Opioid Addiction: Symptoms, Causes, Effects, Treatments And Prevention

Opioid addiction is a recurring disorder marked by the compulsive use of opioids, despite harmful consequences. Opioids belong to a class of drugs that include prescription pain relievers, synthetic opioids like fentanyl, and illegal drugs such as heroin.

Signs of opioid addiction include an inability to control opioid use, intense cravings, and continued use despite negative personal and professional consequences. Physical symptoms of withdrawal include nausea, vomiting, muscle aches, and severe cravings. Behavioral symptoms often involve neglecting responsibilities, social isolation, and engaging in risky activities to obtain opioids.

Opioid addiction occurs due to various factors, including biological (family history of substance abuse, brain chemistry changes), psychological (mental disorders), and environmental (access to drugs, socio-economic) influences.

Effects of opioid addiction include physical (overdose and respiratory depression, dependence), mental, and behavioral (mood changes, cognitive impairment), and social and economic effects (strained relationships, and financial difficulties).

Preventing opioid addiction involves a multi-faceted approach that includes public awareness, implementing policies to regulate opioid prescription, and community efforts to support at-risk people.

What Is Opioid Addiction?

Opioid addiction, also known as opioid use disorder (OUD), is a chronic, recurring disorder. The compulsive use of opioids marks this disorder despite harmful consequences. Opioids are a class of drugs that include prescription pain relievers, synthetic opioids like fentanyl, and illegal drugs such as heroin.

These substances interact with opioid receptors on nerve cells. These nerve cells are located in the brain and body. This interaction produces pain relief and feelings of euphoria. These feelings often lead to misuse and addiction.

The development of opioid addiction usually begins with exposure to opioids. This exposure often occurs through prescribed medications for pain management. Over time, repeated use leads to tolerance. Tolerance means higher doses are needed to achieve the same effect.

Repeated use also leads to physical dependence. Physical dependence means the body adapts to the drug’s presence. Withdrawal symptoms occur if use is reduced or stopped.

Opioid abuse and addiction are on the rise. According to the 2020 report “ Medications to Treat Opioid Use Disorder Research Report” by the  National Institute on Drug Abuse (NIDA), about 2.7 million people in the US, aged 12 years and above, had opioid use disorder (OUD) in the last 12 months. In addition, opioid overdose deaths have been increasing over the years. In 2021, there were 80,411 incidents.

What Are The Signs And Symptoms Of Opioid Addiction?

Signs of opioid addiction include an inability to control opioid use, intense cravings, and continued use despite negative personal and professional consequences.

Physical symptoms of withdrawal include nausea, vomiting, muscle aches, and severe cravings. Behavioral symptoms often involve neglecting responsibilities, social isolation, and engaging in risky activities to obtain opioids.

According to the article “Opioid Use Disorder”, from Johns Hopkins Medicine, signs and symptoms of opioid addiction include: 

Physical Symptoms

• Withdrawal Symptoms: When the drug is not available, individuals experience severe withdrawal symptoms, including muscle pain, sweating, shaking, nausea, vomiting, diarrhea, and intense cravings.

• Tolerance: Over time, the body requires higher doses to achieve the same effect, leading to increased usage.

• Drowsiness and Sedation: Frequent use results in significant drowsiness and lethargy, impairing daily activities.

• Respiratory Issues: Opioids depress respiratory function, potentially leading to shallow or slowed breathing, which is life-threatening.

• Gastrointestinal Disturbances: Chronic use often causes constipation and other digestive issues.

Psychological Symptoms

• Cravings: Persistent and intense urges to use opioids dominate thoughts, making it difficult to focus on other activities.

• Anxiety and Depression: Addiction exacerbates mental health disorders, leading to heightened anxiety, depression, and mood swings.
• Euphoria: While initially providing a sense of euphoria, opioids lead to a diminished sense of pleasure from other activities.

• Cognitive Impairment: Chronic use impairs cognitive functions, leading to poor judgment, memory issues, and difficulty concentrating.

Behavioral Symptoms

• Drug-Seeking Behavior: Individuals engage in risky or illegal activities, such as doctor shopping or stealing, to obtain opioids.

