How opioid addiction occurs
Opioid use — even short term — can lead to addiction and, too often, overdose. Find out how short-term pain relief leads to life-threatening problems.By Mayo Clinic Staff
Anyone who takes opioids is at risk of developing addiction. Your personal history and the length of time you use opioids play a role, but it's impossible to predict who's vulnerable to eventual dependence on and abuse of these drugs. Legal or illegal, stolen and shared, these drugs are responsible for the majority of overdose deaths in the U.S. today.
Addiction is a condition in which something that started as pleasurable now feels like something you can't live without. Doctors define drug addiction as an irresistible craving for a drug, out-of-control and compulsive use of the drug, and continued use of the drug despite repeated, harmful consequences. Opioids are highly addictive, in large part because they activate powerful reward centers in your brain.
Opioids trigger the release of endorphins, your brain's feel-good neurotransmitters. Endorphins muffle your perception of pain and boost feelings of pleasure, creating a temporary but powerful sense of well-being. When an opioid dose wears off, you may find yourself wanting those good feelings back, as soon as possible. This is the first milestone on the path toward potential addiction.
Short-term versus long-term effects
When you take opioids repeatedly over time, your body slows its production of endorphins. The same dose of opioids stops triggering such a strong flood of good feelings. This is called tolerance. One reason opioid addiction is so common is that people who develop tolerance may feel driven to increase their doses so they can keep feeling good.
Because doctors today are acutely aware of opioid risks, it's often difficult to get your doctor to increase your dose, or even renew your prescription. Some opioid users who believe they need an increased supply turn, at this point, to illegally obtained opioids or heroin. Some illegally obtained drugs, such as fentanyl (Actiq, Duragesic, Fentora), are laced with contaminants, or much more powerful opioids. Because of the potency of fentanyl, this particular combination has been associated with a significant number of deaths in those using heroin.
If you're taking opioids and you've developed tolerance, ask your doctor for help. There are other, safe choices available to help you make a change and continue feeling well. Don't stop opioid medications without a doctor's help. Quitting these drugs abruptly can cause severe side effects, including pain worse than it was before you started taking opioids. Your doctor can help you taper off opioids slowly and safely.
Feb. 16, 2018
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- Bruce BK, et al., eds. About pain medications. In: Mayo Clinic Solutions for Living With Chronic Pain. New York, N.Y.: Oxmoor House; 2016.
- America's addiction to opioids: Heroin and prescription drug abuse. National Institute on Drug Abuse. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Accessed Sept. 20, 2017.
- What science tells us about opioid abuse and addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/what-science-tells-us-about-opioid-abuse-addiction. Accessed Sept. 20, 2017.
- Kaye AD, et al. Prescription opioid abuse in chronic pain: An updated review of opioid abuse predictors and strategies to curb opioid abuse: Part 1. Pain Physician. 2017;20:S93.
- Jamison RN, et al. Opioid analgesics. Mayo Clinic Proceedings. 2015;90:957.
- Opioid addiction. American Society of Addiction Medicine. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf.
- Drug overdose death data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/statedeaths.html. Accessed Sept. 20, 2017.
- CDC guideline for prescribing opioids for chronic pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Accessed Sept. 20, 2017.
- AskMayoExpert. Opioid prescribing. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
- Shah A, et al. Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006-2015. Weekly. 2017;66:265.
- Hooten WM, et al. Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: A population-based study. Mayo Clinic Proceedings. 2015;90:850.
- Gupta A, et al. Use of opioids in the management of chronic non-cancer pain. https://www.uptodate.com/contents/search. Accessed Aug. 16, 2017.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 17, 2017.
- Bruce BK, et al., eds. Pharmacology. In: Mayo Clinic Solutions for Living With Chronic Pain. New York, N.Y.: Oxmoor House; 2016.
- Krieger CA (expert opinion). Mayo Clinic, Rochester Minn. Oct. 5, 2017.