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Opioids: Side Effects, Signs of Abuse, and Addiction Treatment

Opioids are substances that are known for their pain-relieving effects. They include both legal and some illegal substances that may have the potential for misuse, which can potentially lead to dependence and/or addiction.1

If you or someone you know is struggling with opioid addiction, know that you’re not alone. Opioid addiction and overdose are serious public health problems in the United States. In 2019, 10.1 million people reported misusing opioids in the past year, with 9.7 million of these people misusing prescription opioids.2

Whether you use opioids as prescribed or misuse opioids, it’s important to understand the dangers that may be associated with them. This may help to prevent potential adverse health effects, addiction, overdose, and even death. Keep reading to learn more about:

  • Opioid addiction.
  • Causes of opioid addiction.
  • Opioid addiction solutions.
  • Options for opioid addiction treatment.

What Are Opioids Used For?

Opioids are a class of drugs that includes illegal substances like heroin and prescription drugs like oxycodone and morphine. Because of their analgesic or pain-killing properties, prescription opioids are widely used to manage many types of painful conditions.4

Naturally occurring opiate substances such as morphine, codeine, and thebaine are derived from the poppy plant. Semi-synthetic opioids like heroin, hydrocodone, and oxycodone are created in labs from these natural opioids. Fully synthetic opioids like fentanyl and methadone are manmade in laboratories.5

Certain prescription opioids are considered essential medicines by the World Health Organization (WHO). This is because they are deemed necessary for pain management and for their use in palliative care, anesthesia, and treating opioid dependence. Opioid analgesic medications on the WHO’s Model List of Essential Medicines include: 6

What Is Opioid Addiction?

Opioid addiction is a chronic and often-relapsing disease. The clinical diagnosis for opioid addiction is known as an opioid use disorder (OUD).4 Though a number of factors are thought to contribute to substance use disorders like OUD, their development may be associated with repeated opioid misuse or using them in a way other than how they were prescribed. OUD is characterized by a loss of control over opioid use, chronic opioid-seeking behaviors, and continuing to use drugs despite the potentially negative consequences this has on a person’s life.4

Opioids affect the brain by binding to and activating opioid receptors.9 Opioid receptor activation is key to the painkilling properties of these drugs, but it also is accompanied by increased dopamine activity in the brain. Dopamine is a brain signaling molecule that, when released in large amounts, can create a rewarding sense of euphoria. This effect can make a person want to repeat the experience that led to the increased dopamine activity to begin with. Such a reinforcement of continued use can lay the groundwork for opioid addiction development.4

Health Risks of Opioid Abuse

Since they have similar mechanisms of action to drugs like heroin, even opioids that are prescribed by a doctor have the potential to be highly addictive. Though opioids can be as safe and effective as painkillers when used as prescribed for short periods of time, the risks of negative consequences and/or misuse begin to build when they are used for longer periods or in greater amounts.

People may misuse opioids by taking medications that aren’t prescribed to them, taking medications in ways other than originally intended, or by taking painkillers to get high.4 Some of the potential health risks of opioid misuse include:10

  • The risk of addiction.
  • Death due to overdose.
  • Widespread, systemic effects on various physiological processes and throughout several organ systems, including the respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.
  • The risk of fractures due to falls (a particular concern in older adults).

Signs of Opioid Misuse

It’s not always obvious when a person is misusing or addicted to opioids. Though an opioid use disorderwoman-feeling-nausea-alcohol-addiction diagnosis is best left to treatment professionals, opioid misuse may be associated with certain physical, psychological, and/or behavioral signs that concerned loved ones might recognize in their friends or family.

The physical effects of opioid addiction can include:11

  • Frequently appearing sedated, drowsy, or sleepy.
  • Changes in sleep habits.
  • Weight loss or appetite changes.
  • Changes in personal hygiene or grooming patterns.
  • Low or no libido.
  • Seeming to have frequent colds or flu-like symptoms (i.e. intermittent withdrawal symptoms).

The behavioral and psychological signs of opioid addiction may include:11

  • Seeking prescriptions or visiting multiple doctors.
  • Reporting lost or stolen medication.
  • Making frequent mistakes at work or school.
  • Wanting to cut down or stop opioid use but being unable to do so.
  • An increase in reported pain levels even though the person’s condition doesn’t seem to be worse than before.
  • A lack of interest in relationships or activities.
  • Isolation from family or friends.
  • Change in exercise habits.
  • Stealing from family, friends, or businesses.
  • New financial or legal difficulties.

Opioid Withdrawal Symptoms

People with significant of levels physiological opioid dependence may experience opioid addiction withdrawal symptoms if they try to quit or slow their use, sometimes within a few hours after their last dose. Opioid withdrawal symptoms are often so unpleasant and uncomfortable that it it quite challenging for people to stop using the drugs. Acute opioid withdrawal symptoms can include:4

  • Fluctuations in mood.
  • Gastrointestinal upset, like vomiting or diarrhea.
  • Body aches and pains.
  • Sleep difficulties.
  • Cold flashes and goosebumps.
  • Fever, sweating, and watery eyes.
  • Sudden, uncontrollable leg movements.
  • Strong and intense cravings to use opioids.

