Opioid Addiction: Definitions, Symptoms, Types, Causes, Effects, And Treatment Approaches

Opioid addiction is a medical condition characterized by an intense and compulsive urge to use opioids despite the negative consequences it has on its users. Opioids are used medically for the management of pain, but they also have a euphoric effect, which induces people to crave them. According to the Centers for Disease Control and Prevention, the number of drug overdose deaths increased by more than 16% from 2020 to 2021. Over 75% of the nearly 107,000 drug overdose deaths in 2021 involved an opioid.

The common symptoms of opioid addiction include drug dependence behavior, various opioid prescriptions from several professionals, symptoms of opioid withdrawal when trying to quit, and excessive opioid cravings.

Types of opioid addiction include heroin addiction, fentanyl addiction, methadone addiction, polysubstance addiction, and buprenorphine addiction.

Opioid addiction is caused by both psychological and physical factors, which include compulsive use, availability of opioids, physical tolerance, the need to use excess quantities, and withdrawal symptoms.

The effects of opioid addiction range from dizziness, constipation, nausea, vomiting, and even respiratory depression.

Opioid addiction treatment and counseling involve withdrawal management and day treatment, while medications like methadone, buprenorphine, naltrexone, and naloxone help reduce cravings, block opioid effects, prevent overdose, and manage withdrawal symptoms for improved recovery success.

What Is Opioid Addiction?

Opioid addiction or opioid misuse is a condition where a person has an intense urge to consume opioids to the extent of becoming dependent on them despite their negative consequences. Addiction to opioids happens when the brain gets used to the opioids and craves more of them to feel normal. According to the World Health Organization, about 296 million people worldwide (or 5.8% of the global population aged 15–64 years) used drugs at least once in 2021. Among them, about 60 million people used opioids. About 39.5 million people lived with drug use disorders in 2021.

Opioid addiction alters the brain’s functioning, making it hard for individuals to resist the urge to use opioids despite adverse consequences. It leads to harmful behaviors, health problems, and difficulty stopping or controlling opioid use. 

The cycle of addiction is challenging to break without proper support and treatment, resulting in significant disruption to life and well-being.

What Is Opioid Use Disorder?

Opioid Use Disorder (OUD) is a type of substance use disorder defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is characterized by the compulsive use of opioids despite harmful consequences and encompasses a range of problematic behaviors. These behaviors include a strong desire to use opioids, unsuccessful attempts to cut down or control use, and continued use despite negative effects on one’s life. 

OUD leads to significant impairment or distress and manifest through symptoms such as tolerance (needing more of the drug to achieve the same effect) and withdrawal symptoms when not using. OUD severity varies from mild to severe based on symptom number and intensity. Opioids include prescription pain relievers, synthetic opioids like fentanyl, and illegal drugs such as heroin.

Why Are Opioids So Addictive?

Opioids like oxycodone, hydrocodone, fentanyl, and tramadol are highly addictive because they activate the brain’s reward system, producing intense feelings of pleasure. People get addicted to opioids because, over time, the brain adapts, requiring higher doses to achieve the same effect, leading to tolerance and dependence. Furthermore, environmental cues and stress trigger cravings, making relapse common.

Opioids like oxycodone, hydrocodone, fentanyl, and tramadol are highly addictive because they activate the brain’s reward system, producing intense feelings of pleasure. People get addicted to opioids because, over time, the brain adapts, requiring higher doses to achieve the same effect, leading to tolerance and dependence. 

According to Kosten, T. R., & George, T. P’s 2002 study, ‘The neurobiology of opioid dependence: implications for treatment’, tolerance develops as opioid receptors become less responsive, necessitating higher doses to achieve the same effects. Dependence arises from alterations in the locus ceruleus, which initially suppresses noradrenaline release, causing drowsiness and slowed respiration. With continued use, this area compensates, maintaining a sense of normalcy while on opioids. However, when opioids are absent, excessive noradrenaline release triggers distressing withdrawal symptoms such as anxiety and muscle cramps. This adaptation creates a challenging cycle of addiction that complicates treatment efforts.

What Are The Symptoms Of Opioid Addiction?

The symptoms of Opioid use disorder are:

1. Using opioids for a long time. (12 months and above).
2. Unsuccessful attempt to quit.
3. Withdrawal symptoms.
4. Spending a substantial amount of time to get, use, and recover from opioid use.
5. Lack of accountability at home, school, or work due to the excessive use of opioids. 
6. Continuous use of opioids even after being diagnosed with complicated health conditions.
7. Avoiding social activities and gatherings that used to be interesting to you.
8. Craving to use more opioids to get the same sensation, such as relive and tolerance. 
9. Crushing, snorting, chewing, or injecting opioids. 
10. Using a particular amount of opioids earlier than prescribed. 

