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Opioid Addiction:
Symptoms and Treatment

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Opioid addiction is a type of substance use disorder where a person uses high amounts of opioids despite the harmful effects they cause and only to experience euphoria and other pleasurable effects.

Opioid drugs can be legally obtained through prescription for pain relievers or cough medications, but some substances such as heroin are illegal. Compulsive urge to use opioids leads to tolerance and dependence. Even when a person decides to stop, these attempts are usually unsuccessful due to withdrawal symptoms.

Also known as opioid use disorder, this condition usually stems from opioid misuse, i.e., the fact that these medications are overprescribed. Many patients go to great lengths to obtain the prescription; some of them attempt to forge a signature or see multiple doctors.

The main reason behind opioid addiction is to numb the pain and feel the pleasant effects these drugs provide. Other factors play a role in the development of addiction. These include family history, presence of a mental health problem, addiction to other drugs, socializing with people who use it, among others.

The biggest misconception about opioid addiction is that it's just a mental health problem, and people need strong willpower only to overcome it. Opioid use disorder is more than that; its mechanisms of action are physical too and include changes in the brain. A lot more than strong willpower is necessary. A patient with opioid use disorder needs a strong support system and a well-structured treatment.

What are the Causes of Opioid Addiction?

Causes of opioid addiction tend to vary from one person to another. Not every person who uses opioid prescription medications is going to develop an addiction. Scientists are still trying to uncover all the mechanisms that lead to addiction to opioids, and one of them is the fact they produce pleasurable effects in some people.

These drugs trigger the release of endorphins, feel-good chemicals. Endorphins muffle a person's perception of pain, thus creating a short-term sense of wellbeing. When the effects wear off, a person finds oneself wanting more just to experience those pleasurable effects. The causes of opioid addiction are listed below:

  • Personal history such as past or current substance abuse
  • Length of time a person uses opioids
  • Untreated psychiatric disorders
  • Younger age
  • Social or family environments that encourage misuse of opioids
  • Stressful circumstances
  • Poverty and unemployment
  • History of criminal activity or legal problems, including DUIs
  • Thrill-seeking or risk-taking behavior
  • Regular contact with people who are addicted to opioids or are at high risk of developing an opioid use disorder

What are the Opioid Addiction Symptoms?

Opioid addiction symptoms are physical, psychological, and behavioral in nature. A person struggling with opioid use disorder may not display symptoms immediately. As their addiction worsens, the signs and symptoms become more apparent.
The most common signs and symptoms of opioid addiction are listed below:

  • Finishing a prescription early due to taking more medication than prescribed
  • Inability to control the use of opioids due to strong cravings
  • Drowsiness
  • Hyperactivity
  • Change in eating and sleeping habits
  • Depression and anxiety
  • Lack of motivation, focus and concentration, and effort
  • Itchy skin
  • Cramping
  • Lack of hygiene
  • Reduced libido
  • Weight loss
  • Diarrhea
  • Muscle and joint pain
  • Headache
  • Nausea and vomiting
  • Confusion and disorientation
  • Mood swings and irritability
  • Abandoning responsibilities
  • Social withdrawal or changing social circle
  • Slurred or slowed speech
  • Poor coordination
  • Stealing money and possessions from other people to buy opioids
  • Loss of interest in activities once enjoyed
  • Engaging in risky behaviors to obtain a prescription for opioids, e.g., visiting more than one doctor, trying to forge a doctor's signature, getting opioids illegally, etc.
  • Shallow or slow breathing
  • Physical agitation
  • Poor decision-making
  • Frequent flu-like symptoms

What are the Opioid Addiction Treatment Methods?

Opioid addiction treatment methods are the use of medications, therapy, and participation in programs that aim to help persons with this substance use disorder.

Addiction specialists in treatment centers recommend the most suitable approach according to the severity of the patient’s addiction. A combination of several strategies works best. Treatment of opioid addiction is provided in either inpatient or outpatient settings.

percocet addiction

More specifically, the most common treatment methods for opioid addiction include:

 

Medications: a patient may receive medications that help reduce the severity of withdrawal symptoms. The most commonly used medications include buprenorphine (Suboxone), methadone, and naltrexone (Vivitrol). Medically-assisted treatment (MAT) reduces opioid use, criminal activity, overdose deaths, and transmission of infectious diseases.

