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Prescription Opioid Addiction

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Prescription opioids are medications to treat moderate to severe pain after surgery, an injury, or specific medical conditions such as cancer.1 Prescription opioids have become increasingly accepted as treatment for other types of chronic pain, such as back pain, despite the potential risks and questionable effectiveness for being used in this manner.

The acceptance of opioids as treatment has led to an increase in the number of opioid prescriptions in the U.S.1 In 2019, there were nearly 10 million Americans at least 12 years of age or older, who reported misusing prescription opioids, and as a result, the concern about the dangers of prescription opioids continues to rise.6

Due to the way that opioid painkillers act on the brain’s reward center, some people may begin to compulsively misuse these medications, which can lead to withdrawal symptoms if they try to stop or reduce use, and/or opioid use disorder.2,3

If you or a loved one feel that you are misusing prescription opioids and need opioid addiction help, this article will explain more about prescription opioids and answer questions you may have, including:

  • What are prescription opioids and how are they abused?
  • How do opioids affect the body, and why are they addictive?
  • What are the signs and symptoms of prescription opioid dependence?
  • What are the withdrawal symptoms associated with prescription opioids?
  • What are the dangers associated with prescription opioid abuse?
  • How can I get help and find an opioid addiction rehab?

What Are Prescription Opioids?

Prescription opioids are powerful medications used to treat pain and include familiar names such as oxycodone and morphine.3, 23 Some opioids are naturally derived from the opium poppy, while others are created synthetically in a lab by mimicking the chemical structure of natural opioids.4

Prescription opioids are highly effective at treating acute pain, and as a result, they are commonly overprescribed, regardless of the potential risks of addiction.1, 3, 4, 5 Due to their ability to relax the body and/or produce a euphoric high, some people take them for non-medical uses, which can be potentially lethal as opioids have a high overdose risk.4

What Medications Are Prescription Opioids?

There are a number of different prescription opioid medications that include natural opioids, synthetic opioids, and semi-synthetic opioids. Synthetic opioids are completely manmade in a lab whereas semi-synthetic opioids are created in a lab using materials derived from natural sources.4, 9 Some commonly prescribed opioids include:3, 4, 5, 9, 11

What is Prescription Opioid Abuse?

Prescription opioid abuse can occur whenever these drugs are taken differently than intended.3, 4 This can include:3, 4

  • Taking them when they haven’t been prescribed to you.
  • Taking more than prescribed.
  • Taking them more frequently than prescribed
  • Taking them to get high rather than for pain relief.
  • Taking them differently than prescribed, such as chewing the pills, crushing them up to snort the powder, or dissolving the powder to inject the substance.3, 4, 11

Chronic use of prescription opioids can lead to the development of an opioid use disorder (OUD).3, 4, 7, 8 It is possible for this to happen even when opioids are taken as prescribed, but the risk is increased when prescription opioids are misused.3, 4, 7, 8

How Do Prescription Opioids Affect the Body?

Prescription opioids can affect the body in a number of ways from mild side effects to long-term health effects. The way they affect the brain’s reward circuit is particularly significant as it can cause a person to want to use them repeatedly, which can lead to misuse.3

Opioids bind to and activate mu receptors throughout the brain and body, which interfere with how pain signals are processed, causing an analgesic, or pain-relieving effect. Prescription opioids also increase the activity of dopamine in the brain, which can cause a reinforcing, euphoric high.2, 3, 4, 5, 7, 9

Prescription opioids can produce other short- and long-term health effects on the body, including: 2, 3, 4, 5, 7

  • Constipation.
  • Nausea.
  • Respiratory depression.
  • Itchiness or skin irritation.
  • Sleepiness.
  • Suppressing the urge to cough.

Over time, even if you take opioids as prescribed, your brain can develop a tolerance to the effects of opioids, which means a person feels they need to keep taking the substance to produce the same effect.1, 2, 4, 9, 10 Tolerance commonly leads to taking higher doses of prescription opioids to obtain relief or achieve the high they felt when they initially took the medication.

Tolerance and the escalating patterns of drug use that result can also contribute to developing a dependence, where a person continues taking opioids to avoid withdrawal symptoms.1, 4, 9, 10

Opioid painkillers act primarily on the mu opioid receptor in the brain which, in addition to altering pain perception, is subsequently associated with a rewarding sense of extreme pleasure (euphoria). As a result of these reinforcing physical and psychological effects, some people may begin to compulsively misuse these medications.

