How to tell if a loved one is abusing opioids

Signs of opioid abuse may be hard to see clearly, especially in someone you love.

By Mayo Clinic Staff

How to tell if a loved one is abusing opioids

Is someone you love abusing opioid medications? It may not be easy to tell, especially in the early stages of addiction. Perhaps you've noticed changes in your loved one's moods or behavior that don't add up. Or maybe your intuition is telling you there's a problem. Even if you can't put your finger on anything specific, it's worth taking stock of your concerns. If your instincts are right, speaking up could save the life of someone dear to you.

Ask yourself some questions about your loved one's personal risk of addiction and the changes you may have noticed. If your answers point toward a possible addiction, reach out to your loved one's doctor. He or she is a critical partner if you determine it's time to take action.

What are the chances my loved one could be addicted?

People who take potentially addictive drugs as prescribed rarely abuse them or become addicted. But taking them not as prescribed or for an extended period of time increases the risk of misuse and addiction. Studies suggest that up to one-third of people who take opioids for chronic pain misuse them, and more than 10 percent become addicted over time.

Your loved one is also at increased risk of addiction if he or she obtains opioids without a prescription. And using opioids illegally increases the risk of drug-related death. Drugs that pass hands illegally, such as fentanyl (Actiq, Duragesic, Fentora), may be laced with life-threatening contaminants or much more powerful opioids. And people who use opioids illegally often turn to heroin, a cheap replacement with similar effects.

Some factors increase a person's risk of opioid addiction even before they start taking these drugs — legally or otherwise. Your loved one is at increased risk of opioid addiction if he or she:

  • Is a younger age, specifically the teens or early 20s
  • Is living in stressful circumstances, including being unemployed or living below the poverty line
  • Has a personal or family history of substance abuse
  • Has a history of problems with work, family and friends
  • Has had legal problems in the past, including DUIs
  • Is in regular contact with high-risk people or high-risk environments where there's drug use
  • Has struggled with severe depression or anxiety
  • Tends to engage in risk-taking or thrill-seeking behavior
  • Uses tobacco heavily

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. Anyone who takes opioids is at risk of becoming addicted, regardless of age, social status or ethnic background.

What changes have you noticed?

People who are addicted to opioids may still hold down jobs and other responsibilities, maintaining the appearance of stability at work and home. Over time, however, the addiction is likely to lead to serious problems across the board. When a person is addicted to a drug, he or she will continue to use the drug even when it makes his or her life worse.

Common signs of opioid addiction include:

  • Regularly taking an opioid in a way not intended by the doctor who prescribed it, including taking more than the prescribed dose or taking the drug for the way it makes a person feel
  • Taking opioids "just in case," even when not in pain
  • Mood changes, including excessive swings from elation to hostility
  • Changes in sleep patterns
  • Borrowing medication from other people or "losing" medications so that more prescriptions must be written
  • Seeking the same prescription from multiple doctors, in order to have a "backup" supply
  • Poor decision-making, including putting himself or herself and others in danger

If someone you love is addicted to opioids, you're also likely to experience changes in your thoughts and behaviors. You may find yourself:

  • Worrying about your loved one's drug use, ranging from persistent anxiety to full-blown fear that your loved one is going to die
  • Lying or making excuses for your loved one's behavior
  • Withdrawing from your loved one to avoid mood swings and confrontations
  • Thinking about or acting on the urge to call the police when your loved one uses drugs or uses illegal means to obtain them

It's common — and entirely human — to avoid addressing your concerns for fear your relationship or family will fall apart. You may convince yourself that you'd know it was time for action if your loved one's addiction was truly serious. Even doctors may overlook common signs of opioid abuse, assessing the people they treat through the lens of "knowing them" versus an objective assessment of opioid-related problems.

Some addiction experts now recommend that doctors interview family members as part of routine follow-up care for a person taking opioid medications. But don't wait to be asked before you voice your concerns. A person addicted to opioids — or any substance — is much more likely to recover if his or her family refuses to ignore or tolerate the problem. If you think your loved one may be addicted to opioids, talk with his or her doctor right away. Together you can determine the best next steps.

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.

May 09, 2018 See more In-depth

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