• Neglect of Responsibilities: Addiction often leads to neglect of personal, professional, and social responsibilities, causing strained relationships and job loss.

• Isolation: Users may withdraw from family and friends, preferring solitude or the company of other users.

• Changes in Routine: There are significant changes in daily routines, sleep patterns, and personal hygiene.

What Are The Causes Of Opioid Addiction?

The causes of opioid addiction include various factors, such as biological influences like family history of substance abuse and changes in brain chemistry, psychological aspects like mental disorders, and environmental factors including access to drugs and socio-economic conditions.

According to a 2016 study by Volkow N. D., et al, “Neurobiological Advances from the Brain Disease Model of Addiction” biological, environmental, and psychological factors make people vulnerable to substance addiction.

This is demonstrated by the fact that only a minority of people who are exposed to substances develop dependence and addiction. Volkow’s study shows that influences such as heritability, early exposure to substances, child-rearing practices, and societal and family norms, contribute to the development of addiction.

Biological Factors

• Genetics: Genetics plays a significant role in addiction vulnerability. Individuals with a family history of substance abuse are more likely to develop an addiction. Research indicates that genetic factors account for about 40% to 60% of an individual’s vulnerability to addiction.
  
  According to the 2018 article “ Understanding Drug Use and Addiction Drug Facts” from the National Institute on Drug Abuse (NIDA), genes are responsible for about half of the risk for alcohol and drug addiction. Specific genes may influence how an individual responds to drugs, their likelihood of developing dependence, and their ability to quit.
  
  For instance, variations in the dopamine D2 receptor gene have been linked to an increased risk of addiction, as they can affect the reward and pleasure circuits in the brain.

• Brain Chemistry Changes: Alterations in the brain caused by prolonged opioid use lead to dependency. Opioids hijack the brain’s reward system, mimicking feel-good chemicals like endorphins. This creates a surge of pleasure, driving you to repeat use.
  
  Over time, the brain adjusts, needing more and more opioids for the same effect (tolerance). It also downregulates its own reward system, making everyday activities less enjoyable. Stopping opioids triggers withdrawal symptoms, making you crave the drug to feel normal again

• Other biological factors that lead to addiction include a person’s gender, ethnicity and existing mental disorders.

Psychological Factors

• Mental Health Disorders: According to the 2023 article “ How Opioid Use Disorder Occurs”, from the Mayo Clinic, mental health disorders make people vulnerable to addiction due to abuse of opioids.
  People with conditions like anxiety, depression, or PTSD are likely to turn to opioids to cope with uncomfortable emotions or symptoms. Opioids produce feelings of pleasure and relaxation, offering temporary relief.
  In addition, mental health disorders make people more susceptible to addiction. They are highly likely to misuse opioids due to despair or difficulty managing their condition.

Environmental Factors

According to the 2018 article “ 6 Ways Your Environment Is Influencing Your Addiction”, from Psychology Today, environmental factors that contribute to the development of addiction include:

• Home and Family: An unstable home life fosters addiction. Parental substance misuse, mental health issues, and legal troubles increase a child’s risk. Exposure to these issues heightens vulnerability. According to Hudgins, J. D.’s 2019 study, ‘Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study’, a significant source of prescription opioids for adolescents and young adults comes from friends or relatives, with 33.5% of adolescents and 41.4% of young adults obtaining them this way.
• Peer Pressure and Social Circles: Peer influence is strong during adolescence. Friends using opioids pressure others to try drugs. This peer pressure encourages experimentation.
• Socioeconomic Factors: Poverty, lack of education, and limited opportunities cause hopelessness. Hopelessness drives opioid addiction. These factors are linked to higher addiction rates.
• Stressful Life Events: Trauma, abuse, neglect, and chronic stress lead to opioid use. People use opioids to cope with overwhelming emotions. These stressful events push individuals towards addiction.
• Access to Opioids: Easy access to opioids increases misuse and addiction. High saturation of pain clinics and lax prescriptions raise addiction rates. Communities with easy access see more addiction.

What Are The Effects Of Opioid Addiction?