This approach also improves social functioning and retention in treatment. Medications are not prescribed on their own; they are combined with therapy. Keep in mind that medications are primarily administered in detox, the first stage of the treatment.

 

Therapy: psychological treatments focus on every stage of opioid addiction, including recovery. Several types of therapy are available to persons with opioid use disorder. While they have some differences, the therapies work primarily to help patients identify negative thoughts and behaviors and replace them with positive ones. The most common types of therapy in the treatment of opioid addiction include:

  • Motivational interviewing and motivational enhancement therapy: guides patients through various stages of change
  • Cognitive-behavioral therapy: one of the most effective treatments for opioid use disorder. It helps patients identify negative patterns and swap them for positive thoughts and behaviors; which is why CBT is particularly effective for persons who also have a mental health problem
  • Family therapy: helps improve dynamics in families whose loved one is addicted to opioids. The goal of this therapy isn't just to focus on the addicted person but also to help their family cope
  • Couples counseling: used as a part of the comprehensive treatment, works on improving relationship dynamics

 

12-step program: a strategy built on the premise that participation in support groups can help persons with addiction achieve and maintain abstinence.

These programs aren’t just for persons suffering from alcoholism; they are also available for individuals with opioid use disorder. The 12-step program and other support groups are usually a part of outpatient treatment.

Here, all participants share their experiences with addiction and treatment and support one another.

Is Opioid Addiction Treated in Rehabs?

Yes, opioid addiction is treated in rehabs. Most general hospitals don’t admit patients solely for substance abuse treatment and withdrawal unless they also have other medical problems.

Besides dedicated opioid rehab centers, many centers for substance abuse disorder treatment also help patients with this type of addiction. At this point, there are over 14,000 rehab centers in the United States alone. Worldwide statistics aren’t available yet, but we can safely assume there are thousands of them across the globe as well.

Which Opioid Drugs Cause Opioid Addiction?

Opioid drugs that cause opioid addiction include illegal substances such as heroin and medications that can be obtained legally through prescription. These include pain relievers, cough medicines, cancer drugs or drugs to manage some chronic conditions.

Pain-relieving prescription opioids are medications formulated for the management of moderate to severe pain following surgery or injury. These medications are also prescribed for some chronic conditions and other health concerns such as cancer. Pain-relieving prescription opioids include:

  • Oxycodone (OxyContin, Roxicodone)
  • Hydrocodone-acetaminophen (Vicodin)
  • Hydrocodone bitartrate (Zohydro ER)
  • Hydrocodone-ibuprofen (Vicoprofen)
  • Morphine (MS-Contin, Roxanol, Oramorph SR)
  • Morphine-naltrexone (Embeda)
  • Hydromorphone (Dilaudid, Exalgo)
  • Fentanyl
  • Fentanyl citrate (Sublimaze)
  • Meperidine (Demerol)
  • Tramadol (Ultram, Ryzolt)

Cough opioid medications are drugs prescribed in cases of severe and distressing cough. They include:

  • Hydrocodone-homatropine (Tussigon, Hydromet)
  • Hydrocodone-chlorpheniramine (Tussionex)
  • Hydrocodone-cpm-pseudoephedrine (Zutipro)
  • Pseudoephedrine-hydrocodone (Hycofenix)
  • Codeine-poli-chlorphenir poli

How Does Inheritance Affect Opioid Addiction?

Inheritance affects opioid addiction just as it plays a role in other substance use disorders. Scientists have identified genes that could affect the risk of opioid addiction. The journal Biological Psychiatry published a study that adds to a growing body of evidence that genetic factors contribute to addiction development.

This particular study analyzed genomes of over 5000 Americans exposed to opioids. Scientists discovered the presence of a genetic variant on one chromosome nearby the RGMA gene. This variant was linked to opioid addiction. The RGMA gene creates a signal that instructs nerve fibers where they should go. Alterations to these molecules could impair the brain's circuit and predispose a person to psychiatric and neurological conditions. It's still unclear how this gene contributes to addiction risk.

