FAQ: Opioids and Substance Use Disorder

What are opioids?

Opioids are chemicals that bind with the opioid receptors in the brain. They are usually given to reduce pain. They can be taken by mouth, on the skin, or by injection. This depends on the type of opioid and the reason for taking it. Opioids come in many different types and strengths. Natural opioid medicines are derived from the poppy flower, like morphine, heroin, codeine. These are called opiates.

What are other names for opioids?

Opioids are also known as narcotics and painkillers. Many slang terms are used to describe opioids like Dope (heroin), Percs or Oxy (oxycodone).

What are some common opioids I’ve heard of?

Some well-known opioids include oxycodone (also known as Percocet or Oxycontin, which is the long-acting version), morphine, fentanyl and methadone. Percocet contains both acetaminophen (Tylenol) and the opioid oxycodone; Tylenol #3 includes acetaminophen and the opioid codeine. (Too much acetaminophen can cause life-threatening liver damage)

Which opioids are most addictive?

All opioids can be addictive, even when taken as prescribed by a doctor for pain. The risk of addiction goes up when the drugs are crushed/snorted or injected. When opioids are taken this way you feel the effects faster and they create a greater sense of “euphoria.” This can lead to addictive behavior. Long-term daily treatment (more than 30 days) with oral opioids also comes with a high risk of physical dependence and can lead to addiction.

What is addiction?

Addiction is a medical disorder that involves intense cravings for opioids and a loss of control over using them. According to the NIDA (National Institute on Drug Abuse) “Drug addiction is a complex disease, and quitting takes more than good intentions or a strong will. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives”.

Is an addiction a disease?

Yes. Addiction is a chronic disease caused by different biological, behavioral and environmental factors. It involves changes in the brain and body. The initial decision to take a drug is voluntary for most people. But when people continue to use drugs the brain changes. This can make it difficult for a person stop using the drug(s).

What are signs of addiction?

Signs of addiction include loss of interest in activities that do not involve the drug of choice and withdrawal from other aspects of life. A person with addiction may focus on getting and taking their drug of choice. They will change daily behaviors and interactions with others to continue getting and using the drug. People can become irritable and impatient when unable to get their drug of choice.

How does addiction work in the brain?

We are still learning how opioid addiction happens in the brain. Addiction has been linked to the release of dopamine in the brain, activation of a “reward circuit,” and a euphoric sensation that addicted people may try to recreate. Opioid addiction also alters the body’s ability to deal with stress and emotions, and hijacks the normal systems of learning and memory.

How does addiction damage the brain? Is there a difference for teenagers?

Addiction reduces the amount of naturally produced opioids in the brain. This occurs because of negative feedback; as the brain is flooded with opioid medications it produces fewer opioids. Long term addiction and opioid use also leads to changes in the brain’s neurotransmitter system in ways that are still being investigated. Teens are at slightly higher risk of addiction because they often haven’t fully developed the brain pathways that help resist impulsive decisions. Drug use during adolescence can disrupt normal brain development and increase the chance of addiction. A good understanding of the adolescent brain is still not known. Studies are now underway that will hopefully provide answers.

How does the brain bounce back?

The brain bounces back by gradually recovering its ability to produce natural opioids; however, this process generally takes several months.

Why do some people become addicted to opioids and others don’t?

We do not know why some people become addicted, but it might be related to genetics, exposure to childhood trauma, social and environment influences, underlying mental illness, impulsivity, and the structure or pathways of the brain. Life circumstances, history of addiction, past trauma and other factors can make a person more vulnerable to addiction.

Should people be worried about getting painkillers from their doctor or dentist?

You should always talk with your health-care provider about your history and other factors that may make you more vulnerable to addiction. Together you can decide if these medications are the best option for relief of your pain. In general, clinical guidelines and experts agree that opioids are not the best option for most patients with chronic pain. Alternatives for pain management (e.g., acupuncture, physical therapy, mindfulness, cognitive-behavioral therapy, massage, etc.) can be explored. Generally, if patients take prescribed opioids only when needed and closely follow their doctor, prescriber, or dentist’s instructions on opioid use, the risk of addiction and overdose are very low.

What are the potential benefits of opioid use?

The most significant benefit is pain relief. Pain relief can help patients go about their daily lives. They can also relieve pain and suffering for terminally ill patients.

What are extended-release and long-acting (ER/LA) prescription opioid analgesics?

Extended release (ER) and long-acting (LA) prescription opioids are long-acting drugs used to treat serious and chronic pain. They can be dangerous because they remain in the body for an extended amount of time, making overdose a very serious concern. Some ER and LA prescription opioids include MS Contin, OxyContin, methadone, morphine ER, and fentanyl ER.

What is withdrawal?

Opioid withdrawal happens after prolonged or heavy opioid use is severely reduced or suddenly stopped. It occurs because the body has become used to the opioids. Withdrawal symptoms include diarrhea, abdominal pain, chills, aches, agitation, and nausea and vomiting.

When is detoxification (detox) needed?

Detox is needed when a person tries to stop taking opioids but has severe withdrawal symptoms; a short-stay in an inpatient detox unit can allow health professionals to treat a patient’s symptoms and make sure they get connected to longer-term treatment when they leave.

    Please Note

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