What Are The Causes Of Opioid Addiction?

The causes of Opioid addiction are genetic predisposition, brain system, chronic pain, previous hard drug use, mental health disorder, and environmental influence.  

As Brat GA et al, report in their 2018 research, ‘Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study,’ opioid dependence and addiction are products of many biological, environmental, genetic, and psychosocial factors.

The causes of Opioid addiction are detailed below: 

• Genetics: Some individuals have genetic factors that make them prone to addiction. That is to say that people with a history of addiction easily fall into opioid or other forms of addiction.
• Brain System: Opioid alters the brain’s reward system by triggering dopamine, which is in charge of pleasure and reward. Constant consumption and abuse of opioids will alter the brain system, making an individual depend more on drugs to perform appropriately. 
• Chronic Pain: Individuals seeking to manage chronic pains from external or internal injuries are prescribed opioids. Using this drug for a long period of time will lead to abuse and addiction, especially if a professional does not adequately monitor the patient. The American Medical Association (AMA) estimates that between 3% and 19% of individuals who use prescription pain medications develop an addiction to them.
• Previous Hard Drug Use: People who have once in a time been addicted to alcohol and other drugs are more susceptible to overuse and get addicted to opioids. 
• Mental Health Disorders: People suffering from mental health disorders such as depression, anxiety, attention deficit hyperactivity disorder (ADHD), and trauma-related disorders are at more risk of adding opioid addiction to the list of their issues. Opioids are sometimes prescribed or used to self-medicate to cure mental health issues, and the constant use causes addiction. 
• Environmental And Immediate Community Settings: Factors like peer pressure, lineage history of drug abuse, exposure to hard drugs, trauma or stress, and socioeconomic circumstances cause opioid addiction. Not having access to mental health clinics or facilities also slows down or prevents proper healing.

What Are The Effects Of Opioid Addiction?

The effects of opioid addiction are in 3 categories: physical health effects, mental health effects, and behavioral health effects.  According to Sivanesan, E.’s 2016 study, ‘Opioid-induced Hallucinations: A Review of the Literature, Pathophysiology, Diagnosis, and Treatment’,  80% of patients treated with opioids report experiencing at least one side effect. Common issues include constipation (20-41%), somnolence (14-29%), and cognitive impairments such as memory shortfalls (24%) and concentration difficulties (19%).

The effects of opioid addiction are given below:

Physical Effects

Opioid addiction causes gastrointestinal issues, hormonal dysfunction, skin problems, dental issues, and cardiovascular effects. Opioids lead to physical dependence within 4-8 weeks. Here are the physical dependence symptoms of opioid use disorder:

• Gastrointestinal Issues: Opioids cause constipation, which becomes chronic and severe. Opioid use causes gastrointestinal problems, including nausea, vomiting, and abdominal distention.
• Respiratory Depression: Opioid use decreases respiratory function through reduced breathing rate and depth. This respiratory depression constitutes the primary mechanism of fatal overdoses, triggering hypoxia – a dangerous state where insufficient oxygen supply damages brain tissue.
• Neurological Effects: Chronic opioid use triggers opioid-induced hyperalgesia, heightening pain sensitivity in users. Opioids impair cognitive performance through drowsiness, mental confusion, and dulled mental function.
• Hormonal Dysfunction: Long-term opioid use disrupts the normal production of hormones, leading to issues such as reduced libido, infertility, and, in some cases, an irregular menstrual cycle in women. In males, the effect is reduced testosterone levels.
• Cardiovascular Effects: Opioid addiction reduces blood pressure and decreases heart rate, creating life-threatening complications during overdose.
• Musculoskeletal Issues: Chronic opioid use causes muscle weakness and reduces skeletal muscle mass. Chronic opioid use contributes to joint pain and physical deterioration.
• Skin Problems: Injection of opioids, particularly when substances are used intravenously and with non-sterile techniques, leads to skin infections, abscesses, and scarring.
• Dental Issues: Opioid addiction causes poor oral hygiene practices, resulting in dental decay and gum disease. Dry mouth, a common side effect of opioid use, exacerbates discomfort.

Mental Effects

The mental effects of opioid addiction include mood swings, anxiety, depression, cravings, euphoria, and feelings of relaxation.

