Stages of Opioid Addiction

Medically Reviewed by Carol DerSarkissian, MD on May 25, 2023
4 min read

Opioids are a class of powerful drugs designed to treat pain. Anyone who takes them, whether as prescribed or not, can develop problems with how they use them. Doctors can legally prescribe opioids to relieve pain. They might prescribe, for example, hydrocodone or oxycodone. Opioids are also available illegally as heroin, prescription pills, illicit fentanyl, and other substances sold on the street. More than 2 million people in the U.S. misuse these drugs. About 90 people die from opioid overdose each day.

People don’t usually develop an addiction or other problem with opioid use right away. Some might not have any problems with taking the drugs. And others might feel symptoms that make them not want to use opioids at all, including nausea, itchiness, or feeling sedated. It’s not clear exactly what makes someone develop addiction or a related problem, but some risk factors include genetics, a personal or family history of trouble with substance use, the strength of the opioid, and how much a person takes and for how long.

When opioids enter the body, they interact with nerve cells in the brain, spinal cord, the digestive tract, and elsewhere. In the brain, they activate the reward center and trigger the release of feel-good hormones called endorphins. Endorphins reduce pain and create feelings of pleasure.

People use a number of terms to describe problems with opioids, including addiction, dependence, tolerance, abuse, and use disorders. Understanding the differences may help you or a loved one get help and avoid life-threatening health problems or risk of overdose.

Tolerance. Over time, repeated opioid use can change your brain chemistry. Your brain adjusts to the dose you take and gets used to functioning on opioids. That is, your brain now tolerates the drug. Your body will slow the flow of endorphins it releases in response to that dose. To keep feeling good, you’ll need to take larger doses to get the same intensity of pain relief and pleasure.

Dependence. If you’re regularly using opioids, your body will eventually adjust and depend on the drugs in order to function properly. Though everyone is different, your odds of becoming dependent go up the longer you take opioids.

The trouble starts when you try to stop or reduce your regular use of opioids. It can bring on a set of unpleasant physical and mental symptoms called “withdrawal.”

These symptoms can include:

Because the symptoms can be severe, you’ll want to take opioids to allow your body to release the endorphins that make you feel good again. At this stage, you’re no longer taking the opioids to feel “high” but just to keep your body from going through withdrawal symptoms. This becomes a vicious cycle.

Anyone who takes opioids for a long time can become dependent even when they take them as prescribed. But dependence and tolerance aren’t necessarily the same as an “addiction” or a “use disorder.” If you think you are dependent on opioids, tell your doctor. You’ll need professional help to gradually wean yourself off these drugs or find alternative ways to treat your pain.

Abuse refers to the use of illicit drugs or taking medications in a way other than how a doctor has prescribed them. That includes taking too much of a medicine or getting prescriptions from multiple doctors.

Addiction and opioid use disorder, unlike tolerance and dependence, are terms that describe an illness. People often use these words interchangeably, but use disorder is the term preferred by the American Psychiatric Society.

Often, the disorder comes on after you’ve developed tolerance and dependence. At this stage, the drugs disrupt the signals in your brain that control your judgement and decision-making skills. When this happens, it’s hard to control the impulse to use opioids even though you may know it would be best for you to stop.

This loss of judgment and impulse control shows in some of the behaviors that doctors look for when they diagnose addiction or a use disorder. They look for you to do at least two of the following in a 12-month period of drug use:

  • Take more drugs or larger doses than you first intended.
  • Fail to cut down or quit drug use despite trying.
  • Put a lot of energy into getting the drugs and then spend time recovering from the effects.
  • Crave more opioids.
  • Have problems fulfilling responsibilities at school or work.
  • Continue drug use despite problems with family and friends because of it.
  • Cut back or quit certain daily activities because of drug use.
  • Use opioids in a place or situation that is dangerous to your health or safety.
  • Continue using opioids even if it results in mental and physical problems.
  • Develop tolerance for opioids.
  • Have withdrawal symptoms.

Up to 19% of people who take prescription pain medication develop an addiction or use disorder. It results from a pattern of repeated use of opioids that’s hard to stop.

Other risk factors for developing an opioid addiction can include:

  • Your genes
  • A history of substance abuse
  • Depression or other mental health problems
  • Childhood abuse or neglect
  • Impulsiveness
  • Poverty
  • Easy access to prescription opioids
  • A history of addiction

Addiction or opioid use disorder can cause multiple health problems and make it impossible to live your daily life normally. It can also cause disability, relapses, overdose, and death.

If you or a loved one is developing tolerance, dependence, or addiction to opioids, get help from a doctor right away. You can also contact the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline, 1-800-662-HELP (4357), or find resources through your local county government.

Ideally, anyone taking opioids should have access to naloxone, a medicine that can quickly reverse opioid overdose, in case of accidental or other overdose. Naloxone kits are available for free in many places and your doctor can prescribe one.