Signs and Symptoms of Opiate Use, Abuse, Addiction & Facts

opiate addiction physicians

Treatment Might Not Be What You Expect

What Are Opiates? How are they ingested or used?

Opiates are a group of drugs that can be legally prescribed for treating pain. Derived from opium, the drugs originate in the same plant (the poppy) which is used to make heroin. The term opiate is sometimes used interchangeably with opioids and narcotics. ”Opiate” is most often used to refer to close relatives of opium – drugs such as codeine, morphine and heroin that originate from the poppy. It is sometimes also used to describe synthetic opiates such as Oxycontin.

Both synthetic opiates and regular opiates are highly addictive substances. They are classified dangerous narcotics by the government.

Opioids are powerful drugs.

Opioids are drugs that slow down the actions of the body, such as breathing and heartbeat. Opioids also affect the brain to increase pleasant feelings. They get their name from opium, a drug made from the poppy plant.

People take opioids for medical reasons.

Doctors prescribe opioid medication to treat pain and sometimes for other health problems such as severe coughing. The medication comes in a pill, a liquid, or a wafer. It also comes in a patch worn on the skin. Examples of prescribed opioid medications include:1

  • Codeine—an ingredient in some cough syrups and in one Tylenol® product
  • Hydrocodone—Vicodin®, Lortab®, or Lorcet®
  • Oxycodone—Percocet®, OxyContin®, or Percodan®
  • Hydromorphone—Dilaudid®
  • Morphine—MSContin®, MSIR®, Avinza®, or Kadian® Propoxyphene—Darvocet® or Darvon®
  • Fentanyl—Duragesic®
  • Methadone.

People sometimes misuse opioids.

Opioid medications are sometimes misused to self-medicate or to get a good feeling, called a “rush” or “high.” People misuse medications by taking their own prescriptions improperly, stealing medications, going to multiple doctors to get extra, or buying them from drug dealers. Sometimes to get high they drink a large amount of liquid medicine or crush a lot of pills to ingest, snort, or inject. And some people seek a high from heroin, an illegal opioid that can be smoked, snorted, or injected.

Opioids have side effects.

A person who takes opioids can become tolerant to them. This means that more of the drug is needed to obtain its effects. It is also possible to become dependent on opioids— to feel sick if there are no opioids in the body. This sickness is called withdrawal.

Tolerance and dependence are common side effects of prescribed opioid medication. If tolerance is a problem, doctors may adjust the person’s dose or change the medication. People who have become dependent on opioid medication but are ready to stop taking it can taper off (take less and less) to avoid withdrawal. This should be done under a doctor’s care.

Tolerance and dependence also occur in people who misuse medications or take heroin. Over time, such people often begin to feel uncomfortable without the opioid. They need to take it just to feel normal.

Opioids are addictive.

Addiction is a disease that results when the opioid has made changes to the brain. A person using medication properly is not likely to get addicted, but this sometimes happens. Addiction usually occurs through misuse. Some people are at higher risk of addiction because of their genes, temperament, or personal situation. The signs of addiction are:

  • Craving—The mind develops an overwhelming desire for the drug.
  • Loss of control—It becomes harder to say no to using the drug. Use is compulsive and continues even when it causes harm.

It is not usually possible to taper off an addiction. More help is needed because the cravings are so strong and the fear of withdrawal is so great.

Opioid Addiction Can Be Treated

Opioid addiction is a chronic disease, like heart disease or diabetes. A chronic disease is a medical condition for life. It cannot be cured, but it can be managed. A person with addiction can regain a healthy, productive life.

Most people cannot just ‘walk away’ from addiction. They need help to change addictive behavior into nonaddictive, healthful patterns. They can get this help with treatment—with the care of doctors and substance abuse treatment providers.

Treatment helps people stop using the problem drug. It helps them get through withdrawal and cope with cravings. Treatment also helps them move away from other harmful behaviors, such as drinking alcohol or abusing other drugs.

