A Guide to Opioid Addiction: Signs, Symptoms & Treatment

Opioids

Opioids like heroin and prescription painkillers are some of the most dangerous and widely abused substances in the world. With a high potential for addiction and the significant potential for deadly overdose, understanding the risks of abusing opioids is more important than ever. Read on to learn about the impact that opioid abuse can have on your life or the life of someone you love.

The United States is facing a major opioid epidemic. More than 33,000 people died because of an opioid overdose in 2015.¹ The growing numbers of deaths from opioids is attributed in part to overprescribing of addictive painkillers like Vicodin. The grip that opioid abuse can have on a person’s life can be crippling, and the already high risk of overdose is increased exponentially by the influx of street heroin laced with frighteningly potent opioids like fentanyl and carfentanil.

One of the first parts of recovering from an opioid addiction is recognizing the problem. To get a solid understanding of heroin or painkiller addiction, we first have to understand the drugs we’re dealing with.

What Are Opioids?

Opioids are a class of drugs that reduce perceptions of pain and produce a sense of euphoria. They depress activity in the central nervous system, meaning they can slow breathing and cause drowsiness. Drugs in this class include heroin and prescription painkillers. When these drugs are taken in high doses, their depressant effects can be deadly.

Opioid painkillers are prescribed to alleviate acute pain from surgery, cancer, injuries, and dental procedures. They include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine, and many others. These pills are carefully dosed by doctors to protect the patient from serious side effects and addiction, but sometimes people abuse them, meaning taking them more often than prescribed, in higher doses than prescribed, or in a way other than intended. Abusing these medications can put a person on the fast track to addiction.

So how do opioids produce their effects? It helps to first understand your brain’s system for relieving pain. Your brain naturally produces chemicals that reduce your perception of pain and make you feel good, such as endorphins. “Endorphins” comes from “endogenous” (innate to the body) and “morphine” and are what you feel when you engage in strenuous exercise (e.g., a “runner’s high”), get into a serious accident (they protect you from overwhelming pain in the moment), and have sex. Opioid drugs like heroin and oxycodone attach to the same receptors in the brain as these chemicals to mimic their effects, but they can have a much stronger impact.² Those taking opioid drugs may experience extreme relaxation, reduced sensation of pain, intense sleepiness, and an overwhelming sense of happiness and wellbeing. These positive feelings can make someone crave more and more of the drug in order maintain their good feelings. Unfortunately, these feel-good effects also come with many unpleasant side effects (especially at high doses), including a significant overdose risk.

The negative effects of these drugs include:

• Dizziness.
• Nausea.
• Vomiting.
• Severe constipation.
• Slowed or stopped breathing.
• Slowed or stopped heart rate.
• Physical and psychological dependence.
• Addiction.

What Is the Difference Between Heroin and Prescription Opioids?

Both of these drugs fall under the umbrella of opioids. They activate similar receptors and have similar effects, to varying degrees. In effect, there isn’t a huge difference between heroin and painkillers, with the excpetion of their legal status, cost, and methods of use.

Heroin tends to be much cheaper than painkillers (and easier to get), which is why many people whose opioid addiction started with a prescription eventually turn to street heroin to fulfill their cravings and avoid withdrawal.

On top of this, these drugs are often used differently. Several prescription opioids come in pill form, so people will simply swallow or crush and snort the pill. The crushed pill powder can be dissolved into water and injected, but swallowing or snorting tends to be more common among those who abuse painkillers. Heroin, on the other hand, is very commonly injected. It can be smoked or snorted, but the strongest high (the stereotypical “rush”) comes from injection, and many people who begin by snorting or smoking heroin eventually move on to shooting it.

This variance in use may seem meaningless, but it makes a huge difference in the drug experience and risk of overdose. Methods of using that cause the drug to reach the bloodstream faster, like injecting, tend to produce a faster, more intense high. Compare this quick method to the slower metabolic process of swallowing a pill, where the pill has to be processed through digestion before producing the desired effects—the effects may last longer, but they will come on slower and won’t be as intense. This also means that injecting an opioid can put you at a higher risk of both becoming addicted and dying from overdose.

Signs and Symptoms

Opioid abuse can take a major toll on your life. An opioid addiction is a terrible thing to struggle with, and it can be difficult to tell whether you have become addicted. This is especially true when the drug you’re abusing has been given to you by your doctor. However, there are some things you can look out for when you’re trying to tell whether you have a problem.

