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Opioid addiction doesn’t discriminate. A November 2017 presidential commission report examining the country’s opioid crisis found that opioid addiction affects young and old, the financially well-off and economically disadvantaged, and a wide range of people from all ethnic and racial backgrounds.

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In 2016, more than one-third of adults in the United States used prescription opioids. And nearly 2 million adults reported misusing or being addicted to opioids such as prescription painkillers and heroin, according to the National Survey on Drug Use and Health.

Opioid addiction is dangerous, and it can be deadly. An average of 115 Americans die from an opioid overdose every day.

What Are Opioids and Opiates?

Opioids are a class of drugs that include the illegal street drug heroin and powerful prescription painkillers such as oxycodone, hydrocodone, morphine and fentanyl.

Doctors commonly prescribe opioid medications to treat many types of pain, including post-surgical pain and cancer pain. Over the past few decades, doctors have increasingly prescribed opioids to manage chronic pain. Various opioid medications are also used to suppress coughs, treat diarrhea and manage opioid addiction during rehab treatment.

You may also have heard the term opiate and wondered about the differences between opiates and opioids. While many people use the terms interchangeably, there are some subtle distinctions.

Opiates are drugs such as morphine and codeine that come directly from the opium poppy plant. Oxycodone and hydrocodone are not considered opiates because they’ve been chemically created in a lab using natural opiates. These medications are known as semi-synthetic opioids. Completely synthetic opioids — such as fentanyl, which was created to mimic the effects of opiates but has a completely different chemical makeup — also exist.

The term opioid can be used to refer to a group of drugs that includes natural opiates, semi-synthetic opioids and synthetic opioids.

The strength of opioids can vary widely. The potency of these drugs is often measured as a comparison to morphine, which has been used medically for more than 200 years.

Addictive Opioids

Common prescription opioids include codeine, morphine, hydrocodone, oxycodone, tramadol and fentanyl. Heroin, which is processed from morphine, is an illegal opioid with no medical use. Despite differences in strength and duration of action, all opioids are addictive.


Derived directly from the opium poppy plant, morphine has been used since the Civil War to relieve acute pain. Morphine addiction soon followed and continues to be a problem. The potent drug comes in both injectable and tablet form, and is still widely used today.


Since the 19th century, doctors have used the opiate codeine to treat medical issues ranging from coughs to diarrhea to pain. Although codeine is substantially weaker than morphine, it has a high potential for abuse and addiction. Codeine addiction is a serious problem among young people who abuse cough syrups.

Oxycodone (Percocet, OxyContin, Percodan, Tylox)

Oxycodone is one of the most prescribed painkillers in the world and oxycodone addiction is rampant. An extended-release version of the drug, OxyContin, became popular in the 1990s among drug users who would snort and inject the medication. Abuse of the drug causes thousands of overdoses every year.

Hydrocodone (Vicodin, Norco, Lortab)

This semi-synthetic opioid is used to treat moderate to severe pain following surgery or an injury. Vicodin is the most prescribed pain medication in the United States, and hydrocodone addiction is widespread. The risk of overdosing on hydrocodone is significantly higher when it’s combined with alcohol and other drugs.

Hydromorphone (Dilaudid)

This powerful narcotic pain reliever is available in both pill and IV form. As a Schedule II narcotic, Dilaudid has a high potential for abuse, and dependence may develop more quickly than with other opioids because the drug is much stronger. Conquering a Dilaudid addiction can be difficult because the drug causes severe withdrawal symptoms.

Meperidine (Demerol)

Meperidine is a short-acting synthetic opioid about one-tenth as potent as heroin. Once widely used in hospitals, the painkiller is rarely used today because it carries a risk of seizures. It also has a high risk of abuse and dependence, and chronic use can easily lead to a Demerol addiction.

Fentanyl (Sublimaze, Duragesic, Actiq)

Fentanyl is 50 to 100 times more powerful than morphine and intended only for patients with severe pain who have been taking opioids daily. That’s because the drug is so strong that it could kill a person who hasn’t built up a tolerance. Fentanyl is available many forms, including an injectable liquid, a transdermal patch, a pill, a nasal spray and a spray for under the tongue. Fentanyl addiction is sometimes a problem among anesthesiologists because of their easy access to the drugs. More recently, the potent drug has crept into the nation’s heroin supply, causing a spike in opioid overdose deaths. Counterfeit prescription pain pills containing fentanyl are also being sold on the streets.


Tramadol is far less potent than most other prescription opioids, but it can be habit forming. The most common brands are ConZip and Ultracet, which contains both tramadol and acetaminophen.

Tramadol is used to treat moderate, severe and chronic pain. The risk of a tramadol addiction and dependence is generally low, but higher among those with previous substance abuse problems.


Methadone is a long-lasting opioid used to relieve severe pain. It can also relieve symptoms associated with opioid withdrawal. Although the drug is often used to treat opioid use disorders, a person can develop a methadone addiction.


Once on the decline, heroin use and heroin addiction is rising again in the United States. In fact, heroin overdose deaths increased fourfold between 2010 and 2015, according to the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

One theory behind the heroin resurgence is that people who develop an addiction to prescription opioids frequently turn to heroin when they are unable to access or afford prescription painkillers.