Just as important, treatment helps people address life issues they might have that are tied to the addiction, such as feelings of low self-worth, a bad situation at work or home, or spending time with people who use drugs. In short, treatment helps people move into healthy, addiction-free lifestyles—into a way of living referred to as recovery. Treatment may include medication.

Medication Assisted Treatment

Medication-assisted treatment is treatment for addiction that includes the use of medication along with counseling and other support. Treatment that includes medication is often the best choice for opioid addiction.

If a person is addicted, medication allows him or her to regain a normal state of mind, free of drug-induced highs and lows. It frees the person from thinking all the time about the drug. It can reduce problems of withdrawal and craving. These changes can give the person the chance to focus on the lifestyle changes that lead back to healthy living.

Taking medication for opioid addiction is like taking medication to control heart disease or diabetes. It is NOT the same as substituting one addictive drug for another. Used properly, the medication does NOT create a new addiction. It helps people manage their addiction so that the benefits of recovery can be maintained.

There are three main choices for medication.

The most common medications used in treatment of opioid addiction are methadone and buprenorphine. Sometimes another medication, called naltrexone2, is used. Cost varies for the different medications. This may need to be taken into account when considering treatment options.

Methadone and buprenorphine trick the brain into thinking it is still getting the problem opioid. The person taking the medication feels normal, not high, and withdrawal does not occur. Methadone and buprenorphine also reduce cravings.

Naltrexone helps overcome addiction in a different way. It blocks the effect of opioid drugs. This takes away the feeling of getting high if the problem drug is used again. This feature makes naltrexone a good choice to prevent relapse (falling back into problem drug use).

All of these medications have the same positive effect: they reduce problem addiction behavior.

All three medications come in pill form. Methadone also comes as a liquid and a wafer. Methadone is taken daily. The other two medications are taken daily at first. After time, buprenorphine is taken daily or every other day, and doses of naltrexone are taken up to 3 days apart.

Methadone to treat addiction is dispensed only at specially licensed treatment centers. Buprenorphine and naltrexone are dispensed at treatment centers or prescribed by doctors. A doctor must have special approval to prescribe buprenorphine. Some people go to the treatment center or doctor’s office every time they need to take their medication. People who are stable in recovery may be prescribed a supply of medication to take at home. Medication is matched to the person. When a person decides to try medication-assisted treatment, the first step is to meet with a doctor or other medical staff member. This first meeting is called an assessment. The person is asked questions such as:

  • How long have you been taking the opioid drug?
  • Are you taking any other drugs?
  • Do you drink alcohol?
  • What are your drug-taking and drinking habits and patterns?
  • Have you been in treatment before?
  • Do you have other health problems?
  • Are you taking any medicines?
  • Have you ever had reactions to medicines?
  • Are you pregnant?
  • Do you have any special needs?
  • What are your goals for recovery?
  • Do you have family or friends to support you through treatment?

During this meeting, the person learns about treatment choices, rules that must be followed to stay in treatment, and what to expect next.

A physical exam also is part of the assessment. This exam finds out about the person’s general health. It also checks for diseases that are common to people who have been abusing drugs. The exam often includes a drug test. This is usually a check of urine or saliva.

After the assessment, the doctor or substance abuse treatment provider discusses treatment choices with the person, who may choose to include family or friends in the discussion.

The person agrees to a treatment plan. This covers:

  • The goals for treatment
  • The decision on which medication to use and the dose level to start
  • The schedule for visits to the treatment center
  • The plan for counseling
  • Other steps to take, such as attending a support group
  • How success toward goals will be measured.

The plan describes what happens if it is not followed. The person may be asked to sign a form showing that he or she agrees to follow the plan. Medication is introduced carefully. Methadone can be safely taken at the start of recovery. Buprenorphine can be taken once withdrawal has begun. Naltrexone cannot be taken until opioids are completely out of the body, usually 7 to 10 days after withdrawal begins. Taking buprenorphine or naltrexone too soon can make withdrawal worse. Medical staff members meet with the person a few hours after the first dose is taken and regularly for a week or two. These meetings are to make sure the medication is working, that side effects are not too uncomfortable, and that the person is taking medication exactly as told. Following directions is important, because taking the medication improperly can lead to overdose or death.