Effects of opioid addiction include physical (overdose and respiratory depression, dependence), mental, and behavioral (mood changes, cognitive impairment), and social and economic effects (strained relationships, and financial difficulties).

According to the article “Side Effects Of Opioids” from the Faculty of Pain Medicine of the Royal College of Anesthetists, opioid effects are very common. These include itching, constipation, and respiratory depression.

Physical Effects

• Overdose and Respiratory Depression: Opioid overdose is life-threatening. Opioids slow breathing, leading to dangerously shallow or halted respiration. Respiratory depression is a major cause of death from opioid use.
• Dependence and Withdrawal: Opioids create physical dependence for normal functioning. Abrupt cessation triggers withdrawal symptoms, including muscle aches, diarrhea, nausea, vomiting, anxiety, and insomnia. These symptoms drive compulsive drug use, creating a vicious cycle.
• Long-Term Health Problems: Chronic opioid use causes various health problems. Health issues include constipation, weakened immune system, hormonal imbalances, sleep-disordered breathing, and increased fracture risk.

Mental and Behavioral Effects

• Changes in Mood and Behavior: Opioids significantly alter mood and behavior. People with OUD experience depression, anxiety, irritability, and mood swings. They also engage in risky or impulsive behaviors to obtain opioids.
  
• Cognitive Impairment: According to a 2006 study by Rapeli, P., et al., “Cognitive Function During Early Abstinence From Opioid Dependence: A Comparison To Age, Gender, And Verbal Intelligence Matched Controls”, opioid use impairs memory, focus, and decision-making abilities. This affects a person’s work performance, academic success, and overall well-being.
  
• Neglecting Responsibilities: Addiction is all-consuming, and people with OUD begin to neglect their work, school, family, and social obligations. This leads to relationship problems, job loss, and financial difficulties.

Social and Economic Effects

• Strained Relationships: Opioid addiction damages relationships with family and friends. Secrecy, manipulation, and behavior changes erode trust and cause isolation.
• Financial Problems: The immense cost of opioids creates economic problems. Individuals with opioid use disorder steal from loved ones and neglect financial obligations.
• Increased Crime: Addiction increases crime rates. Individuals commit theft, forgery, and fraud to support habits, harming communities and burdening law enforcement.
• Health Effects: Chronic opioid use causes severe health effects. Health issues include respiratory depression, heart problems, and increased infectious disease risk due to needle sharing. Overdose presents a significant and fatal risk.
• Social Effects: Addiction leads to social effects, including strained relationships and social isolation. Families of addicted individuals experience emotional and financial stress.

Economic Effects: The societal cost of opioid addiction is substantial, including healthcare expenses, lost productivity, and law enforcement costs. According to a 2022 report, “ JEC Analysis Finds Opioid Epidemic Cost U.S. Nearly $1.5 Trillion In 2020”, by the U.S. Congress Joint Economic Committee, the cost of opioid epidemic cost the US about $1.5 trillion in 2020. 

 What Are The Available Treatment Options For Opioid Addiction?

Effective treatment for opioid addiction typically involves a combination of medications (Methadone, Buprenorphine), behavioral therapies, and support systems:

Medication-Assisted Treatment (MAT)

This uses medications to reduce cravings and withdrawal symptoms, allowing the person to focus on behavioral therapy and other aspects of recovery. There are three medications approved by the FDA to treat opioid use disorder (OUD):

• Methadone: A long-acting opioid that is dispensed daily at a specialized clinic. Methadone reduces cravings and withdrawal symptoms and prevents relapse to opioid use. According to NIDA (National Institute on Drug Abuse). 2018 article, ‘How effective are medications to treat opioid use’, patients receiving methadone had 33% fewer opioid-positive drug tests compared to those receiving placebo treatments. Also, patients on methadone are 4.44 times more likely to remain in treatment compared to those not receiving medication.

• Buprenorphine: A partial opioid agonist that is prescribed by specially certified physicians and dispensed in pharmacies. Buprenorphine reduces cravings and withdrawal symptoms, but it has a ceiling effect, meaning that taking more of the medication will not produce a greater high.

