals more susceptible even after short-term use.
  • Physical dependence: Regular use of opioids can lead to physical dependence, where the body adapts to the presence of the drug. The risk of addiction increases as individuals may find themselves needing higher doses to experience the initial euphoria or to avoid withdrawal symptoms, reinforcing a cycle of dependence.

Psychological Factors

  • Pleasure-seeking behavior: In the early stages of opioid use, individuals may be driven by the pleasurable effects of the drug. Over time, as tolerance develops and the pleasant sensations diminish, some may increase the frequency or dosage of opioid use in an attempt to restore the initial euphoria. This behavior contributes to the progression of opioid use disorder.
  • Mental health vulnerability: Individuals with pre-existing mental health conditions, such as anxiety or depression, may be more susceptible to the allure of opioids as a means of self-medication. Opioids can temporarily alleviate emotional distress, creating a psychological reliance that can escalate into addiction.

Social and Environmental Factors

  • Prescription practices: The availability and prescription of opioids by healthcare providers play a significant role in the opioid epidemic. Over-prescription and the easy access to these drugs can contribute to the development of addiction. Some individuals may start using opioids legitimately for pain relief and inadvertently find themselves dependent.
  • Peer influence and social norms: Social factors, including peer pressure and societal attitudes towards drug use, can influence an individual’s likelihood of trying opioids and continuing their use. The normalization of opioid use in certain social circles may contribute to the development of addiction.
  • Stressful life events: External stressors, such as traumatic experiences or challenging life circumstances, can contribute to the initiation and continuation of opioid use. Individuals facing stress may turn to opioids as a coping mechanism, increasing the risk of developing an addiction.

What are the Effects of Opioid Addiction?

Misuse of opioids can result in severe effects on the users’ physical and mental health. There are short-term immediate effects and more long-term effects with very debilitating effects. Some of the immediate effects include:

  • Drowsiness
  • Nausea
  • Constipation
  • Slowed breathing
  • Confusion
  • Relaxation
  • Euphoria

The effects of opioid use disorder (OUD) on the body and organs are listed below:

  • Gastrointestinal System: Long-term opioid use can lead to significant gastrointestinal (GI) complications, prominently chronic constipation, which can become severe and potentially result in bowel obstruction—a serious, sometimes fatal condition requiring hospitalization. This severe side effect, along with other GI symptoms such as dry mouth, nausea, vomiting, and bloating, collectively known as opioid bowel dysfunction (OBD), can also exacerbate mental health issues, increasing the risk of psychological distress and depression. These insights are detailed in the article “A Review of the Clinical Manifestations, Pathophysiology, and Management of Opioid Bowel Dysfunction and Narcotic Bowel Syndrome” by Zahra Azizi, Sanam Javid Anbardan, and Naser Ebrahimi Daryani, published in the Middle East Journal of Digestive Diseases in January 2014. The comprehensive review underscores the complex interplay between opioid use and GI health, highlighting the need for targeted management strategies to mitigate these adverse effects.
  • Respiratory System: Opioids significantly impact the respiratory system by diminishing the body’s ability to respond to carbon dioxide, leading to slowed or irregular breathing. In more severe cases, especially during an overdose, this can progress to respiratory arrest, depriving the brain of oxygen and potentially causing coma, brain damage, or death. This respiratory depression is a critical risk factor associated with opioid use, as detailed in the study “Assessing the Respiratory Effects of Approved Opioid Products When Co-administered with Commonly Prescribed Drugs” by the U.S. Food and Drug Administration (FDA). Published findings underscore the dangers of combining opioids with other depressants like benzodiazepines, which can further exacerbate respiratory suppression, highlighting the need for cautious prescribing practices to mitigate these risks.
  • Cardiovascular System: Long-term opioid use has been associated with significant risks to the cardiovascular system, including heart rhythm abnormalities which may escalate the risk of adverse cardiac events like stroke, heart failure, and death. According to new research highlighted in the study “Hidden Dangers of Opioid Epidemic: Study Links Prescribed Opioids to Cardiovascular Disease” by Isabella Backman from the Yale School of Medicine, there is a notable correlation between prescribed opioids and an increased risk of coronary heart disease, particularly in women. The study, published in the Journal of Pain on November 27, 2023, also notes that individuals who inject opioids face additional cardiovascular risks, including bloodborne bacterial infections that can lead to fatal endocarditis. These findings underscore the complex and severe impact of opioids not only on public health but specifically on cardiovascular health, necessitating careful consideration in the management of chronic pain, especially among populations already at risk for heart issues.
  • Reproductive Health: Opioid use affects reproductive health in both men and women, influencing fertility and other outcomes. In women, opioid use is associated with decreased fertility, an increased risk of pregnancy complications, and the occurrence of neonatal abstinence syndrome in newborns. Men may experience reduced testosterone production and diminished sperm quality. Additionally, older adults using opioids face an increased risk of falls, fractures, and cognitive impairments. These findings are detailed in the study “Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications” by Kerry S. Flannagan and colleagues, published in the journal Epidemiologic Reviews in October 2020. This study highlights the complex and multifaceted impacts of opioids on reproductive health across different populations, underscoring the need for careful consideration of these drugs’ use, especially among those of reproductive age or the elderly.
  • Mental Health: Continued misuse of opioids significantly raises the risk of developing mental health conditions such as anxiety disorders and depression. The study “Understanding the Opioid Overdose Epidemic,” published by the CDC, delves into the myriad impacts of opioid abuse, highlighting the strong link between opioid misuse and the exacerbation of mental health issues. Addressing these mental health effects is critical for alleviating symptoms and breaking the cycle of addiction, which the study notes is crucial for both recovery and prevention of further misuse. Effective management of these conditions is imperative to prevent the perpetuation of opioid addiction and improve overall patient outcomes.
  • Social Impacts of Opioid Misuse: Opioid misuse not only affects an individual’s health but also brings about social repercussions. As outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), individuals with an opioid use disorder may exhibit symptoms that negatively impact their social lives, including:
  • Spending excessive time acquiring, using, or recovering from opioid use.
  • Neglecting responsibilities at home, work, or school due to opioid use.
  • Persisting in opioid use despite causing problems in relationships.
  • Sacrificing important social, recreational, or occupational activities to use.

