Painkillers and Opioid Use Disorder

Medically Reviewed by Jennifer Casarella, MD on September 16, 2022
Written by Matthew Hoffman, MD
10 min read

One of the most frequent reasons people go to the doctor is for pain relief. A number of different drugs can ease pain.

About 20% of people will get a medication called an opioid. You may also hear your doctor call it an opiate or a narcotic. These pain relievers are historically made from opium, which comes from the poppy plant, although synthetic lab-made opioids also exist. Morphine and codeine are two natural opioids.

Lab-made versions of morphine produce these other opioids:

Now called opioid use disorder (OUD), painkiller addiction was a term used for years along with terms like opioid abuse, drug abuse, drug dependence, and drug addiction.

A national health crisis, 3 million people in the U.S. have OUD, or they’ve had it in the past. Your doctor will look for these symptoms if they think you have OUD:

  • Using more of the drugs or using them longer than you intended
  • Inability to control or cut down use
  • Spending lots of time finding drugs or recovering from use
  • Having a strong desire or urge to use
  • Using the drugs despite legal or social problems
  • Stopping or cutting down important activities
  • Using these drugs while doing something dangerous, like driving
  • Using these drugs despite physical or mental problems
  • Becoming tolerant -- needing more of the drug or needing to take it more often
  • Having withdrawal -- physical symptoms when you try to stop

You may experience the following during opioid withdrawal:

  • Sweating
  • Confusion
  • Enlarged pupils
  • Tremors
  • Loss of appetite
  • Diarrhea or vomiting
  • Cramps and muscle aches
  • Yawning
  • Flu-like symptoms

While they’re usually not life threatening, these symptoms can be painful and hard to live with. That unpleasantness can lead to continued drug use.

In general, the length and severity of opioid drug withdrawal depends on the drug you’re using and the amount you’re taking.

Your doctor can give you meds to help prevent withdrawal symptoms, a process called detoxification (detox). The most common ones are buprenorphine (Buprenex, Butrans, Probuphine, Suboxone) and methadone (Dolophine, Methadose). Lofexidine hydrochloride (Lucemyra) and clonidine are non-opioid drugs that can be used to ease the symptoms during detoxification.

Naltrexone (Revia) can help with detoxification in special circumstances, but it’s more commonly used to treat OUD chronically by blocking your body’s response to opioids and reducing cravings. Methadone and buprenorphine are also used in the long term to help prevent relapse and improve your quality of life.

After your withdrawal is complete, you’re no longer physically dependent on the drug. But you could still be psychologically hooked. You might be more likely to relapse when you’re under stress or if you’re exposed to other powerful triggers. Learn more about the treatments for opioid abuse.

It’s always important to be careful with prescription meds. But it’s especially important to try to use opioid medications in a safe way because of the risk of misuse, addiction, and overdose.

Several things can help:

  • Store opioids in a safe place. Try a lockbox if you have kids.
  • Never sell or share your prescriptions.
  • Check warnings and instructions each time you take a dose.
  • Take your medicine exactly as prescribed.
  • Never add an extra dose unless your doctor tells you to.
  • Don’t chew, crush, break, or dissolve opioid medication.
  • Don’t drive or use machinery on opioids. (They make you drowsy.)
  • Talk to your doctor about side effects.
  • Use the same pharmacy, if possible, for all medicines so they can warn you of interactions that could cause problems.
  • Dispose of unused opioids at a drug take-back program or pharmacy mail-back program.

Using opioids for more than 5 days increases your risk of addiction. But there are some other factors that studies show also play a role. Those include social determinants of health that include genetic, psychological, and environmental influences such as:

  • Poverty
  • Unemployment
  • Family history of substance misuse
  • Personal history of substance misuse
  • Young age
  • History of criminal activity or legal problems including DUIs
  • Regular contact with high-risk people or high-risk environments
  • Problems with past employers, family members, and friends (mental disorder)
  • Risk-taking or thrill-seeking behavior
  • Lack of access to medical care
  • Heavy tobacco use
  • History of severe depression or anxiety
  • Stressful circumstances
  • Prior drug or alcohol rehabilitation

Women have additional risk factors for opioid addiction that men don’t have. They’re more likely to have chronic pain. They’re also more likely to be prescribed opioid medications, and at higher doses and for longer periods of time. Women may also have more biological tendencies than men to become dependent on prescription pain relievers. Women’s risk for opioid misuse is also linked to their body size typically being smaller than men’s, and their higher incidence of traumas including relationship violence.