As the body and brain can become increasingly dependent on prescription opioids, people want to continue using them for long periods of time or in higher doses to prevent withdrawal symptoms.2

While some degree of tolerance and dependence can develop even if you take prescription opioids as prescribed, you are at increased risk for developing these issues if you misuse them.3, 4, 7, 11 Long-term use of opioids may also increase the risk for developing an addiction and/or lead to an overdose.3

Signs and Symptoms of Prescription Opioid Addiction

It can be difficult to identify when someone is misusing prescription opioids, so it can be helpful to know some of the common signs and symptoms of misuse. While knowing the signs and symptoms can be helpful in recognizing potential misuse, it’s best for a professional to formally diagnose an opioid use disorder.12

The following criteria from the Diagnostic and Statistical Manual of Mental Disorders (5TH edition) are used by professionals to diagnose an OUD. If you or a loved one have experienced 2 or more of these criteria in the past 12 months, it may be time to seek help for opioid misuse:14

  • Prescription opioids are taken in larger amounts and/or over a longer period than was intended.
  • A person has a persistent desire and/or unsuccessful efforts to reduce or control prescription opioid use.
  • Spending more time seeking out prescription opioids, using them, and/or recovering from the effects of use.
  • Craving, or a strong desire or urge to use prescription opioids.
  • Repeated prescription opioid use that prevents a person from fulfilling work, school, or home obligations.
  • Continued prescription opioid use despite having ongoing interpersonal problems as a result of prescription opioid misuse.
  • Social, professional, and/or recreational activities are given up or reduced because of prescription opioid use.
  • Continued prescription opioid use even in situations that could be physically dangerous, such as driving a car or operating a heavy piece of equipment.
  • Continued prescription opioid use even when a person has a known physical or psychological problem that could have been caused or worsened by the substance.
  • A person shows signs of tolerance to prescription opioids.
  • A person is experiencing withdrawal symptoms.

If you are assessed by a clinician, they may ask about how your use of prescription opioids affects various areas of your life, including: 13,14

  • Your physical and mental health.
  • Your social relationships.
  • How you function at work, school, and home.
  • Potential financial or legal troubles.

Prescription Opioid Withdrawal

When you are dependent on opioids, your brain chemistry adjusts to their presence to function normally. This means that if you stop using prescription opioids or drastically reduce your use, you may experience physical withdrawal symptoms.2, 4, 10, 15

Opioid withdrawal, although not lethal, can be extremely uncomfortable, and people often relapse in an attempt to seek relief.3, 4, 10 Common signs and symptoms of opioid withdrawal include the following:3, 11, 14, 15, 16

  • Agitation.
  • Alternating bouts of chills and hot flashes.
  • Depressed mood.
  • Diarrhea.
  • Dilated pupils.
  • Increased blood pressure.
  • Insomnia.
  • Muscle and bone pain.
  • Nausea and vomiting.
  • Racing heart.
  • Restlessness.
  • Runny nose.
  • Stomach cramps.
  • Strong cravings for opioids.
  • Sweating.
  • Tearing eyes.

Dangers of Mixing Prescription Opioids with Other Substances

Mixing prescription opioids with other substances, particularly those with similar sedating or respiratory depressant effects, may increase the risk of experiencing adverse health effects.3, 7 If you are taking prescription opioids and other medications, it’s important to tell your doctor so you can avoid the potentially harmful effects.

Substances to avoid using with prescription opioids include benzodiazepines, alcohol, or other types of depressants.1, 3, 7, 11 Many overdose deaths involve a combination of prescription opioids and alcohol or benzodiazepines such as Valium (diazepam) or Xanax (alprazolam). This lethal combination can result in slowed breathing and heart rate that could be life-threatening.1, 3, 7, 11

Older adults are more likely to be diagnosed with chronic medical diseases and as a result, may have multiple daily prescription medications, which may put them at an increased risk of accidentally misusing opioids.4, 11 Additionally, older adults may be taking medications prescribed by different healthcare providers who are not aware of how these medications can interact.4, 7, 11

As people age and their metabolism slows down, their bodies may take longer to break down medications. This means that opioids can stay around longer in the body, increasing the likelihood of accidental overdose in certain individuals.11