Withdrawal Symptoms

  • Yawning and other sleep problems
  • Sweating more than normal
  • Anxiety or nervousness
  • Muscle aches and pains
  • Stomach pain, nausea, or vomiting
  • Diarrhea
  • Weakness

If the medication is not working as expected, the doctor may adjust the dose up or down or prescribe a different medication. The person may feel some symptoms similar to withdrawal as adjustments are made.

Methadone and buprenorphine can cause drowsiness at first. For this reason, a person starting on either medication should not drive or perform other high-risk tasks, to avoid accidents. If drowsiness continues to be a problem, the doctor may adjust dose levels.

The right medication has been found when the person feels normal, has minor or no side effects, does not feel withdrawal, and has cravings under control. Medication can be taken safely for years. People can safely take treatment medication as long as needed— for months, a year, several years, even for life. Sometimes people feel that they no longer need the medication and would like to stop taking it. Use of methadone and buprenorphine must be stopped gradually to prevent withdrawal. Stopping naltrexone does not cause withdrawal. Plans to stop taking a medication should ALWAYS be discussed with a doctor.

Counseling Can Help

Many people on medication-assisted treatment benefit from counseling—from the opportunity to talk with a professional either one-on-one or in a group with others in treatment.

Through counseling, people learn about the disease of addiction. They also learn why the addiction occurred, the problems it has caused, and what they need to change to overcome those problems.

Counseling can provide encouragement and motivation to stick to treatment. It can teach coping skills and how to prevent relapse. And, it can help people learn how to make healthy decisions, handle setbacks and stress, and move forward with their lives.

In group counseling, people connect with others in treatment and make new friends who don’t use drugs. They can get these benefits from support groups, too. These are informal meetings of people facing similar challenges. Family and friends are important, too. It is very hard to go through recovery alone. Support from family and friends is very important. Love and encouragement can help a person make the decision to enter treatment and stick with it. Family and friends can provide help in practical ways—for example, by offering rides to treatment, a safe place to live, or help finding work. Family and friends also can help the person in recovery avoid or overcome setbacks. Some treatment programs offer counseling for loved ones.

They do this because being close to a person with addiction can be very hard and can cause pain and anger or feelings of shame and hopelessness.

Counseling is a useful way for family and friends to learn more about the person’s situation, how to help, and how to handle the problems their loved one’s addiction has caused them, too. It is a safe place to express feelings and to find out what help is available for them.

There are support groups, too, that are just for family and friends. These are safe places to share information and encourage others who have loved ones who are dealing with addiction.

Many people overcome opioid addiction and regain normal, healthy lives. One way they do this is with medication-assisted treatment. Medication, counseling, and support: together they can help your loved one or your friend.

Common names for opiates that are both prescribed and abused:

  • Oxycontin, Percocet (oxycodone)
  • Vicodin, Hycodan (hydrocodone)
  • Duragesic (fentanyl)
  • Codeine
  • MS Contin Kadian (morphine)
  • Dilaudid (hydromorphone)

Street names for various opiates:

  • China girl
  • China white
  • Dance fever
  • Friend (fentanyl)
  • Goodfella
  • Miss Emma (morphine)
  • M (morphine)
  • Vikes (hydrocodone)
  • Viko (hydrocodone)
  • Norco (hydrocodone)
  • Hydro (hydrocodone)
  • Schoolboy (codeine)
  • Purple Drank (with cough syrup that containscodeine)
  • T-three’s (Tylenol #3 with codeine
  • Oxys or Oxies (oxycodone)
  • OxyContin (oxycodone)
  • Oxycet (oxycodone)
  • Junk (heroin)
  • H (heroin)
  • Horse (heroin)
  • Black Tar (heroin)

What Are the Symptoms of Opiate Use or Abuse?