According to the National Institute on Drug Abuse, nearly 80 percent of people who started abusing opioids in the 1960s and entered rehab for heroin addiction misused prescription opioids before moving on to heroin.

Opioid Dependence

All opiates and opioids work in the same general way, acting on the central nervous system to reduce the perception of pain.

Opioids are structurally similar to endorphins, natural pain-killing chemicals that our brain manufactures when we experience pain or stress. Like endorphins, opioids attach to specialized receptors in the brain and spinal cord that interrupt pain signals and trigger euphoria.

Opioids also flood the brain with dopamine, a chemical that stimulates the brain’s motivation and reward circuits and encourages us to repeat an experience. That’s why people often continue to take opioids even when they don’t need them for pain.

“Anyone who takes a prescription opioid can become addicted.”

Dr. Stephen Mudra, Chief, Primary Pain Management, North Florida/South Georgia Veteran Health System

This sort of compulsive use can lead to tolerance and dependence, the hallmarks of addiction.

Over time, the original dose of the opioid fails to create the same level of pleasure it once did, so people take more and more. Eventually, a person will be unable function normally without the drug, and going without it will cause agonizing withdrawal symptoms such as anxiety, muscles cramps and diarrhea.

To avoid those painful withdrawal symptoms, people seek more of the drug, reinforcing their addiction.

The misery of withdrawal has even driven some people to abuse massive amounts of anti-diarrheal medication that contains loperamide, a weak opioid. Imodium abuse is common enough that the Food and Drug Administration has asked manufacturers to change the way they label and package the over-the-counter medication.

Signs and Symptoms of Opioid Addiction

Prescription opioids have high potential for addiction — even when used as directed. The signs and symptoms of opioid addiction are similar to opioid side effects.

Physical signs and symptoms of opioid abuse can include:

  • Reduced sense of pain
  • Slowed breathing
  • Nausea
  • Drowsiness or sedation
  • Poor coordination
  • Small, pinpoint pupils
  • Changes in mood
  • Mental confusion
  • Constipation
  • Runny nose or nose sores
  • Needle marks
  • Lack of awareness or inattention to surroundings

A 2018 study found that for every additional week that patients take prescription opioids such as codeine, oxycodone or hydrocodone, their likelihood of abusing the drugs increases by 20 percent. Each time a prescription was refilled, the chance of misuse rose by 44 percent.

Several signs and symptoms can help you determine if you’re addicted to prescription opioids. Risky behaviors include taking more pills than prescribed, seeking opioids from multiple doctors and stealing pills from friends or family members. You might also experience withdrawal symptoms, such as insomnia, muscle cramps, chills, nausea and diarrhea when you stop taking your pills.

Opioid Overdose

Because opioids slow breathing, the drugs can be deadly. In 2016, more than 42,000 Americans died of an opioid overdose — a record number that was a 28 percent increase over 2015, driven in large part by accidental ingestion of fentanyl.

Those at highest risk of an opioid overdose include:

  • People who are opioid dependent
  • People who inject opioids
  • Those who use prescription opioids (especially at higher doses)
  • People who use opioids in combination with other sedating substances
  • People with medical conditions such as HIV, liver or lung disease and depression
  • People living in a home with others who possess opioids

Source: World Health Organization

Individuals with an opioid use disorder are at an especially high risk of overdose following detox, after completing a drug rehab program or following release from jail or prison because of a reduced tolerance. Even a low dose of an opioid or opiate can be fatal after a short time of abstinence.

The three main signs of an opioid overdose are:

  1. Pinpoint pupils
  2. Loss of consciousness
  3. Slow or stopped breathing

Death from an opioid overdose is often preventable. If administered in time, the drug naloxone, also known by the brand name Narcan, can reverse the effects of an opioid overdose.

Highly potent opioids such as fentanyl, however, may require multiple doses of the medication. It may take six or more shots of naloxone to reverse the effects of carfentanil, a synthetic opioid 10,000 times stronger than morphine that is used to tranquilize elephants and other large animals.

Treating Opioid Addiction

Opioid addiction is difficult to treat and characterized by frequent relapses. Treatment starts with detox to help people overcome their physical dependence on opioids.

During medically monitored detox, medications may be prescribed to help decrease the uncomfortable symptoms of opioid or opiate withdrawal.

After detox is complete, individuals are ready to begin the rest of the opioid rehab and treatment process. This usually includes a mix of individual and group counseling, education on opioid addiction and coping strategies to deal with cravings and other factors underlying addiction.

Your treatment team may also prescribe medications such as Suboxone (buprenorphine and naloxone) or Vivitrol (naltrexone) to help your brain recover from addiction.

According to the National Institute on Drug Abuse, these medications improve social functioning and increase the likelihood that people will complete treatment. One study reported that heroin overdose deaths plummeted by 37 percent after buprenorphine became available in Baltimore.

Because relapse is common, drug testing is an important component of many drug treatment programs. Most opiates and opioids remain in your system for several days to a week. However, hair tests may detect opioids for up to three months after last use.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
Kim Borwick, MA

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