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Opioid Abuse

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Dangers of Opioids

Opioids include drugs that can be legally obtained, such as fentanyl, codeine, oxycodone, hydrocodone, and morphine, as well as heroin, which is illegal.1 Misusing opioids, becoming addicted to them, overdosing, and even dying are possible dangers of prescription opioid use, as well as other possible negative effects.7,10 With heroin use, a person may get addicted, overdose, die, and/or experience other problems.11

Prescription opioid misuse might be a gateway to using heroin – individuals nonmedically using pain medications may be far more likely, compared to individuals who are not, to start using heroin.1,12 Research suggests that heroin being more obtainable and more inexpensive are some reasons individuals transition to heroin from prescription opioid abuse.12 However, it is thought that, of people inappropriately using prescription opioids, most do not transition to heroin.5

Multiple factors influence the risk of an individual becoming addicted to opioids.2 Among people using prescription opioids, there is a higher risk of addiction in those misusing them than those using them as prescribed. 17 Based on 2017 surveys, it was estimated that over 2.1 million people ages 12 and up in the U.S. had an opioid use disorder in the previous year.3

Research suggests that heroin being more obtainable and more inexpensive are some reasons individuals transition to heroin from prescription opioid abuse.

People who use opioids may develop a tolerance to them.2,10,13 When this occurs, a person needs more of the substance to elicit the same response.2 Tolerance can develop even in people who take prescription opioids as prescribed.10

Opioid use can also lead to dependence, where withdrawal symptoms occur if the person stops using opioids.2 Dependence can occur when taking prescription opioids as instructed.14 Dependence can occur with addiction, but dependence and addiction are different.2,15

According to the Centers for Disease Control and Prevention (CDC), in 2017 over 47,000 people died from overdoses involving opioids.16 Of all fatal overdoses involving opioids in 2017, over 35% involved prescription opioids; the prescription opioid category for this calculation included semi-synthetic opioids, natural opioids, and methadone but not synthetic opioids aside from methadone.7

Some other possible consequences of opioid use may include:17

  • woman-feeling-nausea-alcohol-addictionVomiting.
  • Nausea.
  • Constipation.
  • Feeling confused.
  • Breathing stopping.
  • Slowed breathing.
  • Tiredness.
  • Muscular pain.
  • Infection of the heart.
  • Infection of the lung(s).

Signs and Symptoms

Symptoms of an opioid use disorder include:12

  • Craving opioids.
  • Frequently using opioids more or for more time than intended.
  • Use leading to stopping or decreasing significant work-related, fun, or social activities.
  • Getting, using, or recovering from opioids takes up a lot of time.
  • Using opioids repeatedly in dangerous situations.
  • Not completing important responsibilities at school, work, or home due to repeated use.
  • Not succeeding in managing or decreasing use despite attempts to do so, or persistently wanting to manage or reduce use.
  • Although opioids are bringing about or worsening social issues that occur repeatedly or are enduring, still using them.
  • Even when knowing that opioids are probably generating or worsening a mental or physical issue that occurs repeatedly or is enduring, using them still.
  • Still taking the same opioid dose is noticeably less effective or getting intoxicated or the result wanted requires noticeably higher opioid doses.*
  • Experiencing opioid withdrawal, or using opioids or similar drugs to prevent or reduce symptoms of withdrawal.*

*Except if a person is only using opioids while being properly overseen by a medical provider.

Opioid overdose signs can include:18

  • Unconsciousness.
  • Body that is limp.
  • Small pupils.
  • Breathing that is shallow and slow.
  • Blue or pale skin.
  • Gurgling noises.
  • Choking.
  • Skin that is cold.

If you or someone else may have overdosed on opioids (or something else), right away on 911.18

Symptoms and signs of withdrawal from opioids can include:12

  • Opioid overdose signs can include small pupils.Runny nose.
  • Enlarged pupils.
  • Trouble sleeping.
  • Sweating.
  • Aching muscles.
  • Dysphoria.
  • Diarrhea.
  • Nausea.
  • Vomiting.

Opioid Abuse Treatment

Options for opioid addiction treatment include behavioral therapies and medications.10 Some people who may be involved in treating addiction include physicians, counselors, nurses, and psychologists.19


Clinicians are not advised to try managing without medication symptoms of opioid withdrawal that are significant (symptoms that continue for several hours and are uncomfortable). Some medications used for opioid detoxification include methadone and buprenorphine.15

Detoxification may also be called medically supervised withdrawal. A panel of experts advises that, rather than short-term medically supervised withdrawal, maintenance therapy using medicine should be offered.20 

Detoxification can be completed on an inpatient, residential, or outpatient basis, but inpatient treatment can give further medical oversight.15

For people with addiction, only detoxification is not enough usually to help them stay abstinent long term.19 

For individuals who have opioid use disorders, most who go through medically supervised withdrawal relapse and do not stay in recommended treatment.20

Ongoing Treatment with Medications

Maintenance treatment is when individuals continue taking medicine as long as they are still benefiting from it. Methadone or buprenorphine may be used for maintenance.20

If an individual has an opioid use disorder and has taken no long-acting opioids in the past 10-14 days and no short-acting opioids in the past 7-10 days, naltrexone may be an option.20

According to a Substance Abuse and Mental Health Services Administration (SAMHSA) publication, every level of care should offer medications to treat opioid use disorder. 20


Possible treatment settings include inpatient treatment, residential rehab, and outpatient treatment. Individual therapy, group therapy, and/or family therapy may be available.19

There are several types of therapy.19 Therapy may help you to manage triggers, deal with stress, change your drug use behaviors, alter your perspective on using drugs, and/or more.1

Additional Support

For those who are not staying at an inpatient or residential treatment facility, a sober living facility may be beneficial. Sober living houses require residents to stay sober and involved in the household. They often also mandate that residents attend mutual-help groups, such as 12-step groups.21

Some people may attend a mutual-help group, such as Narcotics Anonymous, where individuals collaborate to achieve and stay in recovery. However, some programs might push individuals to discontinue medicines for opioid use disorder, so, if prescribed those medications, look for ones that are accepting of medications for opioid use disorder.20

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Sophie Stein received her master’s of science in nursing from Vanderbilt University School of Nursing. She previously worked as an advanced practice registered nurse at an outpatient psychiatric practice providing mental health care for children, adolescents, and adults. She performed patient evaluations and medication management, including using pharmacogenetic testing to guide her treatment plans. Sophie is passionate about helping those struggling with mental illness and substance use disorders, and she believes that providing those individuals and their loved ones with thorough, accurate educational resources is essential. 
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