Here are the key mental effects of opioids:

• Euphoria and Relaxation: Opioids induce feelings of euphoria and relaxation, which are psychologically reinforcing, leading to continued use.
• Depression and Anxiety: Chronic opioid use leads to changes in brain chemistry that result in symptoms of depression and anxiety, even when the drug is not being used.
• Cravings: Opioid addiction is characterized by intense cravings for the drug, which dominate thoughts and lead to compulsive drug-seeking behavior.
• Mood Swings: Opioid use causes mood swings, with periods of euphoria followed by periods of irritability, anxiety, or dysphoria.
• Cognitive Impairment: Chronic opioid use impairs cognitive function, including memory, attention, and decision-making abilities.

Other mental effects include; 

• Isolation and Withdrawal
• Increased Risk of Mental Health Disorders
• Risk of Overdose
• Loss of Control
• Co-occurring Disorders

Behavioral Effects

The behavioral effects of opioid addiction on its users are; 

• Depression: Depression is a mood disorder characterized by persistent sadness and a lack of interest in activities. Opioids disrupt the brain’s reward system, leading to feelings of emptiness.
• Anxiety: Anxiety is an excessive state of worry or fear that interferes with daily life. Opioid use heightens anxiety levels, especially during withdrawal.
• Irritability: Irritability is a heightened state of agitation or annoyance. Opioids affect mood regulation, increasing irritability as the drug’s effects wear off.
• Mood Swings: Mood swings are rapid and extreme changes in emotional state. Opioid use causes fluctuations in mood due to its impact on neurotransmitter levels.
• Cravings: Cravings are intense desires to use opioids again. These cravings arise from changes in brain chemistry and physical dependence on the drug.
• Obsessive thoughts about opioids: Obsessive thoughts about opioids are persistent and intrusive thoughts focused on obtaining and using the drug. This results from altered reward pathways in the brain.
• Social withdrawal: Social withdrawal is a tendency to isolate oneself from friends and activities. Opioid use decreases motivation and interest in social interactions.
• Difficulty concentrating: Difficulty concentrating is an impaired ability to focus or maintain attention. Opioids affect cognitive function, leading to challenges in processing information.
• Impaired decision-making: Impaired decision-making is a reduced ability to make sound judgments. Opioids alter cognitive processes, resulting in poor decision-making.
• Risk of co-occurring mental health disorders: The risk of co-occurring mental health disorders is the likelihood of experiencing additional mental health issues alongside opioid use disorder. This interplay worsens symptoms and increases vulnerability to disorders like depression and anxiety.

What Are The Treatment Approaches To Opioid Addiction?

The treatment approaches to opioid addiction include medication and counseling strategies. Opioid use disorder medication options such as Methadone, Buprenorphine, and Naltrexone help manage cravings and withdrawal symptoms, while counseling approaches like contingency management, motivational interviewing, and cognitive behavioral therapy address the psychological aspects of addiction.

Medication Approach

• Methadone (Dolophine Methadose): Methadone represents an opioid that does not produce a high or intoxication. Methadone requires daily use and is available only in specialized clinics. When used in the correct amount, methadone reduces opioid cravings and prevents strong withdrawal symptoms.
• Buprenorphine: Buprenorphine affects the same brain receptors as opioids but possesses a lower complexity and addiction potential. Buprenorphine presents a very low risk of addiction and is available in combination with naloxone. It comes in various forms, including tablets, injections, films for oral use, skin patches, and implants under the skin.
• Naltrexone: Naltrexone proves more effective as part of a comprehensive recovery treatment program, especially after detoxification. It is administered orally as Revia or by injection as Vivitrol. According to Dr. Fiellin, in 2014, along with other Yale faculty members, a study published in JAMA Internal Medicine showed that patients who maintained a consistent dose of buprenorphine for 12 weeks had a significantly lower chance of relapsing into opioid use compared to those who underwent taper therapy.

Counseling Approach

Counseling and behavioral therapy effectively treat opioid addiction. Counseling addresses the psychological aspects of addiction and teaches individuals to manage cravings and prevent relapse. The counseling approach involves the following:

• Contingency Management: Contingency management is a behavioral therapy that uses positive reinforcement to encourage abstinence from opioids. Rewards or incentives are provided for negative urine tests, attendance at treatment sessions, and completion of treatment milestones. This approach helps individuals with opioid use disorder (OUD) who struggle with motivation and relapse. According to Petry, N.’s 2013 study, ‘Contingency management is efficacious in opioid-dependent outpatients not maintained on agonist pharmacotherapy’, Patients in the Contingency Management (CM) condition attended more treatment sessions than those in the Standard Care (SC) condition, with a significant difference of F(1, 225) = 16.38, p = .001, and a moderate effect size of d = 0.26, which means the CM group attended about 1/4 more treatment sessions than the SC group.
• Motivational Interviewing: Motivational interviewing is a goal-oriented, client-centered approach that enhances motivation to change behavior. This method helps individuals resolve ambivalence about quitting opioids and develop a recovery plan. It is effective for individuals with OUD (Opioid Use Disorder) who experience ambivalence about treatment or struggle with denial. 