Treatment for Prescription Opioid Abuse

Recovery is a lifelong process, yet treatment for prescription opioid abuse is an important part of recovery and should be tailored to meet your unique needs.7, 13, 17 For many people, addiction treatment may take place in more than one setting, for varying lengths of time, and include different levels of care.17 Follow-up care and ongoing support, such as family, friends, or recovery groups, can be especially helpful in maintaining long-term sobriety after completing treatment.13, 15, 18, 19

Since quitting or cutting back on opioid use can lead to uncomfortable withdrawal symptoms, many people begin treatment by attending a detox that can provide proper care and management of withdrawal symptoms.7, 19 Effective treatment addresses all issues that can contribute to substance use, including physical illnesses and co-occurring mental health disorders, in order to provide you with the best chance at long-term recovery.7, 13, 17, 19

Detox

Detox is the initial phase of recovery that allows your body to eliminate opioids under medical supervision in a safe and comfortable setting. This can occur in an inpatient or outpatient setting, depending on: 15, 16, 17

  • The severity of your symptoms.
  • Your physical and mental health needs.
  • Substances being used.
  • The type of support you have at home.

Medical detox is strongly recommended for opioid withdrawal since it can make the process easier and safer, lower the risk of relapse, and may encourage people to continue treatment after detox.10, 15, 17 It is common to use either methadone or buprenorphine during medical detox to manage withdrawal symptoms, ease cravings, and reduce the risk of complications.2, 15, 16, 20

Detox is a good start to recovery, but on its own, is seldom enough to create long-term change. Instead, detox is commonly followed with a more comprehensive addiction treatment program for people to continue their recovery efforts.17, 19 Once detoxification is completed, you may enter into further treatment to continue recovery and learn healthy coping skills to help you succeed in your lifelong recovery journey.19

Medication-assisted Treatment (MAT)

MAT, or medication-assisted treatment, is the combined use of FDA-approved medications and behavioral therapeutic techniques to treat OUD.21 It has been found to help stabilize brain chemistry, reduce cravings, improve safety, and block the effects of any opioids that are ingested. MAT may lower the likelihood of relapse and may help some people maintain their recovery.7, 17, 19, 21 Common medications used include the opioid agonists methadone and buprenorphine (both also potential medical detox drugs), as well as the opioid antagonist naltrexone.2, 7, 10, 11, 17

Many studies have shown MAT to be effective. MAT can:10, 21, 22

  • Encourage the reduction in opioid use.
  • Increase the chances of staying in treatment.
  • Lower the likelihood of overdose.
  • Improve your ability to function in various life areas.

Behavioral Therapy

Various types of behavioral therapies can help you change how you think and behave so that you can stop misusing prescription opioids, and instead use healthy coping skills to overcome life’s challenges and daily stressors.4, 7, 17, 19 This is a vital part of recovery since it helps you develop important skills needed to live a life without misusing prescription opioids.4, 7, 19 Commonly used behavioral therapies include:4, 11, 17, 19

  • Cognitive behavioral therapy (CBT) helps you explore your behaviors and expectations, develop effective coping skills to manage triggers and stressors, learn better communication skills, identify cravings early on, and learn techniques to help avoid situations that are high-risk for relapse.
  • Contingency management uses small rewards to reinforce desirable behaviors such as attending treatment sessions and maintaining sobriety.
  • Motivational interviewing/enhancement works to explore mixed feelings about treatment and sobriety, allows you to resolve these emotions on your own timeline, and helps you develop effective coping skills for stressors that put you at risk for relapse.

If you or someone you care about is struggling with prescription opioid use, seeking treatment is a courageous first step in the recovery process. American Addiction Centers (AAC) is here to help you find the right treatment. Our caring admissions navigators are available 24/7 at 1-888-744-0069 to provide information about prescription opioid addiction treatment options and help you verify your benefits so you can begin the road to recovery today.

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Kristen Fuller, MD, enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine and contributes to medicine board education. Her passion lies in educating the public on the stigma associated with mental health. Dr. Fuller is also an outdoor activist, an avid photographer, and is the founder of an outdoor women's blog titled, GoldenStateofMinds. In her free time, she enjoys hiking, backpacking, skiing, camping, and paddle boarding with her dogs in Mammoth Lakes, California, where she calls home.
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