These drugs are generally safe when you take them for a short time as prescribed by your doctor. But in addition to helping your pain, they can also give you feelings of well-being or euphoria. Those feelings can lead you to misuse opioids by:

  • Taking a higher dose than prescribed
  • Taking the drugs in ways different from how they’re prescribed, such as crushing pills to be inhaled or injected
  • Taking someone else’s prescription, even for a legitimate problem, like pain
  • Taking the drugs to get high

If your doctor prescribed medication to treat your pain and you take it as directed, you are less likely to have a problem.

But some people become addicted even when taking opioids as prescribed. Warning signs include:

You think about your medication a lot. One of the first signs of addiction is becoming preoccupied with two things: when you can take your next dose and whether your supply is enough, says Debra Jay, co-author of Love First: A Family’s Guide to Intervention.

Watching the clock so you can take your next dose may be a concern, notes Joe Schrank, co-founder of Rebound Brooklyn recovery center in New York.

“If it’s fresh dental work and you’re in pain, it makes sense," he says. But if it’s gone on for a while, it’s possible you’ve become dependent on the medication.

Dependency and addiction are not the same thing. You can be physically dependent on a drug but not addicted.

Confused? Here's the difference.

When you're physically dependent on a drug, your body has built up a tolerance to it, and you need higher doses of the medication to get the same effect.

When you're addicted to a drug, it's more than physical, it’s also emotional. The addiction can be associated with uncontrollable behaviors. You keep using the drug, even though it's causing you serious problems at work or school, in your family, or in your social life.

You take different amounts than your doctor prescribed. Maybe you take more than you should or take it more often than your doctor prescribed. If you think your doctor doesn’t understand your level of pain, or that they meant you should take it whenever you need to, it may be a warning sign.

Do you stretch out the time between doses or shrink some doses you take so you can take more later? If you're trying to control how you take your painkillers instead of following your doctor's instructions, you may have a problem.

“Whenever we are trying to control things, it can be a really good indication of how out of control we are,” Schrank says.

You’re “doctor shopping.” Do you go to more than one doctor for the same prescription?

Once you stop working with your doctor and try to find someone else who’ll write you another prescription, something may have shifted.

Your goal may be to boost your supply of painkillers so you have as much as you need. But if it’s not in line with what your doctor ordered, that's reason for concern.

Do you seek out doctors known for overprescribing, or running “pill mills”? Have you lied and said you lost your prescription or been dishonest with your doctor about what you’ve already been prescribed?

 “If we are telling different doctors different things to get medication, that’s a real red flag,” Schrank says.

You get painkillers from other sources. You feel like you don’t have enough medication to ease your pain, so you try to get more. These ways of stocking up signal the possibility of addiction:

  • Ordering drugs over the internet.
  • Stealing other people’s leftover or long-forgotten prescription drugs from their medicine cabinets.
  • Stealing drugs from a sick relative or friend.
  • Buying other people’s prescription drugs.
  • Stealing prescription pads from doctor’s offices and illegally writing your own prescriptions.
  • Hurting yourself so you can go to a hospital emergency room and get a new prescription.
  • Buying drugs on the street.

You’ve been using painkillers for a long time. You probably started taking pain medication because something hurt. But if you’re still using narcotic painkillers long after your pain should’ve gone away, Schrank says it’s time to ask for help.

Maybe you’re taking them because you like the way they make you feel instead of to relieve pain. Or maybe you’ve started to have physical cravings. Both are signs of an issue.

“Pain medication is intended to bridge a gap or get you through a rough patch,” Schrank says. “It’s not really meant to be a way to maintain or manage chronic pain.”

You feel angry if someone talks to you about it. Have your friends or family tried to talk to you about how you’re using your medication? If you feel defensive or irritated when they approach you, you may be getting in too deep, Schrank says.