How is Opioid Addiction Treated?


Opioid addiction is treated through a comprehensive approach that combines medication-assisted treatment (MAT), counseling, behavioral therapies, and strong support networks, according to the American Society of Addiction Medicine in their guide, “Opioid Addiction Treatment: A Guide for Patients, Families and Friends” (2016). Here’s a detailed look at the treatment modalities:

  1. Medication-Assisted Treatment (MAT): MAT is often the cornerstone of treatment for opioid addiction. It includes the use of FDA-approved medications such as methadone, buprenorphine, and naltrexone. These medications help to manage withdrawal symptoms, reduce cravings, and maintain sobriety. Methadone and buprenorphine work by binding to the same opioid receptors in the brain as the addictive drug but are safer and less likely to produce the harmful behaviors that characterize addiction. Naltrexone blocks opioid receptors and prevents opioid drugs from producing a high.
  2. Counseling and Behavioral Therapies: Alongside medications, behavioral therapies are critical for treatment. These therapies help modify the patient’s behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication. Patients may engage in individual therapy, group therapy, or family therapy, which help address issues underpinning addiction and foster healthier interpersonal dynamics.
  3. Levels of Care: Treatment can be administered in various settings that correspond to the severity of the individual’s addiction and their specific needs. This ranges from outpatient treatment (ASAM Level 1), where patients do not stay overnight, to intensive outpatient programs (ASAM Level 2) and residential treatment centers (ASAM Levels 3 and 4), where more comprehensive 24-hour care is provided.
  4. Support from Family and Friends: Recovery from opioid addiction is often more successful when supported by loved ones. Families are encouraged to be involved in the therapeutic process, providing emotional support and understanding of the challenges faced by the person in recovery. Education for family members about addiction and how to best support their loved one is also crucial.
  5. Aftercare and Recovery Support: Sustained recovery from opioid addiction requires ongoing commitment and support. Many individuals benefit from continued participation in support groups like Narcotics Anonymous or other community-based recovery networks. These groups provide a supportive environment where individuals can share their experiences and challenges, thereby reinforcing their commitment to recovery.

What is the prevalence of opioid overdoses in the United States according to the CDC?

Over 70,000 Americans died from drug overdoses in a recent year, with the majority involving opioids, as reported in the CDC’s study “Understanding the Opioid Overdose Epidemic.” This statistic highlights the severe impact of the opioid crisis in the United States.

How does the American Psychiatric Association define successful treatment outcomes for Opioid Use Disorder?

Successful treatment outcomes for Opioid Use Disorder, as defined by the American Psychiatric Association in their guide “Psychiatry.org – Opioid Use Disorder,” include a significant reduction in opioid use, improved personal health and social functioning, and reduced criminal behavior.

What drugs increase the risk of respiratory depression when combined with opioids, according to the FDA?