• Naltrexone: An opioid antagonist that blocks the effects of opioids, including cravings and euphoria. Naltrexone is not effective for treating withdrawal symptoms. According to the 2014 article “Medication Assisted Treatment (MAT)”.
  
  The Department of Corrections of the Commonwealth of Pennsylvania started providing Naltrexone (Vivitrol), to female reentrants returning to their communities for opioid use disorder. Over time, Vivitrol was extended to the men’s program. 

Behavioral Therapies

Cognitive-behavioral therapy (CBT), Contingency Management (CM), and Motivational Interviewing (MI ): According to a 2021 study by Carley, J. A., et al., Therapeutic Approaches To Opioid Use Disorder: What Is The Current Standard Of Care?

Published in the International Journal of General Medicine, these therapeutic approaches are highly effective in treating opioid addiction as they help individuals modify their attitudes and behaviors related to drug use and develop healthy coping strategies.

Support Systems

Participation in support groups such as Narcotics Anonymous (NA) or other peer support networks provides ongoing encouragement and accountability. Family therapy is also beneficial in repairing relationships and providing a supportive environment for recovery.

How Can You Prevent Opioid Addiction?

Opioid addiction can be prevented by educating the public about the risks, implementing policies to regulate opioid prescribing, and supporting community-based programs.

According to a 2024 study by Ballard, P.J., et al, “Pathways To Opioid Use And Implications For Prevention: Voices Of Young Adults In Recovery”, strategies such as creating public awareness, safe disposal of opioids, and reducing overprescribing are highly effective in preventing opioid abuse.

• Education: Public health campaigns aimed at educating the public about the risks of opioid use and the signs of addiction are crucial. Healthcare providers should also be trained to prescribe opioids responsibly and monitor patients for signs of misuse.

• Policy: Implementing policies that regulate opioid prescribing and distribution helps reduce the availability of these drugs. Prescription drug monitoring programs (PDMPs) track prescriptions and identify patterns of abuse.

• Community Efforts: Community-based programs that provide support and resources for at-risk individuals prevent the onset of addiction. These programs include mental health services, employment assistance, and recreational activities that promote healthy lifestyles.

Can Opioid Addiction Be Treated Solely With Medication?

Opioid addiction cannot be treated solely with medication. While medications are a critical component of treatment, the most effective approach combines medication with behavioral therapies and support. This holistic approach addresses the physical, psychological, and social aspects of addiction. The 2016 study by Volkow demonstrated that apart from medication, psychotherapeutic approaches are also highly effective in treating opioid addiction.

What Are The 4 A’s Of Opioid Therapy?

The 4 A’s Of Opioid Therapy are analgesia, activities of daily living, adverse effects, and aberrant drug-taking behaviors.
According to a 2009 study by Passik, S. D., et al, “Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions”, physicians treating chronic pain using opioids should observe the 4 A’s of pain treatment. This is a framework used to assess chronic pain treatment outcomes and identify potential risks associated with opioid use. It stands for:

1. Analgesia: This refers to the effectiveness of pain relief. Medications, physical therapy, and other interventions are all evaluated to see how well they are reducing the patient’s pain.

2. Activities of Daily Living (ADLs): This assesses how well a patient is able to perform everyday tasks such as dressing, bathing, eating, and working. Pain significantly impacts a person’s ability to function, so it’s important to see if treatment is helping them regain their independence.

3. Adverse Effects: This refers to any side effects that the patient is experiencing from their pain medication or other treatments. Common side effects of opioids include constipation, nausea, and drowsiness. It’s important to weigh the benefits of pain relief against the risks of side effects.

4. Aberrant Drug-Taking Behaviors: This assesses whether the patient is misusing their pain medication. This could include taking more medication than prescribed, taking it in a way that is not prescribed, or doctor-shopping to obtain more medication.

How Can Communities Help Prevent Opioid Addiction?

Communities help prevent opioid addiction through education, creating supportive environments, and implementing policies that reduce access to opioids. Community programs that promote mental health and provide resources for those at risk are also vital. According to the 2024 study by Ballard, community-based programs identify the most at-risk groups and put in place preventative measures to help keep them from developing dependence and addiction.