Opioid addiction

Opioids are a group of substances that relieve pain and can produce feelings of relaxation or euphoria. They include prescription painkillers, heroin and synthetic opioids such as fentanyl. Using opioids over time can lead to tolerance, needing more for the same effect, and physical dependence, where the body reacts when the drug is reduced.

Opioid use disorder goes beyond dependence. It describes a pattern of use that a person struggles to control and that continues despite harm to health, relationships, work or safety. People may start with a legitimate prescription for pain and gradually find they cannot stop, or they may begin using opioids recreationally.

OUD is a medical condition, not a moral failing. Stigma is one of the biggest barriers to treatment, and it can stop people from asking for help that could save their lives.

Signs that someone may be struggling with opioids include:

• Taking more opioids than prescribed or for longer than intended
• Repeated attempts to cut down that do not succeed
• Strong cravings
• Spending a lot of time getting, using or recovering from opioids
• Neglecting work, school or family responsibilities
• Continuing use despite health, legal or relationship problems
• Needing more to get the same effect
• Withdrawal symptoms when not using
• Seeing multiple doctors for prescriptions or buying pills from unofficial sources

Others may notice drowsiness, small pupils, changes in mood, secrecy, money problems or withdrawal from friends and activities.

Opioid withdrawal happens when someone who is physically dependent reduces or stops use. Symptoms can include anxiety, restlessness, muscle aches, sweating, runny nose, yawning, stomach cramps, diarrhea, nausea, vomiting, goosebumps and difficulty sleeping, along with intense cravings.

Withdrawal is rarely life-threatening in itself for otherwise healthy people, but it is very uncomfortable, and dehydration can be a risk. More importantly, after a period without opioids, tolerance drops. Returning to a previous amount can lead to a fatal overdose. For this reason, withdrawal is best managed with medical support and followed by ongoing treatment rather than stopping alone.

Fentanyl is a very strong synthetic opioid. It is increasingly found in the illegal drug supply, often mixed into other drugs or pressed into counterfeit pills without the user knowing. This has made overdose a much greater risk, even for people who do not intend to use opioids.

Signs of an opioid overdose include very small pupils, unresponsiveness, slow or stopped breathing, blue or gray lips and fingertips, and gurgling sounds. An opioid overdose is a medical emergency. Call 911 or your local emergency number immediately. If an overdose-reversal nasal spray is available, use it according to its instructions and stay with the person until help arrives. Many areas have laws that protect people who call for help during an overdose.

Medication for opioid use disorder, prescribed and monitored by a doctor, is one of the most effective treatments. It reduces cravings and withdrawal, lowers the risk of overdose and helps people stabilize their lives. It is a recognized medical treatment, not "replacing one drug with another."

Psychological and social support are also important. Helpful approaches include cognitive behavioral therapy, motivational interviewing, contingency management, family therapy and peer support groups. Treating co-occurring conditions such as depression, anxiety, PTSD or chronic pain is often key to long-term recovery.

Treatment can be outpatient, intensive outpatient or residential, depending on needs. Harm reduction services can keep people safer while they consider their next steps.

An addiction medicine physician or psychiatrist can assess opioid use and discuss medication. Psychologists, licensed clinical social workers and counselors provide therapy and help with practical issues such as housing, work and family. A primary care doctor can be a good first contact.

A first appointment will cover your substance use history, physical and mental health, safety and goals. You will not be judged, and you do not need to have decided to stop completely to ask for help.

Seek help as soon as possible if opioid use feels out of control. In an emergency or suspected overdose, call 911 or your local emergency number. If you are having thoughts of suicide, call or text 988 in the US, or Samaritans on 116 123 in the UK and Ireland.