Physical Symptoms

One of the most obvious signs of an addiction is the development of tolerance and, eventually, dependence. Having a tolerance to opioids means that you need more and more to feel what you used to when you began taking them. For some, this means taking the drug more often than before. For others, it means taking higher doses than before. It might also mean both, taking greater amounts more often (a recipe for overdose).

Developing a dependence on opioids means that you’ve come to physically rely on the drug—you need it just to feel normal. At the point that you’re taking opioids to avoid withdrawal, which can feel like a terrible flu, you are physically dependent. Even people who take opioids as prescribed will develop some level of tolerance and may become dependent; however, these two phenomena go hand in hand with the development of an addiction.

Other physical indicators that you may have a problem with opioid abuse are:^4,5

• Slow pulse
• Low blood pressure
• Low body temperature
• Poor coordination
• Frequent drowsiness and “nodding off”
• Itching skin and frequent scratching
• Pinpoint pupils
• Irritability
• Slurred speech
• Slow movement
• Sleeping more or less than normal
• Shallow or slow breathing
• Nausea and/or vomiting
• Chronic constipation
• Poor eating habits
• Track marks or collapsed veins

Psychological Signs

There are also many non-physical symptoms of an opioid problem. Some mental or behavioral indications that you may have a problem include:⁴

• Taking more than you intended.
• Using for longer than you intended
• Experiencing cravings to use opioids
• Lying about your painkiller use
• Spending a lot of time trying to get, use, or recover from opioids
• Feeling defensive when approached about your opioid use
• Wanting to stop using or cut back, but being unable to do so
• Developing problems at work, school, or home related to your opioid use
• Using in situations where it is physically dangerous (like driving)
• Continuing to use opioids despite related social and interpersonal problems
• Feeling generally unhappy with life
• Having trouble with your memory or ability to pay attention

Consequences

Addiction to opioids doesn’t happen overnight. It is the result of a long-standing pattern of escalating abuse, and it can have long-lasting consequences for the addict. An opioid addict may neglect loved ones, ignore important responsibilities, suffer financial issues, face legal troubles, struggle with low self-esteem, or feel trapped and isolated.

Opioid abuse can damage areas of the brain related to initiating and following through on a plan of action, so getting help can be even more difficult.⁵ On top of this, the brain changes that opioid abuse can cause may also affect your emotional control and motivation.⁶ This means that opioid-related brain damage can cause extreme mood swings, so one minute you might feel entirely ready to start treatment, but not long after you could feel afraid to take the next step. It may also mean you might have trouble even recognizing when you need help.

Without intervention, the opioid addict is left at risk of the serious consequences of continued abuse, which may include:^7-9

• Dangerous breathing problems, which may be fatal.
• Hypoxia, or lack of oxygen to the tissues, which can be life-threatening and can cause permanent brain damage.
• Disease transmission (HIV, hep C, etc.) from injecting drugs.
• Painful, dangerous skin infections and vascular inflammation.
• Progression to heroin use (if currently using pills).
• Neonatal abstinence syndrome (withdrawal in babies born to opioid-addicted mothers).

Overdose Symptoms

It is very important to know the warning signs of an opioid overdose. Recognizing it early on could save a life, including your own. When a person is experiencing an opioid overdose, their brain activity is slowed down so much that their breathing and heart rate simply stop.¹⁰ This is why opioid overdose can be so lethal.

Identifying the symptoms of an overdose can mean the difference between life and death, so if you suspect that someone you are with may be experiencing an opioid overdose, look for the combination of the following 3 signs (the “opioid overdose triad”):¹⁰

• Pinpoint pupils
• Unconsciousness
• Slowed or stopped breathing

This triad of symptoms will help you recognize an opioid overdose and get help quickly, which could save that person’s life. In emergency overdose situations, a drug called naloxone can be administered. Naloxone blocks opioid receptors in the brain, meaning it can immediately halt the effects of an opioid overdose. Naloxone is available in some pharmacies around the U.S. and is sometimes used by bystanders who witness an overdose. Once naloxone is administered, emergency medical care should be initiated immediately. In some cases, one dose of naloxone may not be enough; this may occur with heroin that has been contaminated with potent synthetic opioids like fentanyl or carfentanil.

What Happens in Opioid Withdrawal?

