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

See also

  1. Medication-free hypertension control
  2. Alcohol: Does it affect blood pressure?
  3. Alpha blockers
  4. Ambien: Is dependence a concern?
  5. Angiotensin-converting enzyme (ACE) inhibitors
  6. Angiotensin II receptor blockers
  7. Antidepressant withdrawal: Is there such a thing?
  8. Antidepressants and alcohol: What's the concern?
  9. Antidepressants and weight gain: What causes it?
  10. Antidepressants: Can they stop working?
  11. Antidepressants for children and teens
  12. Antidepressants: Side effects
  13. Antidepressants: Selecting one that's right for you
  14. Antidepressants: Which cause the fewest sexual side effects?
  15. Anxiety: A cause of high blood pressure?
  16. Atypical antidepressants
  17. Automated external defibrillators: Do you need an AED?
  18. Bedtime routines: Not just for babies
  19. Beta blockers
  20. Beta blockers: Do they cause weight gain?
  21. Beta blockers: How do they affect exercise?
  22. Bipolar disorder
  23. Bipolar disorder and alcoholism: Are they related?
  24. Bipolar in children
  25. Bipolar medications and weight gain
  26. Bipolar treatment: I vs. II
  27. Blood pressure: Can it be higher in one arm?
  28. Blood pressure chart
  29. Blood pressure cuff: Does size matter?
  30. Blood pressure: Does it have a daily pattern?
  31. Blood pressure: Is it affected by cold weather?
  32. Blood pressure medication: Still necessary if I lose weight?
  33. Blood pressure medications: Can they raise my triglycerides?
  34. Blood pressure readings: Why higher at home?
  35. Blood pressure tip: Get more potassium
  36. Blood pressure tip: Get off the couch
  37. Blood pressure tip: Know alcohol limits
  38. Blood pressure tip: Stress out no more
  39. Blood pressure tip: Watch the caffeine
  40. Blood pressure tip: Watch your weight
  41. Screenings of newborns and athletes for genetic heart disease
  42. Caffeine and depression: Is there a link?
  43. Caffeine and hypertension
  44. Calcium channel blockers
  45. Calcium supplements: Do they interfere with blood pressure drugs?
  46. Can whole-grain foods lower blood pressure?
  47. Can't sleep? Try daytime exercise
  48. Central-acting agents
  49. Choosing blood pressure medications
  50. Clinical depression: What does that mean?
  51. Coffee after dinner? Make it decaf
  52. Depression and anxiety: Can I have both?
  53. Depression, anxiety and exercise
  54. Depression: Diagnosis is key
  55. Depression in women: Understanding the gender gap
  56. Depression (major depressive disorder)
  57. Depression: Provide support, encouragement
  58. Depression: Supporting a family member or friend
  59. Disposal of unused pain medications
  60. Diuretics
  61. Diuretics: A cause of low potassium?
  62. Do you know your blood pressure?
  63. High blood pressure and exercise
  64. Fish oil and depression
  65. Foods and sleep
  66. Free blood pressure machines: Are they accurate?
  67. Home blood pressure monitoring
  68. Heart arrhythmias
  69. High blood pressure (hypertension)
  70. High blood pressure and cold remedies: Which are safe?
  71. High blood pressure and sex
  72. High blood pressure: Can you prevent it?
  73. High blood pressure dangers
  74. How opioid addiction occurs
  75. How to use opioids safely
  76. Hypertensive crisis: What are the symptoms?
  77. Insomnia
  78. Insomnia: How do I stay asleep?
  79. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  80. Integrative approaches to treating pain
  81. Intervention: Help a loved one overcome addiction
  82. Isolated systolic hypertension: A health concern?
  83. Depression and diet
  84. Kratom: Unsafe and ineffective
  85. Kratom for opioid withdrawal
  86. Lack of sleep: Can it make you sick?
  87. L-arginine: Does it lower blood pressure?
  88. Lexapro side effects: Is breast tenderness common?
  89. Lifestyle strategies for pain management
  90. Low blood pressure (hypotension)
  91. Male depression: Understanding the issues
  92. MAOIs and diet: Is it necessary to restrict tyramine?
  93. Marijuana and depression
  94. Medications and supplements that can raise your blood pressure
  95. Menopause and high blood pressure: What's the connection?
  96. Mental health: Overcoming the stigma of mental illness
  97. Mental health providers: Tips on finding one
  98. Mental illness
  99. Mild depression: Are antidepressants effective?
  100. Monoamine oxidase inhibitors (MAOIs)
  101. Natural remedies for depression: Are they effective?
  102. Nervous breakdown: What does it mean?
  103. Not tired? Don't go to bed
  104. Opioid use during pregnancy
  105. Opioids and other drugs: What to watch for
  106. Pain and depression: Is there a link?
  107. Pain Medication Safety
  108. Prescription drug abuse
  109. Prescription sleeping pills: What's right for you?
  110. Pulse pressure: An indicator of heart health?
  111. Reactive attachment disorder
  112. Recreational ED drug use
  113. Resperate: Can it help reduce blood pressure?
  114. Selective serotonin reuptake inhibitors (SSRIs)
  115. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  116. Skip booze for better sleep
  117. Sleep deprivation: A cause of high blood pressure?
  118. Stress and high blood pressure
  119. Tapering off opioids: When and how
  120. Teen depression
  121. Teen drug abuse
  122. Nutrition and pain
  123. Pain rehabilitation
  124. Self-care approaches to treating pain
  125. Treating pain: When is an opioid the right choice?
  126. Treatment-resistant depression
  127. Tricyclic antidepressants and tetracyclic antidepressants
  128. Unexplained weight loss
  129. Valerian: A safe and effective herbal sleep aid?
  130. Vasodilators
  131. How to measure blood pressure using a manual monitor
  132. How to measure blood pressure using an automatic monitor
  133. What is blood pressure?
  134. Vitamin B-12 and depression
  135. Weightlifting: Bad for your blood pressure?
  136. What are opioids and why are they dangerous?
  137. What's your high blood pressure risk?
  138. White coat hypertension
  139. Wrist blood pressure monitors: Are they accurate?