What Makes Opioids Addictive?

There are many addictive substances that can negatively affect our lives, from illegal drugs like cocaine to legal drugs like alcohol. Opioid drugs — both legal and illegal — are particularly dangerous because of their effect on the brain.

According to the National Institute on Drug Abuse (NIDA), somewhere between 21% and 29% of people with an opioid prescription for chronic pain management misuse their medication. Additionally, 8% to 12% of those taking an opioid for their chronic pain will develop opioid use disorder. Understanding why opioids are so addictive and what increases a person’s odds of developing an addiction is important for anyone who uses these drugs.

Opioids and the Brain

Opioids alter the chemistry of the brain. This happens when opioids bind to specialized opioid receptors in the brain. This triggers the release of endorphins, which are naturally occurring chemicals, also known as neurotransmitters, that increase feelings of pleasure and reduce the body’s perception of pain.

The body quickly adapts to the powerful sense of well-being that opioids create. However, once past the initial dose of opioids, future doses often stop producing the same effect. This leaves the opioid user seeking the same release of endorphins they first experienced. As a result, they may need to take more of the opioid to feel the same level of pain relief.

Opioid Dependence vs. Addiction

Dependence is likely for anyone who takes opioids for an extended period. If the person stops taking the opioid, they will experience a variety of withdrawal symptoms. These can range from physical symptoms, such as muscle cramps, to psychological symptoms, such as anxiety.

A smaller percentage of people will develop an addiction. A person who has developed an opioid addiction will experience serious negative impacts in their lives because of their need to find and take opioids. Consuming the drug may take priority over their relationships, their jobs, and their health.

Of course, it is possible to take opioids responsibly. To do so, users should closely follow the instructions of the health care provider who has prescribed the opioids. Individuals should also take responsibility for their own health and be actively involved in the pain control strategy they will be using.

Effects of Opioid Use

There are both legal and illegal forms of opioids. Commonly prescribed opioids include codeine, fentanyl, hydrocodone, oxycodone, oxymorphone, and morphine. These medications are sold under brands names that include OxyContin, Percocet, Palladone, and Vicodin. Heroin is an illegal opioid.

Side effects of opioids include sleepiness, constipation, and nausea. More serious and life-threatening side effects range from shallow breathing to reduced heart rate to a loss of consciousness. Overdose is also a serious risk when individuals abuse opioids.

Even when someone has been prescribed opioids and has taken them as their health care provider ordered, they may still experience withdrawal symptoms when they begin to taper off their usage. It is important to discuss any plan to stop the use of opioids with a doctor. Individuals should be prepared to experience withdrawal symptoms including:

• Drug cravings
• Anxiety
• Insomnia
• Abdominal pain
• Vomiting
• Diarrhea
• Tremors (shaking)

Risk Factors of Opioid Addiction

A variety of factors can increase someone’s risk of developing a dependence or an addiction to opioids. The dosage of opioids is one risk factor. The higher the dosage, the higher the potential for misuse or overdose.

Another area of concern is how long someone has been taking the opioid. Prolonged use increases the chance of developing an opioid addiction. Finally, extended-release and long-acting types of opioids have been shown to put someone at greater risk than newer formulations with an immediate release.

There are a variety of genetic, psychological, and environmental factors that can increase a person’s odds of addiction. These include:

• Poverty
• Unemployment
• Family or personal history of substance abuse
• 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
• Risk-taking or thrill-seeking behavior
• Heavy tobacco use
• History of severe depression or anxiety
• Stressful circumstances
• Prior drug or alcohol rehabilitation

Certain people may be at higher risk of issues connected to opioids, whether that is addiction or overdose. For example, adults who are 65 and older can be more sensitive to the effects of opioids. Anyone with conditions like sleep apnea, asthma or chronic obstructive pulmonary disease may also be at higher risk. Women are more likely to experience chronic pain and they may have biological tendencies that result in an increased risk of dependency on opioids and other pain killing medicine.

Others at a higher risk of misuse include individuals between 18 and 25 years old and anyone with a mental health disorder, like depression, anxiety, and post-traumatic stress disorder.

The safest way to use opioids is to manage pain for a very brief period, such as several days only. Examples of the type of brief pain relief that opioids are best for is acute pain, such as the pain from surgery or a bone fracture. In these instances, the lowest dosage for the shortest time is the safest route. For chronic pain, it is best to talk to a health care provider about other options, from less-addictive pain medications to nonpharmacological therapies.

At Bridges of Hope, we have extensive experience helping people recover from opioid addiction. Our treatment philosophy is based on a comprehensive and integrated approach to addressing substance use and mental health disorders. We use therapeutically proven, evidence-based clinical practices to provide superior client care across Indiana.