Dangers of Opioid Misuse

Even when they are used as directed, opioids are associated with physiological tolerance and dependence—though the likelihood of developing both effects may be increased in instances of misuse. Both tolerance (in prompting increased levels of use) and dependence (continued use to avoid withdrawal) can fuel the cycle of addiction. Opioid misuse can also increase the potential for an opioid overdose.4

Opioids are associated with certain adverse side effects, the likelihood of which may increase when these drugs are misused. Short-term side effects of opioid use can include:4

  • Over-sedation or sleepiness.
  • Feeling confused or disoriented.
  • Nausea and vomiting.
  • Constipation.
  • Slowed breathing. In overdose situations, respiratory arrest or completely stopped breathing may result. This can result in hypoxia, a dangerous condition that can cause brain damage, coma, or death due to a lack of oxygen.

Long-term effects of opioid use can include:14

  • An increased risk of addiction.
  • A cumulatively increased risk of overdose.
  • An increased likelihood of significant dependence and increasingly severe opioid withdrawal.
  • Risk of neonatal abstinence syndrome if using opioids while pregnant.

Combining Opioids With Other Substances

Some of the inherent risks of opioid use can be made worse when they are used at the same time as other substances, like alcohol or other drugs. Some older adults may be particularly at risk because they commonly take several prescription medications, have more chronic health problems, and may metabolize drugs more slowly or less efficiently.4

Using benzodiazepines and opioids together can be especially risky and can result in serious interactions. According to the National Institute on Drug Abuse, more than 30% of overdoses involving opioids also involved benzodiazepines.16 Similarly, drinking while taking opioids can be very dangerous because of the increased risk of slowed heartbeat and breathing, which can lead to coma or death.14

Opioid overdose is a serious risk associated with any type of opioid misuse—both that of street drugs like heroin and illicitly-manufactured fentanyl, as well as prescription painkillers. In the U.S., over 70% of the 71,000 overdose-related deaths in 2019 involved opioids.17 People may face an increased risk of opioid overdose when they take higher-than-recommended doses of prescription opioids. In some cases, if they resume using any type of opioid after a period of abstinence, they may also be at risk of overdose.18

Opioid Addiction Treatment Types

If you are wondering how to treat opioid addiction and are considering rehab, it’s important that treatment is tailored to a person’s specific needs and focuses on treating the whole person. Treatment for opioid addiction has the potential to be very effective and may help to prevent relapse.

Even if the opioid withdrawal period is successfully endured, merely quitting these drugs often does little to help people manage chronic, compulsive opioid misuse. Instead, more comprehensive and longer-term care that can include a combination of treatment types may be more effective in helping a person maintain recovery.19

The precise approach to treatment for opioid addiction can vary depending on individual factors, including how long a person used drugs for and whether they have co-occurring mental or physical health conditions. Recovering from relapse-prone addictions like opioid addiction can be a lifelong process that requires ongoing support.20 For opioid addiction, people often start with detox and progress through additional treatment efforts, such as inpatient or outpatient opioid addiction rehab programs, support groups, and various types of aftercare following the initial treatment period.


Detox is often the first step in the recovery process. It involves a set of interventions designed to help a person safely and comfortably withdraw from a substance and become medically stable before entering other forms of treatment.

Detox can take place in an inpatient or outpatient setting, depending on what’s most appropriate for an individual’s recovery needs. A supervised medical detox is commonly utilized by people undergoing opioid withdrawal due to the challenges presented by often markedly unpleasant withdrawal symptoms.21

Medications used during detox can minimize or prevent withdrawal symptoms. They may also help to prevent relapse and increase a person’s chances of staying in treatment. Some of the common medications that are used to treat opioid withdrawal include:22

  • Lofexidine. The FDA recently approved this medication to help reduce certain types of opioid withdrawal symptoms.
  • Methadone. When used as directed to stabilize someone during detox, it should not elicit a rewarding euphoria of its own.
  • Buprenorphine. This medication acts similarly to methadone as an induction or stabilizing detox medication to reduce cravings and withdrawal symptoms, yet has a limit to its opioid effects to increase its safety profile and deter abuse.

Detox should not be viewed as a substitute for more comprehensive addiction treatment. Alone, it may do little to impact long-term drug abuse, and for this reason, additional treatment measures may be especially beneficial in supporting lasting recovery.26

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) involves a combination of medication and behavioral therapies to support recovery from opioid addiction. It is a very effective method of treating opioid use disorder because medications can help people stop using drugs, prevent relapse, restore normal brain function, and decrease cravings. Behavioral therapies may help people modify the thoughts and behaviors that led to or contributed to their opioid addictions.19

The following medications can be effective in treating OUDs:23

  • Buprenorphine
  • Methadone
  • Extended-release naltrexone

MAT has been shown to decrease opioid use and reduce opioid-related deaths, criminal activity, and the spread of infectious disease. It has also been shown to help people stay in treatment and increase their ability to function in society.23 

Addiction Therapy Types

Therapy can be an important component of the recovery process. There are different approaches to addiction therapy that take place in various settings to address specific concerns and needs.