Additionally, a study from BMC Psychiatry identified variation on a different gene associated with opioid addiction. This is rs1799971 of the OPRM1 gene.

Are There Demographic Differences for Opioid Addiction?

There are demographic differences for opioid addiction, studies show. For example, the April 2021 issue of the Drug and Alcohol Dependence published a study that focused on racial and ethnic differences in past-year prescription opioid misuse and heroin use.

The scientists analyzed data on 1,117,086 subjects aged 12 and older from the 1998-2018 National Survey on Drug Use and Health. Results showed that prescription opioid misuse was higher in non-Hispanic Whites than in Hispanic, Black, and Asian subjects during this entire period.

In every time period, the misuse was the highest among Native American persons. Additionally, the difference in misuse among White, Hispanic, and Asian subjects widened significantly over time. However, the gap between Black and White subjects and their misuse of opioid prescriptions decreased significantly.

When it comes to heroin use, in the beginning, it was the highest among Hispanic and Black subjects. In the 2007-2010 period, heroin use among Whites surpassed all other groups and consistently increased from that point on.
Speaking of demographic differences, it’s also useful to mention men are more likely than women to meet the criteria for opioid dependence.

The role of heredity in opioid addiction goes beyond the variations of certain genes. It extends to the environment to which a person is exposed. For instance, a person whose parents and other family members are addicted to opioids is exposed to those substances regularly. The severity of exposure contributes to someone's behavior, and they may start misusing opioids too.

Can Someone Notice Their Opioid Addiction?

Someone can notice signs of opioid addiction, but many people are reluctant to acknowledge the existence of a problem to the point they seek help. Additionally, a person may notice signs of opioid use disorder and attempt to stop unsuccessfully due to strong cravings.

For example, a person may realize they don’t use opioids for their intended purpose anymore or that they take more than recommended. They also notice withdrawal symptoms when they try to quit using opioids on their own.

As mentioned above, many persons with opioid addiction are in denial and aren’t ready to admit they have a problem.

In most cases, family members and friends are the first to notice something’s not right.

How Is Opioid Addiction Diagnosed?

Opioid addiction is diagnosed by a doctor or mental health professional after a medical assessment that also includes testing for mental health disorders. A urine drug test is also necessary.

If patients have a history of IV drug abuse, the healthcare professional also orders tests for HIV and hepatitis B and C. Opioid addiction is diagnosed when a patient has at least two of the following DSM-5 Diagnostic Criteria for OUD during a period of 12 months.

The opioid addiction diagnostic criteria are listed below:

  • Withdrawal symptoms
  • Taking opioids in larger amounts or longer than intended
  • Developing tolerance to the drug
  • Persistent desire or unsuccessful efforts to stop or control opioid use
  • Continuing using opioids despite consequences they cause
  • Spending a great deal of time thinking about opioid use, using them, or recovering from its efforts
  • Recurrent use of opioids even in situations when it’s physically dangerous
  • Failing to fulfill obligations at home, school, or work due to opioid use
  • Giving up occupational, social, and recreational activities in favor of opioid use

 

In Overcoming Opioid Addiction: The Authoritative Medical Guide for Patients, Families, Doctors, and Therapists, author Adam Bisaga describes details of an opioid use disorder, how to recognize and understand it, and treatment options available to patients.

How to diagnose opioid addiction?

Is Opioid Addiction a Drug Dependence?

Opioid addiction is a drug dependence primarily because opioids are a class of drugs formulated to treat health problems such as pain. Some opioids, such as heroin, are illegal.

Opioid addiction is, like any other form of addiction, a disorder wherein a person feels strong cravings to use opioids and experiences withdrawal symptoms when they stop. These cravings stem from a strong urge to experience pleasurable effects that a person feels when using opioids.

The National Institute on Drug Abuse listed prescription opioids and heroin on the list of the most commonly used drugs. They explained that opioids could cause euphoria and are oftentimes taken non-medically, which can lead to overdose and death.

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