What are opioids?


Opioids are a class of painkillers that may affect the brain.

They include a large group of prescription medications that help to manage pain, as well as the illegal recreational or “street” drug heroin. The first opioids came from opium, a substance made from poppy plants, which people have known about and used for thousands of years.

It has also long been known that opioids can be addictive and that, especially with improper use, they can harm health and dominate lives.

Many people are aware of the dangers of an illegal drug like heroin.

However, prescription opioids, which may be prescribed to treat severe pain, can be just as addictive and dangerous, especially if they are not used in the way the doctor has instructed. Prescription opioids are often sold and supplied illegally because they can produce a “high” in the same way as heroin.

Many have also been given alternative or “street” names, the same way that heroin is commonly called “smack” or “skag”. Here are some examples:

Name Examples of brand names* Examples of street names
Oxycodone OxyContin®, Roxicodon® OxyCotton, Hillbilly Heroin
Fentanyl Duragesic®, Actiq®, Fentora® Apache, China Girl, Dance Fever
Hydrocodone Vicodin®, Lortab®, Lorcet® NorHydro, Vikes
Tramadol Ultram®, Ultracet® Chill Pills, Ultras

*All trademarks are the property of their respective owners.

What is opioid dependence?


“Opioid dependence” is a chronic medical condition in which people experience cravings and “withdrawal effects” or “withdrawal symptoms,” unpleasant physical and mental symptoms, if they don’t keep taking the opioid in the amounts they are used to.

This can lead to addictive behavior, which means that they become obsessed with getting enough of the opioid, they no longer feel in control about when and how much they use, and they start to neglect other aspects of their lives.

When people take opioids for non-medical purposes (recreational use) or take them in excessive doses, too frequently, or in inappropriate ways (for example, snorting or injecting them when they are meant to be taken by mouth) this is called “misuse”. Misuse can lead to dependence and addiction, causing uncontrollable cravings and continued use of the opioid despite obviously harmful consequences. The word “addiction” comes from a Latin word meaning “enslaved”. Anyone who has struggled to overcome an addiction, or has tried to help someone else to, will understand why.

People used to believe that people who developed addictions were somehow weak or had less willpower. We now know that this isn’t true. Opioid dependence and addiction is a medical condition; it is a chronic disease. Just as high blood pressure damages your arteries and diabetes affects your pancreas, addiction to opioids can affect your brain.

“I think, especially at the beginning before you really experience many consequences, it is hard to see that it is a problem.”

Personal experience

Who develops opioid dependence?


It’s important to know that people who misuse opioids and develop opioid dependence come from all walks of life.

They may be people who experimented with heroin or prescription opioids sold for recreational use, or they may be people who were taking an opioid prescribed by a doctor to control severe pain; for example, pain caused by some types of cancer, pain after an accident or injury, or pain following surgery.

Taking more of the opioid than the doctor prescribed can set up the same pathway to dependence and addiction that happens when opioids are used recreationally. There is some evidence that genetics may make some people naturally more likely to develop opioid dependence.

People who have a mental illness like depression, or have suffered major traumas in their life, could also be at greater risk. The important thing to remember is it can happen to anyone, and should not be used to judge personality or strength of character.

“Intellectually I knew it was a problem, this is what happens to people who do things like this, but I thought it would be forever until that happens to me or I’m smart enough where I can manipulate the situation so that bad things won’t happen to me.”

Personal experience

How common is opioid dependence?


If you have become dependent on opioids, you are not alone.

Nearly 5 million people in the United States misuse opioids every month and, of these, almost 2 million people (roughly equal to the entire population of Houston, Texas) are dependent on prescription opioids. What is more, the problem is growing. Between 2001 and 2011, the number of people starting treatment programs for prescription opioid dependence increased fivefold.

 

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How can I tell if I am dependent on opioids?


Symptoms that may be associated with opioid dependence and addiction include:

 

Increasing your opioid use over time because you need more to achieve an effect

Starting to feel unwell if you have to go without the opioid, or if you take less than usual

Personality changes like alterations in energy, mood, and concentration

Starting to keep away from family and friends (except maybe other people who misuse opioids)

Continuing to use the opioid even though you suspect it’s becoming a problem - or when you no longer need pain relief

Spending large amounts of time planning (and sometimes travelling) to get more opioid, whether it’s from doctors, dealers, other people who misuse opioids or the internet

Neglecting your appearance, diet, and personal hygiene

Starting to ignore things like household chores and bills

Calling in sick to work or school more often than before

Finding that senses and emotions are stronger and more stimulating than before

Forgetting events that have taken place and experiencing blackouts

Denying that you may have a problem

Only a doctor can accurately diagnose opioid dependence. If you think you, or someone you know, may have a problem with opioids, please talk to a doctor as soon as possible.

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The experience of opioid withdrawal


If someone who is dependent on an opioid stops taking it, or doesn’t take enough, he or she may experience a wide range of withdrawal symptoms.

These can include: muscle aches, restlessness, watery eyes, runny nose, excessive sweating, constant yawning, diarrhea, abdominal cramps, nausea, vomiting, blurred vision, rapid heartbeat, anxiety, depression, and insomnia (inability to sleep).

Withdrawal feels different from person to person. It is difficult to explain how unpleasant and strong the feeling of withdrawal is for many people. Some descriptions include:

 

  • "The worst thing in the world"
  • "Desperately needing to breathe but being trapped underwater"
  • "Hell on earth"
  • "Like being hit by a train"
  • "The flu x 1000"

 

Taking opioids temporarily stops the symptoms of withdrawal, which is why addiction to opioids is such a trap.

“With withdrawal, there is a feeling of so much pain and being so uncomfortable in your own body that it is physically impossible to do anything aside from get and use the drug. Before I could go to work, before I could brush my teeth, it was just that bad. It was so automatic and I had become so conditioned that it was the same as how people wake up and make a cup of coffee first thing in the morning or go to the bathroom first thing in the morning. It was an automatic impulse like that. The withdrawal symptoms and the anxiety that accompany the impulse are just so horrible that you will do anything to avoid them – it is impossible to do anything else until you have dealt with the withdrawal symptoms and anxiety… The panic attack level of anxiety that accompanies all of the physical things makes it that much worse – it sends you into a mental spiral.”

Personal experience

“Physically, it feels like you have the flu. Psychologically it’s like a depression. If you take having the flu and then being down in the dumps and combine them together – that’s how I can best describe what withdrawal feels like.”

Personal experience

“A lot of it’s not the fact that you are in pain. The hardest part about the withdrawal is knowing that there is a way to take away the pain. When you are sick, you take medicine – you take whatever is going to make you feel better because you are sick.”

Personal experience

Opioid dependence ultimately affects almost every aspect of life.


  • Related health problems include mental health issues and an increased risk of serious infections, including HIV and hepatitis C. In addition, the number of deaths from overdosing on prescription opioids has more than tripled in the United States over the past 20 years.
  • Misuse of drugs is likely to negatively impact family members.
  • Excessive spending to buy opioids can lead to serious financial difficulties.
  • Preoccupation with the addiction can jeopardize social relations and performance at work.

 

For some, the most painful effect of opioid dependence (as with other serious addictions) is the loss of self-esteem.

 

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“It will get better. It doesn’t seem like it. Keep in mind that it’s going to get better. It’s really horrible at the onset, whether it be physical withdrawal or mental torment. If you stick with it, there is a light at the end of the tunnel.”

Personal experience

 

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