According to Durpoix, A.’s 2024 study, ‘Psychotherapies in opioid use disorder: toward a step-care model’, 49% of patients continued care after a motivational interview, compared to 30% after a standard educational interview. Opioid abstinence rates were also higher, at 40.2%, for patients who received a brief motivational interview, compared to 30.6% for control groups. However, motivational interviewing may be most effective for less motivated patients and potentially counterproductive for highly motivated ones.

• Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy (CBT) identifies and changes negative thought patterns and behaviors contributing to opioid addiction. CBT helps individuals develop coping skills to manage cravings and avoid relapse. CBT benefits individuals with OUD who need to address underlying psychological issues or develop relapse prevention skills. According to the 2020 National Survey of Substance Abuse Treatment Services, 94% of treatment facilities reported using CBT as part of their approach to treating substance use disorders (SUDs). This widespread acceptance underscores its perceived efficacy in real-world settings.
• Family Therapy: Family therapy addresses the impact of opioid addiction on the family system. This approach improves communication, reduces conflict, and increases recovery support. Family therapy helps individuals with OUD and family members affected by addiction, providing support and education. According to Horigian, V. E.’s 2016 study, ‘Family-Based Treatments for Adolescent Substance Use’, family-based approaches have shown a 40% larger reduction in drug use compared to other treatments.
• 12-Step Program: The 12-step program is a peer-led support initiative that follows a structured recovery framework. Individuals share experiences, receive support, and work through the 12 steps to achieve sobriety. This program supports individuals with OUD (Opioid Use Disorder) who require a structured approach and peer support for long-term recovery.
• Support Groups: Support groups provide a safe and supportive environment for individuals to share experiences and receive support from others facing similar challenges. These groups benefit individuals with OUD (Opioid Use Disorder)  who seek social support, connection, and a sense of community during recovery.

How Do I Treat Opioid Overdose?

To treat an opioid overdose, you use Naloxone (Narcan). Naloxone is a medication that quickly reverses opioid overdose effects by blocking opioid receptors in the brain. Follow the instructions on the naloxone kit for administration. According to Bennett, A. S., & Elliott, L’s 2021 study, ‘Naloxone’s role in the national opioid crisis-past struggles, current efforts, and future opportunities’, between 1996 and 2010, community-based take-home naloxone programs trained over 53,000 individuals in overdose response, leading to more than 10,000 reported reversals of opioid overdoses during that period. In a hospital environment, healthcare providers conduct drug tests to identify opioid overdoses and perform additional assessments to evaluate the patient’s overall health and identify any potential complications.

How Long Does It Take To Get Addicted To Opioids?

The time it takes to get addicted to opioids is very short, sometimes within just a few weeks of regular use. This varies depending on individual and environmental factors. The brain’s reward system is significantly affected by opioids, leading to tolerance, dependence, and eventually addiction.

Where To Find Treatment For Opioid Addiction?

Treatment for opioid addiction is available in rehabilitation centers, outpatient programs, and clinics specializing in addiction treatment. Support groups like Narcotics Anonymous also provide assistance.

To find a suitable treatment center for opioid addiction, search online for “opioid addiction treatment centers” or check websites like the Substance Abuse and Mental Health Services Administration (SAMHSA) or the National Institute on Drug Abuse (NIDA). Ask for referrals from your doctor, insurance provider, or local health department.

Look for a licensed and accredited center that offers a comprehensive treatment plan and has experienced staff. A good center should provide medication-assisted treatment, counseling, and support groups in a supportive environment.

What Are The Different Forms Of Opioids?

The different forms of Opioids include prescription pills (e.g., oxycodone, hydrocodone), illicit opioids (e.g., heroin), synthetic opioids (e.g., fentanyl), and combination opioids (e.g., Percocet).