For example, a person may participate in individual therapy to help address issues that may have led to the development of their addiction. In group therapy, people can address shared issues with others, gain support, and learn new skills. Depending on a person’s situation, they can also participate in family counseling or couples’ therapy to help address relationship issues. Therapy is typically offered in both inpatient and outpatient settings.

Regardless of the setting, many evidence-based therapies are used to treat opioid addiction. These therapies can include:19

  • Cognitive behavioral therapy (CBT). A person can learn to make beneficial changes to problematic thoughts and behaviors, learn new coping skills, and discover ways to help prevent relapse.
  • Contingency management. This is a form of therapy designed to encourage a person to continue not using a substance and encourage ongoing recovery progress by providing incentives for positive behavioral outcomes (such as receiving vouchers in exchange for rewards if a person provides negative drug tests).
  • Motivational interviewing/enhancement. This is a style of therapy designed to help people resolve any lingering ambivalence about treatment and recovery.

What Rehab Facilities Are Available for Opioid Addiction?

As mentioned above, a treatment plan for opioid addiction will likely involve detox, medication, and behavioral therapy. Treatment can take place in an inpatient or outpatient setting, depending on what is most appropriate for an individual’s treatment needs. Inpatient and outpatient treatment plans can involve individual, family, and/or group counseling; informational sessions or classes; drug and alcohol education; medical care; and recovery support groups or 12-Step programs.

The American Society of Addiction Medicine (ASAM) maintains guidelines for determining the intensity and length of treatment for individuals undergoing addiction treatment. These include the level of addiction and withdrawal potential; co-occurring conditions—including medical, emotional, behavioral, and cognitive issues—; motivation toward addiction treatment; relapse risk; and the individual’s living/working environment.27

Depending on what is determined during initial assessment or intake, an individual may enter an inpatient or outpatient treatment program:

Inpatient Treatment Programs

Inpatient treatment offers 24/7 monitoring and support by medical and addiction treatment professionals. Inpatient (residential) treatment is best suited for those who require a higher level of care. Inpatient programs involve living at the center for the duration of treatment. These facilities can effectively manage patients who require medication therapy and who have additional needs that should be considered, such as co-occurring mental health disorders and a history of prior relapse.28 In addition to a high level of care, inpatient treatment can also provide the distance or distraction an individual may need to focus on their personal recovery efforts.29

Outpatient Treatment Programs

While inpatient treatment involves living full-time at a facility for addiction treatment services, outpatient is different. When a person undergoes outpatient treatment, they will live and sleep at home while participating in treatment during the day. Outpatient treatment often allows an individual to continue with their home, work, or school responsibilities. The time commitment varies according to the type of treatment program selected, but most individuals attend treatment between one and several times per week, usually in the evenings or weekends. Outpatient treatment can be delivered through various settings, including hospital or community clinics, local health departments, therapists’ offices, or via video or telephone. Outpatient treatment can be further classified into the following types:

  • Partial hospitalization programs. A partial hospitalization program (PHP) is the most intense form of outpatient treatment. An individual engaged in a PHP will likely attend treatment for about 20 hours each week in a highly structured environment.
  • Intensive outpatient programs. An intensive outpatient program (IOP) serves individuals who do not require 24-hour supervision or medical detoxification, but who are struggling with substance use disorders or co-occurring mental health and substance use disorders.29
  • Standard outpatient therapy. This is the least intensive form of outpatient treatment. Standard outpatient therapy is offered in different settings, and involves sessions with a counselor, therapist, or clinician in various treatment facilities.

How to Pay for Opioid Rehab

Undergoing addiction treatment is the most important step in your recovery. Although the process may seem overwhelming, worrying about how to pay for rehab should not be a source of stress. There are a number of ways to pay for opioid addiction rehab.

You will first want to consider the following factors when choosing a rehab provider:

  • What substances you were taking.
  • The severity of your condition.
  • The type/intensity/length of program you need.
  • Any co-occurring disorders.

You have a good chance of finding a payment arrangement and cost that is right for you. A few options include:

  • Medicare and Medicaid. These programs are government-funded health insurance plans that can help pay for drug rehab.
  • State-funded rehab. These facilities often offer addiction treatment services for a lower fee or no fee at all.
  • Out-of-pocket. Private loans or financing may be an option.

Using Health Insurance to Pay for Rehab

One of the most common ways to pay for addiction treatment is through a personal or employer-based health insurance plan. The following insurance companies may be able to assist with all or some of the costs for substance abuse rehab services:

The Affordable Care Act (ACA) requires that insurance providers with marketplace plans guarantee people coverage for essential benefits, which includes coverage for mental health and substance abuse treatment.30

Find Opioid Addiction Treatment Programs

If you or someone you care about is struggling with addiction, know that help is available. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Find Treatment tool to search for facilities. Many state government websites will provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) is a leading treatment provider and offers a free, 24/7 helpline. You can contact us at . Call today to speak to an admissions navigator who can provide information about opioid addiction treatment options and verify your benefits.

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