Opiates are a highly addictive drug as a result of the euphoria (often described as a wonderful “sense of well-being” that they give the user. Many people addicted to opiates started out with a legitimate medical reason to take the painkiller. Unfortunately, many people who use opiates develop a tolerance and become physically dependent on the drug. They need more of it to get the same effects and euphoria.

A person who is abusing opiates may become withdrawn and less talkative. While they are on the drug, they may seem “out of it” or even incoherent. A person who is high on an opiate may get sick (vomit) or have trouble maintaining their balance. They may “nod off” in the middle of doing a task.

What Are the Long-Term Effects and Dangers of Opiate Use?

When opiates are legitimately used for treating pain, they are typically used on a short-term basis. Even when used for pain relief, many people develop tolerance to the drug, meaning they need a higher dose to get the same pain relief.

As tolerance to the effects of opiates occurs, the opiate users run the risk of overdose. This occurs while trying to get high and their bodies cannot handle the dosage. Many opiate abusers die from cardiac or respiratory arrest. Depressed respiration from the opiates affects the amount of oxygen that reaches the brain. This condition, called a hypoxia, can have short- and long-term psychological and neurological effects. It can leave opiate users in a coma and cause permanent brain damage.

Studies have also shown that using heroin — a relative of prescription opiates — causes deterioration of the brain’s white matter. This can affect decision-making abilities, the ability to regulate behavior, and the user’s responses to stressful situations. This explains, in part, why addiction and dependence can be so insidious to the user.

Signs and Symptoms of Opiate Dependency/Addiction

The top hazard of opiate use is developing a full-blown addiction to the drug. Addiction to opiates is not always apparent, but its effects can be gripping to the user and devastating to their family and friends. A person who is addicted to opiates may keep stashes of pills around the house. They may appear to ration pills. They will participate in drug-seeking behaviors such as stealing or doctor shopping. They may even get in trouble with the law while trying to support their habit. They may get sick, angry, or filled with anxiety when they are unable to obtain the drug.

An opiate addict may look pale and malnourished. They may look sickly or lose dramatic weight as they use more and more of their drug of choice. They may no longer take care of themselves and appear generally disheveled, suffer from skin problems and infections, and seem to be in poor health with no obvious medical problem.

Opiate users experience intense withdrawal symptoms when they try to quit using. Although, in most cases, withdrawal is not life threatening, it’s advised that if you want to detox from opiates you do so with the supervision of a medical professional. Some underlying health conditions may be exacerbated by withdrawal, and that can make the process more dangerous as well as miserable. A qualified professional will be able to prescribe medications that help alleviate some of the more intense symptoms or help you taper from the drug on a schedule.

Opiate withdrawal symptoms can last anywhere from one week to one month. Many of the emotional symptoms of withdrawal, such as a lack of energy, anxiety, depression and insomnia may last a few months.

The Transition to Heroin Which Has Plagued the United States

Increasingly, the painful withdrawals will lead the user to buy a street version of the drug out of desperation. If the person who is becoming physically addicted to the opiates can’t obtain more of the medication, or it is prohibitively expensive (often more than $50 per pill), the $5-10 price tag of heroin might become too tempting to avoid.

This phenomenon has become incredibly widespread in the United States, and particularly has shocked families in middle and upper class neighborhoods. Often the first warning the family ever receives is the death of their loved one. For this reason, the prescription drug epidemic is considered the nations #1 health crisis.

Also,  for obvious reasons, opiate abuse should be taken very seriously, not even one more day of condoning the use should be allowed if someone is abusing opiates.

Getting Help for an Opiate Problem

If you think you, or somebody you love, has a problem with their opiate use, there are many treatment options that are available for the user who wants help. Sometimes medication can be prescribed to ease side effects or reduce cravings for the drug. Most people find that they benefit from a supervised detox followed by a treatment program. Not sure what will be right for you? Worried that you can’t find a program that meets your needs? We can help. The phone call is 100% free and confidential.


1.Prescription Opioids DrugFacts, available here.
2.Opioid Resources, available here.