Here are the different forms of opioids in detail below:

• Prescription Opioids: Medications prescribed for moderate to severe pain, such as oxycodone and hydrocodone.
  • Oxycodone: A strong pain reliever for moderate to severe pain, available in various formulations.
  • Hydrocodone: Hydrocodone treats moderate pain and combines with acetaminophen (e.g., Vicodin).
  • Morphine: A natural opioid for severe pain, commonly used in medical settings.
  • Codeine: A milder opioid for mild to moderate pain, also found in cough syrups.
• Illicit Opioids: Illegal opioids, like heroin, are associated with high addiction risk.
  • Heroin: An illegal opioid derived from morphine, known for high addiction potential.
• Synthetic Opioids:  Synthetic opioids are man-made opioids that are more potent and used for pain management, including fentanyl and tramadol.
  • Fentanyl: A potent synthetic opioid used for severe pain, with a high overdose risk.
  • Carfentanil: An extremely potent opioid for large animals, not safe for human use.
  • Tramadol: A less potent synthetic opioid for moderate pain, with lower addiction risk.
• Combination Opioids: Medications that mix an opioid with a non-opioid pain reliever, like oxycodone/acetaminophen (Percocet).
  • Oxycodone/Acetaminophen (Percocet): Combines oxycodone with acetaminophen for enhanced pain relief.
  • Hydrocodone/Acetaminophen (Vicodin): Combines hydrocodone with acetaminophen for pain management.

What Are The Different Slang Names For Opioids?

Slang names for opioids include oxy, perc, dope, smack, and blues.

Here are all the slang names for various types of opioids:

• Prescription Opioids:
  • Oxy: Oxycodone
  • Perc: Percocet (oxycodone/acetaminophen)
  • Vics: Vicodin (hydrocodone/acetaminophen)
  • Hydro: Hydrocodone
  • Roxy: Roxicodone (a form of oxycodone)
  • Tabs: Tablets of prescription opioids
• Illicit Opioids:
  • Dope: Dope is a general term for illicit opioids, referring specifically to heroin.
  • Smack: Heroin
  • H: Heroin
  • Brown: Brown heroin (a type of heroin)
  • China White: A potent form of heroin or fentanyl
  • Skag: Heroin
• Synthetic Opioids:
  • Fent: Fentanyl
  • Blues: Fentanyl pills or counterfeit pills containing fentanyl
  • Apache: A slang term for fentanyl
  • Tango & Cash: A combination of fentanyl and other substances
• Combination Opioids:
  • Percs: Percocet (oxycodone/acetaminophen)
  • Lortab: Hydrocodone/acetaminophen
  • Norco: Hydrocodone/acetaminophen

How Does The Chronic Use Of Opioids Affect Brain Function And Behaviour Over Time?

Chronic use of opioids leads to significant changes in brain function and behavior over time. Opioids affect the brain’s reward system by flooding it with dopamine, altering the brain’s natural production and regulation of this neurotransmitter. This alteration decreases the ability to feel pleasure from natural rewards, increases cravings, and drives compulsive drug-seeking behaviors. These changes result in cognitive impairments, emotional instability, and an increased risk of mental health disorders, including depression and anxiety.

Where And How Is Opioid Typically Manufactured And Produced?

Opioids are manufactured and produced in two distinct ways: through legal pharmaceutical facilities and illegal laboratories. Licensed pharmaceutical companies manufacture opioids from carefully regulated opium poppy (Papaver somniferum) cultivation. These regulated facilities produce both natural opioids (morphine, codeine) and semi-synthetic variants (hydrocodone, oxycodone) under strict quality controls. 

Modern research is investigating alternative production methods, such as using engineered yeast to manufacture opioids from sugar, though this remains experimental. Illegal manufacturing occurs primarily in clandestine laboratories, where producers extract morphine from opium and convert it through dangerous chemical processes. 

Major illegal production centers, particularly in Afghanistan, manufacture opioids without safety protocols or quality standards. While legal manufacturing follows rigorous regulations to ensure safety, illegal production creates significant risks due to uncontrolled manufacturing conditions and a lack of purity standards.

What Are The Law Enforcement Efforts And Legal Implications Of Opioids?

The law enforcement efforts and legal implications of opioids are focused on conducting raids, arrests, and prosecutions related to opioid production and distribution, with consequences including fines and imprisonment.

How Can The Presence Of Nicotine Addiction Complicate The Treatment Of Opioid Addiction, And What Strategies Can Address Both Addictions Simultaneously?

The presence of nicotine addiction complicates the treatment of opioid addiction by exacerbating withdrawal symptoms and increasing overall stress and anxiety, which leads to relapse. Nicotine stimulates the same reward pathways in the brain as opioids, making it harder to break the cycle of addiction. Strategies to address both addictions simultaneously include integrating smoking cessation programs with opioid addiction treatment, using medications like varenicline or nicotine replacement therapy alongside methadone or buprenorphine, and providing comprehensive behavioral therapies that target both addictions.

How Are The Effects Of Opioid Addiction And Other Drug Addiction Different Or Similar?

The effects of opioid addictions compared to other drug addictions are different because opioids create physical dependence and withdrawal symptoms, while other drug addictions primarily involve psychological dependence. Both lead to negative consequences, such as impaired judgment and risky behavior.