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.

Opioid addiction risk factors

Opioids are most addictive when you take them using methods different from what was prescribed, such as crushing a pill so that it can be snorted or injected. This life-threatening practice is even more dangerous if the pill is a long- or extended-acting formulation. Rapidly delivering all the medicine to your body can cause an accidental overdose. Taking more than your prescribed dose of opioid medication, or more often than prescribed, also increases your risk of addiction.

The length of time you use prescribed opioids also plays a role. Researchers have found that taking opioid medications for more than a few days increases your risk of long-term use, which increases your risk of addiction. The odds you'll still be on opioids a year after starting a short course increase after only five days on opioids.

A number of additional factors — genetic, psychological and environmental — play a role in addiction, which can happen quickly or after many years of opioid use.

Known risk factors of opioid misuse and addiction include:

  • Poverty
  • Unemployment
  • Family history of substance abuse
  • Personal history of substance abuse
  • Young age
  • History of criminal activity or legal problems including DUIs
  • Regular contact with high-risk people or high-risk environments
  • Problems with past employers, family members and friends (mental disorder)
  • Risk-taking or thrill-seeking behavior
  • Heavy tobacco use
  • History of severe depression or anxiety
  • Stressful circumstances
  • Prior drug or alcohol rehabilitation

In addition, women have a unique set of risk factors for opioid addiction. Women are more likely than men to have chronic pain. Compared with men, women are also more likely to be prescribed opioid medications, to be given higher doses and to use opioids for longer periods of time. Women may also have biological tendencies to become dependent on prescription pain relievers more quickly than are men.

Steps to prevent opioid addiction

Opioids are safest when used for three or fewer days to manage acute pain, such as pain that follows surgery or a bone fracture. If you need opioids for acute pain, work with your doctor to take the lowest dose possible, for the shortest time needed, exactly as prescribed.

If you're living with chronic pain, opioids are not likely to be a safe and effective long-term treatment option. Many other treatments are available, including less-addictive pain medications and nonpharmacological therapies. Aim for a treatment plan that makes it possible to enjoy your life without opioids, if possible.

Help prevent addiction in your family and community by safeguarding opioid medications while you use them and disposing of unused opioids properly. Contact your local law enforcement agency, your trash and recycling service, or the Drug Enforcement Administration (DEA) for information about local medication takeback programs. If no takeback program is available in your area, consult your pharmacist for guidance.

The most important step you can take to prevent opioid addiction? Recognize that no one is safe, and we all play a role in tackling the grip these drugs currently hold on our loved ones and communities.

Vivien Williams: The face of addiction is changing. What once seemed relegated to desperate souls hiding in the shadows now impacts our friends, families and coworkers. More people are addicted to opioid painkillers than ever before.

Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): I believe that in the past 20 years, the indication and the setting in which opioids are provided has changed dramatically.

Vivien Williams: Mayo Clinic pain management specialist Dr. Michael Hooten says that's good and bad. People are able to get relief from severe pain, but they're also able to get prescriptions for opioids when less addictive options such as ibuprofen may work just as well.

Mike Hooten, M.D.: If they are predisposed to develop addiction, either neurobiologically or from a behavioral perspective, then all of a sudden, we are selecting the individuals who may go on to have long-term problems.

Vivien Williams: And with addiction comes the possibility of accidental overdose. Every day 78 people in the U.S. die from opioid-related overdoses.

Vivien Williams: Dr. Hooten says educating people about the dangers of opioid misuse may be an important step in managing this public health crisis. For the Mayo Clinic News Network, I'm Vivien Williams.

Vivien Williams: Opioid painkiller addiction can destroy lives. The CDC reports that in 2014, 2 million Americans abused or were dependent on painkillers, such as hydrocodone, oxycodone and methadone.

Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): The most important first step is recognizing you have a problem.

Vivien Williams: Mayo Clinic pain management specialist Dr. Mike Hooten says the second step is to talk to the doctor who prescribed the medication.

Michael Hooten, M.D.: The medication, under medical direction, can be gradually tapered and then at the same time, other pain therapies can be introduced if needed. And, finally, you need to be referred to the appropriate addiction specialist.

Vivien Williams: Dr. Hooten says breaking free from opioids is not easy. But, unlike alcohol withdrawal, which can be life threatening, …

Michael Hooten, M.D.: Acute opioid withdrawal is a non-lethal syndrome. It's very, very uncomfortable, but not necessarily associated with death.

Vivien Williams: Every day 78 people die from an opioid overdose. Experts urge anyone who is addicted to get help. It can save your life. For the Mayo Clinic News network, I'm Vivien Williams.

Feb. 16, 2018 See more In-depth

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