The opioid withdrawal syndrome has been described by many who have gone through it as the worst flu you can imagine. It may not be deadly, but it can certainly feel as if you’re about to die. Opioid withdrawal can start anywhere between 8 to 48 hours after the last dose, depending on which opioid you’re recovering from.⁵ Heroin withdrawal, for example, can start as soon as 8 to 12 hours after the last dose, whereas methadone withdrawal typically starts 36 to 48 hours after the last dose.⁵ Despite the variety in timeline, the withdrawal syndrome for any opioid drug can have many uncomfortable symptoms, including:⁵

• Anxiety
• Fast heart rate
• High body temperature
• Insomnia
• High blood pressure
• Sweating or clammy skin
• Chills
• Increased breathing rate
• Extreme headache
• Teary eyes
• Muscle and bone pain
• Runny nose
• Muscle spasms
• Abdominal cramping.
• Nausea and vomiting
• Diarrhea

The extreme unpleasantness of opioid withdrawal can push a person back into using just to stop feeling so awful, so having professionals on hand to take care of you during this process is very important.

Detox

Detox from opioids means completely clearing them from your system so you can move into recovery without their influence on your body and mind. You do this through extended abstinence, and it’s not a comfortable process due to the symptoms described above. Luckily, however, working with a professional detox program can help you get through it with as little discomfort and psychological distress as possible.

Detox programs can provide the medical care and support that you need during opioid withdrawal. Some people experience more dangerous symptoms like dehydration, fever, heart issues, blood pressure issues, and anxiety, which all must be properly treated.⁵ Addicts who struggle with pain-related conditions may have a particularly difficult time during opioid detox, as their painful symptoms may return at an even greater intensity during this period.⁵

Addiction treatment professionals know what to expect when it comes to opioid detox, so they can help you prepare for what’s to come and make sure you have the best care throughout the process.

Medications

Treatment professionals can prescribe medications to treat certain opioid withdrawal symptoms, such as nausea, vomiting, diarrhea, insomnia, muscle pain, bone pain, headaches, and stomach cramps.⁵ These can help alleviate the physical challenges, but what about the biggest test: cravings? It is particularly challenging to face opioid cravings in the midst of withdrawal sickness, especially when you know that using will put an end to all of your pain. Nobody said getting clean was easy, but it is incredibly important, and fortunately there are other medications to help you cope with opioid cravings and other withdrawal symptoms as you detox:⁵

• Methadone: The most frequently used medication to alleviate opioid cravings during detox. It activates the same receptors as opioid drugs and helps relieve cravings without the intense, addicting rush. But, its effects can turn dangerous if it is abused.
• Buprenorphine: A partial opioid agonist that works at the same receptors as opioid drugs but does not activate them as powerfully. It is available as a sublingual tablet as well as a long-term implantable form (Probuphine), or in combination with naloxone as Suboxone.
• Clonidine: This non-opioid medication can relieve opioid withdrawal symptoms without producing the opioid high, but may not have as much of an effect on drug cravings.

There is no single medication profile that works for everybody, which is where detox treatment programs come into play. Treatment professionals can help you determine what medicine will be the most beneficial for you, prescribe it in safe doses, and monitor you for any complications.

Why Is Treatment Needed?

Quitting on your own can be extremely difficult, especially as cravings start to flare up and the flu-like withdrawal syndrome sets in. Relapse can be very tempting, and having a sober support network around can make a huge difference for your recovery. Treatment programs allow you to learn how to cope with relapse temptations without having to face the triggers to use that are so prevalent in your day-to-day life.

Treatment Options

Once detox is complete, treatment can begin. When it comes to opioid addiction treatment, you have many options. The type of program you choose must match your individual needs, so make sure you look into the treatment centers that you’re considering by checking out online reviews.

One of the most important questions to consider is whether you want to work through treatment with an inpatient program or an outpatient program. Inpatient programs tend to cost more, but they allow you to stay at the treatment facility so you have access to professional support 24/7. You get to work on recovery in a 100% sober environment with peers that understand the challenges you will face. In addition, if any medical complications were to arise, you would have immediate access to professional care.

Outpatient programs, on the other hand, allow you to continue to live at home throughout treatment. You will check in on a regular basis with the treatment program for therapy sessions. Outpatient programs require a lot of self-discipline because you will likely be living in the same environment in which you used to use. Your home can be full of opioid use triggers, which can be difficult to deal with during early recovery as you try to gain sober footing. However, for some people, such as those who are unable to leave home due to personal obligations or who are unable to afford inpatient treatment, this can be a good option. Outpatient treatment can also serve as a great next step following completion of inpatient rehab, as it allows you to continue your therapy and retain your focus on recovery.