In fact, studies show the degree of your anger isn’t just a sign that you may need treatment, but it can actually be a predictor of how effective treatment would be.

You’re not quite yourself. Maybe you’re not taking care of yourself like you usually do. You’re less concerned about your personal hygiene or the way you look. Or maybe you feel moodier than usual. Do you feel angrier? Have your eating habits changed? Do you feel nervous or jittery?

Changes in sleep are another sign. People who become addicted to drugs like morphine and codeine are known to sleep their days away, often in a locked, dark room, Jay says.

Have you stepped back from your responsibilities? Maybe you haven't been paying your bills like you used to, you’ve neglected household chores, or you’ve called in sick to work. If you’re ignoring your children, your responsibilities, or life in general, it’s time to ask for help, Jay says.

If you recognize yourself or someone you love in any of these signs, your next step is to ask for help and get more information. Learn more about how to stage an intervention.

It can be easy to misuse painkillers, even when you try not to.

“The key is honesty -- honesty with physicians, trusted friends, addiction professionals, but most of all with ourselves,” Schrank says.

Don't be afraid to talk to your doctor. They can refer you to a treatment center or addiction specialist.

Or you can call a local drug treatment center, which has addiction experts trained to recognize the signs and give you the help you may need. Look for a center that’s certified by the state you live in.

You can also call 800-662-HELP (4357), the national helpline run by the U.S. government's Substance Abuse and Mental Health Services Administration (SAMHSA). It provides free, confidential information and referrals about substance abuse and mental health.

There are FDA-approved meds that can help treat your OUD, manage withdrawal symptoms, sustain recovery, and prevent relapse. They’re called medication-assisted treatment (MAT) and include buprenorphine, methadone, and naltrexone. Along with counseling and behavioral therapies, it provides a whole-person approach that’s proven effective.

Behavioral therapy for OUD can help you:

  • Manage cravings
  • Build healthy habits and thoughts
  • Avoid triggers that could lead to relapse

Therapy could be just you as an individual, it could include your entire family, or you could be part of a group with similar issues. It can help you work on relationships and your role at work and in the community.

If you’re taking opioids it’s also a good idea to have a naloxone kit on hand. It can be used to reverse a potentially life-threatening overdose. Naloxone is available in all 50 states, usually without a prescription. It can be given as a nasal spray or an injectable. Talk to your doctor or pharmacist about getting one.

The most important step in preventing painkiller misuse or addiction is to recognize no one is immune, experts say.

You’re less likely to become addicted to opioids when you use them for only a few days after injuries like a broken bone or after surgery. As for long-term treatment of chronic pain, opioids may not be your safest option.

Talk to your doctor about using less addictive meds. You also might ask them about ways to treat your pain that don’t involve drugs at all. These include things like hypnosis, physical therapy, and neurostimulation.

It’s important to help protect your family and community from opioid misuse, too.

The steps include storing your prescription painkillers securely and disposing of them properly. Contact your local law enforcement agency, your trash and recycling service, or the Drug Enforcement Administration (DEA) for information about medication mail-back programs. If there isn’t one in your area, talk to your pharmacist about safe ways to get rid of your unused opioids.

Over 10 million people ages 12 and over misused opioids in 2019, according to the National Survey on Drug Use and Health. And of all drug overdose deaths in the U.S. in 2018, two out of three involved opioids, according to a report by the U.S. Department of Health and Human Services.

But even though the number of opioid prescriptions declined significantly from 2012 to 2020, it remains high in some areas. In 3.6% of counties across the country, there were enough opioid prescriptions written in 2020 for every person living in that county to have one, the CDC reports.

If you have OUD, it’s a chronic illness so you’ll have it for the rest of your life. And many people have a relapse at some point. 

But the good news is there’s hope.

Studies and statistics show 75% of people with substance use disorders, including OUD, survive and report being in recovery. Those who received treatment for their addiction were more likely to be in the recovering group.

If you’ve become addicted to opioids and need help, talk to your doctor or mental health professional.  Or try the SAMHSA treatment finder at 800-662-HELP (4357) or www.samhsa.gov/find-treatment.