Opioids can help you manage severe pain when used as prescribed. It’s essential to follow guidelines to avoid possible addiction symptoms.
Health professionals have prescribed opioids to manage chronic pain and control severe coughs for centuries. When used as prescribed, opioids can help you manage pain and improve your quality of life.
As with all medications, it’s important to use opioid medications exactly as prescribed and not use them for longer than the intended treatment time. Not doing this could impact your health and in some cases lead to developing symptoms of addiction.
If you’re currently taking prescription opioids or your healthcare team is considering prescribing opioid medications for pain relief, you may have questions, including whether opioids cause addiction. These questions are important and you might want to start with learning more about what addiction is.
Can opioids cause addiction? Yes, opioid use may lead to dependence and addiction. However, it’s important to understand why and what’s meant by addiction.
You may hear the phrases opioid addiction and opioid use disorder used to mean the same thing. However, opioid addiction is an older term no longer officially used to define opioid use disorder.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the tool used by health professionals to diagnose mental health conditions.
In 2013, the DSM-5 officially changed the terms opioid addiction and substance abuse to opioid use disorder.
The DSM-5 defines opioid use disorder as a pattern of opioid use that leads to problems or distress.
To make a diagnosis of opioid use disorder, at least two of the following symptoms must occur within a 12-month period:
- taking larger amounts of opioids or for longer periods than prescribed
- wanting to stop taking opioids but not being able to
- spending large amounts of time trying to get opioids, use opioids, or recover from the effects of opioids
- feeling the urge to take opioids
- not being able to complete tasks at work, school, or home because of opioid use
- continuing to take opioids even though they may be causing social or relationship challenges
- giving up or cutting back on regular activities because of opioid use
- continuing to use opioids even when it’s not safe to do so
- continuing to take opioids knowing that they cause you physical or psychological challenges
- showing signs of tolerance to opioids
- showing signs of withdrawal when stopping opioids
If tolerance and withdrawal are the only two symptoms present, a health professional won’t reach an opioid use disorder diagnosis.
Opiates and opioids attach to receptors in your brain and other parts of your body. This leads your brain to release dopamine, which is a chemical that blocks pain messages and makes you feel good.
Parts of the brain create a memory of those good feelings you get when you take an opioid medication, which may lead you to want that feeling of well-being after the opioids wear off.
Over time, your body may get used to a certain dose of opioids. This means you might not get the same effect if you continue taking the same amount of medication. This could lead you to need more medication to get the same pain relief effect. This is called opioid tolerance, and it happens because opioid receptors in the brain gradually become less responsive to opioids.
Opioid addiction can be a result of increasing your dose or frequency without a health professional’s supervision or guidance. It’s because opioids can change the chemistry in your brain, which has an effect on how you feel and behave, that they can make you feel you need and want them. This is what some people describe as an addiction to opioids.
However, your chances of opioid addiction decrease significantly when you take the medications as prescribed and keep all of your health professionals informed about past and current opioid use.
Some people may experience withdrawal symptoms when they stop taking opioid medications.
Certain brain cells release a chemical called noradrenaline. That’s one of their jobs.
Noradrenaline tells your brain to be alert and awake and sends messages telling your body to breathe. Noradrenaline also increases your blood pressure.
So, when opioids attach to receptors in these noradrenaline-producing cells, your brain releases less of this chemical. This may cause you to feel drowsy. It may also slow your breathing rate and decrease your blood pressure.
But, over time, your brain adjusts to the presence of opioids. It may start compensating. Your brain starts releasing more noradrenaline again, even when opioids are attached to brain cells.
If you suddenly stop taking opioids, your brain cells continue to release that amount of noradrenaline — typically more than they used to before you started taking opioids.
Among other symptoms, this may cause:
- jittery feelings
- anxiety
- cramps
- diarrhea
- irritability
- insomnia
- sweating
Yes, opioid use disorder is treatable. There are effective treatment programs that can help relieve your need to use as well as the withdrawal symptoms and block the pleasurable effects of opioids that may have kept you returning for more.
If you’re considering treatment for opioid use disorder, a mental health professional who is experienced in substance use can discuss counseling and therapy options with you.
They may also prescribe some medications.
Medications
There are three main medications health professionals use in the treatment of opioid use disorder:
Methadone
Methadone is a long-acting opioid agonist. This means it attaches to and activates opioid receptors in your brain. It helps reduce the need for opioids and also reduces withdrawal symptoms. It blocks the effects of other opioids.
Methadone is available as tablets or liquid that you take by mouth, but only clinics that are licensed to treat opioid use disorder can prescribe them.
Buprenorphine
SAFETY ALERT FOR ORAL BUPRENORPHINE
In January 2022, the Food and Drug Administration (FDA) issued a
Buprenorphine is a partial opioid agonist. This means that it attaches to opioid receptors in your body, but it has different effects than full opioid agonists, such as codeine.
Taking buprenorphine as prescribed by your healthcare team helps reduce opioid need and withdrawal symptoms. In fact, only certain health professionals can prescribe this drug.
It’s important to follow your health professional’s instructions when taking buprenorphine. You’ll likely need to stop taking opioids for at least 12 to 24 hours before starting buprenorphine.
Buprenorphine is available as tablets that you dissolve under your tongue or films that you dissolve under your tongue or inside your cheek. It also comes as an injection that you use once a month or an implant that’s placed under your skin every 6 months.
Several buprenorphine formulations are combined with naloxone. Naloxone on its own is a medication used for overdose emergency situations. It can help reverse the effects of an opioid overdose in just minutes.
However, when added to the buprenorphine, the naloxone has no effect if the medication is taken as sublingual tablets. The combination of buprenorphine and naloxone should never be injected.
Naltrexone
Naltrexone is an opioid blocker that helps reduce opioid need. It comes as a tablet and an extended-release injection. Only the injection is approved by the FDA for opioid use disorder since the tablet can increase the chance of accidental death when used for this purpose.
Depending on the type of opioids you’ve been taking, you’ll likely need to stop taking opioids for at least 7 to 14 days before starting naltrexone. Having this opioid-free period prevents naltrexone from causing withdrawal symptoms.
Opioid addiction is more likely to happen when opioid medications aren‘t taken as prescribed.
Opioids can effectively manage some types of acute (short-term) and chronic (long-term) pain when used under a health professional’s supervision.
Opioids work by attaching to receptors in your brain, which leads your brain to release chemicals that block pain and produce pleasurable feelings.
Over time, your body may need more opioids to get the same effect, or you may experience withdrawal symptoms when you stop taking opioids. These are some of the criteria used to diagnose opioid use disorder.
The primary treatment program for opioid use disorder is the use of medications, which are sometimes combined with counseling or other types of psychotherapy.