The fine line between opioid use and addiction

When you have a headache or muscle ache, an over-the-counter pain reliever is usually enough to make you feel better. If your pain is more severe, your doctor might recommend a prescription opioid.

Opioids are a type of narcotic pain medication. They can have serious side effects if not used correctly. For people who have an opioid addiction, their problem often started with a prescription.

Opioids are used to treat moderate to severe pain that may not respond well to other pain medications. They include codeine, fentanyl, hydrocodone, meperidine, methadone, morphine and oxycodone. While you’re on opioid pain medication, keep in touch with your doctor regularly, who will want to know how your pain is responding to the drug, whether you’re having any side effects and if you’re taking the drug properly.

How addiction occurs

Anyone who takes opioids is at risk of developing addiction. Opioids are safest when used for three or fewer days to manage acute pain, such as pain following surgery or with a broken bone. Work with your doctor to take the lowest dose possible, for the shortest time needed and exactly as prescribed.

Addiction is a condition in which something that started as pleasurable now feels like something you can’t live without. Doctors define drug addiction as an irresistible craving for a drug, out-of-control and compulsive use of the drug, and continued use despite repeated, harmful consequences.

Taking more than your prescribed dose of opioid medication or more often than prescribed increases your risk of addiction. Opioids are most addictive when you don’t take them as prescribed, such as crushing a pill to snort or inject it. This is life threatening because rapidly delivering all the medicine to your body can cause an accidental overdose.

After taking opioid medication for a while, you might find that you need a higher dosage to achieve the same effect in easing pain. This is called tolerance and is not the same as addiction but can easily lead to addiction. Higher doses often lead to more or dangerous side effects. Your doctor can change the opioid you take or add another kind of pain reliever to combat problems of tolerance and relieve pain.

Mental health and substance abuse conditions can increase your risk for addiction, including heavy tobacco use, prior drug or alcohol rehabilitation, or family or personal history of substance abuse.  

Signs of trouble

Opioids can affect your thinking and judgment, even when taking as prescribed.

Watch for these signs:

• Making decisions too quickly
• Regularly taking more than the prescribed dose
• Taking the medication “just in case” even when you’re not in pain
• Mood changes
• Using medication prescribed for someone else

  Signs of addiction include:

• Can’t stop taking the drug
• Feel anxious, moody, depressed or uninterested
• Spend all of your money on drugs
• Lie, hide or steal because of drugs
• Slur your speech or feel agitated
• Neglect work, family and your appearance

How to safely stop

Do not abruptly stop taking your opioid medication because you can experience severe side effects, including worse pain, diarrhea, nausea, vomiting, anxiety, irritability, chills and restlessness. Work with your doctor to taper off opioids slowly and safely.

If you're living with chronic pain, opioids are not likely to be a safe and effective long-term treatment option. Many other treatments are available, including less-addictive pain medications and nonpharmacological therapies. Aim for a treatment plan that makes it possible to enjoy your life without opioids, if possible.

Sources:
“How opioid addiction occurs.” www.mayoclinic.org, Mayo Foundation for Medical Education and Research (MFMER), 16 February 2018.
“How to use opioids safely.” www.mayoclinic.org, Mayo Foundation for Medical Education and Research (MFMER), 24 April 2019.
“Opioid (Narcotic) Pain Medications.” www.webmd.com, WebMD LLC, 20 September 2018.
“What Are Opioids?” www.webmd.com, WebMD LLC, 30 May 2019.