Drugs such as benzodiazepines and certain antidepressants are known to increase the risk of severe respiratory depression when used in combination with opioids, according to findings from the FDA in the study “Assessing the Respiratory Effects of Approved Opioid Products When Co-administered with Commonly Prescribed Drugs.”

How is Suboxone used in the treatment of opioid addiction?

Suboxone is a medication commonly used in the treatment of opioid addiction as part of medication-assisted treatment (MAT). It contains buprenorphine and naloxone, which work together to reduce withdrawal symptoms and cravings. Buprenorphine is a partial opioid agonist that binds to opioid receptors in the brain, providing relief from withdrawal symptoms without producing the same high as other opioids. Naloxone is an opioid antagonist that blocks the effects of opioids, discouraging misuse. When taken as prescribed, Suboxone helps individuals stabilize and engage in therapy and counseling, which are critical components of a comprehensive addiction treatment program.

Can opioid addiction affect pregnancy and newborns?

Opioid addiction poses significant risks to both pregnant individuals and their newborns. Pregnant individuals with opioid addiction risk complications such as preterm labor, placental abruption, and fetal growth restriction. Newborns exposed to opioids in utero may develop neonatal abstinence syndrome (NAS), a condition characterized by withdrawal symptoms such as irritability, poor feeding, tremors, and seizures. Treatment for pregnant individuals with opioid addiction often includes medication-assisted treatment (MAT) with methadone or buprenorphine to manage withdrawal symptoms and reduce the risk of complications.

What is the relationship between opioid prescriptions and heart disease risks?

Older adults prescribed opioids are at a higher risk of coronary heart disease, a finding detailed in the Yale School of Medicine’s study “Hidden Dangers of Opioid Epidemic: Study Links Prescribed Opioids to Cardiovascular Disease,” which calls for cautious opioid prescribing in this vulnerable population.

What are the effects of opioids on the risk of pregnancy loss as reported in the Epidemiologic Reviews?

Opioid use may increase the risk of pregnancy loss, as suggested in the review “Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications” by Flannagan et al., highlighting the importance of cautious opioid use during pregnancy.

How can I prevent opioid addiction?

To prevent opioid addiction, it is essential to adhere strictly to the following guidelines. If prescribed opioids, take them precisely as directed by your healthcare provider. Maintain open communication with your doctor regarding any concerns or side effects. Store opioids securely in a safe and inaccessible location to prevent misuse. Dispose of unused medications properly, following recommended guidelines. Engage in open conversations with loved ones about the potential dangers of opioids and seek support from healthcare professionals or support groups if needed.

What are the withdrawal symptoms of opioid addiction?

Withdrawal symptoms associated with opioid addiction may include muscle aches and pains, restlessness and insomnia, diarrhea, vomiting, nausea, and sweating, as well as anxiety and depression. Chills and fever may also occur. These symptoms signify the body’s reaction as it adjusts to the absence of opioids.

What are the symptoms of opioid overdose?

If you suspect an opioid overdose, it is crucial to call 911 immediately. Recognizable symptoms include slowed or shallow breathing (less than 12 breaths per minute), pinpoint pupils (very small and constricted), blue or pale skin color, loss of consciousness or inability to respond, gurgling or snoring sounds, and seizures. Prompt action is vital in the event of an overdose to ensure timely medical intervention and potentially save a life.

What are the risks of mixing opioids with benzodiazepines, according to the FDA study?

Mixing opioids with benzodiazepines can significantly increase the risk of respiratory depression, which can be fatal. This interaction is highlighted in the FDA’s study “Assessing the Respiratory Effects of Approved Opioid Products When Co-administered with Commonly Prescribed Drugs,” underscoring the need for medical oversight when these drugs are prescribed together.

Does the combination of opioids and antidepressants affect respiratory function?

Yes, combining opioids with certain antidepressants, like SSRIs and SNRIs, can enhance the risk of respiratory depression. This interaction is detailed in the FDA’s research, as outlined in “Assessing the Respiratory Effects of Approved Opioid Products When Co-administered with Commonly Prescribed Drugs,” highlighting a critical consideration for prescribing practices to ensure patient safety.

What has the FDA found about the safety of opioids when used with other central nervous system depressants?

The FDA’s study “Assessing the Respiratory Effects of Approved Opioid Products When Co-administered with Commonly Prescribed Drugs” notes that opioids, when used with other central nervous system depressants such as muscle relaxants and sleep aids, can lead to severe respiratory depression, significantly increasing the risk of overdose and death.

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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