Most treatment programs will incorporate various forms of therapy to their process. Therapy and counseling sessions can take place in both individual and group settings. Many programs ask that you participate in both, and both options add their own value to the recovery process. Therapy types commonly used in opioid addiction treatment include:11

• Contingency Management: This type of therapy is also called motivational incentives, and it involves the earning of rewards for meeting recovery goals. It has been proven effective for people recovering from opioid addiction.
• Community Reinforcement Approach: This is an intensive 24-week outpatient therapy that helps you recognize that living without drugs is more rewarding than continuing to feed your addiction.
• 12-Step Facilitation: This therapy encourages you to engage with 12-step programs like Narcotics Anonymous at the same time that you are working through a treatment program. It highlights the importance of accepting your addiction, surrendering to a higher power, and being actively involved in your recovery journey.

Medication-Assisted Treatment

On top of behavioral therapy, you may have the option of taking medications to help maintain your sobriety. For some people, especially those who also struggle with a pain disorder, cravings can be almost irresistible. This is where medication comes in. Medications like methadone and buprenorphine aren’t only useful during detox. For some, they’re a vital and effective part of controlling relapse urges and maintaining long-term sobriety.¹² Medications used in combination with behavioral therapy has been shown to be extremely effective. 12, 13 This combination is referred to as medication-assisted treatment, or MAT. Taking multiple approaches can help you build up a stronger defense system when you’re faced with relapse temptations.

Another MAT medication that can be used is naltrexone, which is available in both pill (Depade) form and a once-monthly injection (Vivitrol).¹³ Unlike buprenorphine and methadone, naltrexone blocks the opioid receptors, preventing you from getting any kind of opioid high if you decide to use again.¹³ This helps protect you from returning to opioid abuse, but might not necessarily stop your cravings (although it might reduce them).¹³ People with strong outside motivation may find naltrexone effective in opioid recovery, but make sure you talk with your treatment professionals to figure out what medication may be right for your particular situation.¹²

Another medication that may be used in MAT is Suboxone, which is a combination medication containing buprenorphine and naloxone.¹⁴ This allows it to both alleviate cravings and discourage opioid abuse.

There are some people who take the stance that those using an MAT approach are “not sober,” but the truth is that you should utilize whatever method works for you. For some, therapy alone can get them to a place where they can maintain long-term sobriety. Other people need a little extra help, and there is absolutely nothing wrong with that. In fact, the option that has shown the highest rate of success for people who’ve used for long periods of time is a combination of MAT and behavioral therapy.^12,13 No matter which approach works for you, as long as you are no longer letting your addiction put your life at risk, you are on the right track.

Alternative Pain Management

For opioid addicts who also struggle with pain management, recovery can be especially tricky. Opioids are often a go-to for pain management, which is part of what started the opioid addiction in the first place for many people. Finding other ways to manage pain is a very important part of recovery for these people. Some alternative options that have shown promising results for alleviating pain include:

• Acupuncture: Professional insertion of very thin needles into certain points on the body. Acupuncture has shown positive results in helping with headache issues and back pain.¹⁵
• Exercise or Physical Therapy: Regular physical activity regimens that are specifically tailored to the individual’s condition are the most effective.^16-18
• Reducing Stress Levels: Stress reduction practices can help alleviate the sense of pain. These can include yoga, mindfulness meditation, massage, music therapy, and biofeedback.^19-30
• Psychological Therapy: Pain and depression are often linked; in fact, 66% of people struggling with depression are also facing chronic pain.³¹ Working with a therapist, particularly in cognitive-behavioral therapy, can help you learn how to minimize the impact that pain has on your life.^32-34
• Hypnosis: Being hypnotized means that you are in such a focused state of concentration that it helps you take your mind away from the pain. It may help with pain associated with arthritis, cancer, surgery, headaches, and fibromyalgia.¹⁵
• Medical Marijuana: While still considered federally illegal, many states have approved marijuana for medical use with a doctor’s recommendation. It has been found to help people cope with multiples types of pain but can have adverse health effects.^35-37 Make sure you consult with a medical professional before trying out marijuana for pain management.

Ultimately, non-opioid pain management comes down to what works for you. Every person is different, and what helps one person cope with pain may not work in the same way for you. The best pain management results come when multiple options are combined, so make sure you explore the options to find the best approach for you.^38,39 Managing pain without opioids could save your life.

How to Quit Abusing Opioids

We understand, opioid abuse can be one of the most challenging things to overcome. But recovery is possible! If you do not get help, you are letting heroin and pills control your life, and they don’t care whether you live or die.

The truth is that opioids these days are especially deadly. The potency of street drugs has increased exponentially and thousands of people are dying every year—people that struggled in the same way that you are currently struggling. Don’t become a statistic; reach out for help and start learning how to live a great life without opioids. We’re here to help you any time of day or night. Don’t wait until it’s too late to start over.