Physical addiction to opioids

In this article we explain how you can recognize the symptoms of physical addiction to opioids. Then, we offer adequate treatment options to help you get past physical addiction to opioids.

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A slippery slope

Opioid drugs are mainly used for the treatment of pain. These painkillers include medicines like hydrocodone, oxycodone, or tramadol. They work because they change the way our brains perceive and respond to pain. But, they can also get you high.

So, how does physical addiction to these drugs start? How can you identify the signs of opioid addiction? Most importantly, what is the first step you should take to address the problem?

In this article, we inform you about the practical ways you can recognize opioid addiction – in yourself or in a loved one. Then, we recommend ways that you can seek professional help. At the end, we invite your questions via the comments section. In fact, we try to respond to all real life questions personally!

NOTE HERE: Using opioids for euphoric effect can be just as dangerous and addictive as using heroin.


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Does physical dependence = opioid addiction?


Dependence and addiction are two different medical terms. It is important to make a clear distinction between DEPENDENCE vs. ADDICTION because they are two different conditions that require different treatment protocols.

Q: What is PHYSICAL DEPENDENCE on opioids?

A: Dependence is an expected outcome and a manifestation of the body’s normal adaptation to opioids.

When you are prescribed an opioid medication to manage a pain, you can expect physical dependence to form after daily dosing of a few weeks, or more. This is a predictable condition, and one that can be easily managed. The brain adjusts to painkillers as a way to maintain balance. So when you are physically dependent on opioid medications, you will likely experience withdrawal symptoms if you reduce usual doses or stop suddenly and abruptly.

Repeated use of any opioid drug will likely make your body and brain adapt to the presence of the substance in your system i.e. develop dependence to its effects. Physical dependence can also be accompanied by drug tolerance, a kind of slippery slope – requiring regular or increasing opioid dosing in order to continue feeling the wanted effects and to prevent withdrawal.

Q: What is opioid ADDICTION?

A: Addiction is a state of physical brain change(s) and mental conditioning that is treated with a combination of medicine and psychotherapy.

Addiction is considered to be a neurological disease caused by genetic, psychosocial, and environmental factors. It is characterized by continued use of a drug despite negative harm in your life. Main signs of opioid addiction include uncontrollable cravings, compulsive drug seeking behavior, and inability to stop or control use. Opioid addiction is dangerous and can be deadly, especially when brain changes due to drug tolerance result in increased dosing and possible overdose.

Physical signs of opioid use

You can tell if someone has started to abuse opioids if you notice these physical symptoms. They may include:

  • constricted pupils
  • diarrhea or constipation
  • drowsiness or extreme fatigue
  • loss of appetite
  • nodding off or sedation
  • slowed breathing or heart rate

When you’re physically dependent

The one way to know if you’re dependent on an opioid – or not – is to significantly lower doses or miss a regular dose of your pain medication. This way, you can recognize physical dependence by observing changes in psychological response when regular use is discontinued. Here’s a list of common withdrawal symptoms that occur as a result of dependence.

Psychological symptoms during withdrawal:

  • anxiety
  • confusion
  • increased sensitivity to sensory stimuli
  • irritability
  • panic attacks
  • psychosis
  • sleep problems

Physical symptoms during withdrawal:

  • headache
  • muscle cramps
  • nausea and vomiting
  • restlessness
  • sweating

Medical detox for physical dependence

Why is medical treatment necessary for quitting opioids? Because relapse is very common, especially in the early stages of detox and withdrawal. Plus, quitting an opioid drug under the watchful care of doctors and nurses increases your chances of quitting for good.

Here is what you can expect during a medical detox:

1. Evaluation – This is an important initial part of detox and takes place as you enter treatment. During this phase doctors will interview you, assess your physical and mental health condition, and run the necessary blood or urine lab tests. The evaluation process helps doctors determine the level of care you require during your detox period, so they can adapt the medical care to your specific needs.

2. Stabilization – As all traces of opioids are eliminated from your body, your physical state starts to normalize. It can take 3-7 days to go through acute detox. During this time, doctors will still monitor and support you, and administer medications for opioid withdrawal symptoms that can lessen, manage, and minimize any possible risks and discomfort.

3. Transition into treatment – Detox is just your starting point in the treatment process and serves to prepare you for further rehabilitation and recovery. Ongoing therapy sessions may require extended treatment involvement, even after you leave your opioid addiction rehab program. Detox and rehab programs provide a combination of therapy and medical care to treat opioid addiction and ultimately stop the progress of addiction.


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How does pain pill addiction happen?

There are two (2) ways to get addicted to opioid painkillers:

  1. Unintentionally, by regular Rx therapy use.
  2. By abusing pain pills, i.e. taking them without a medical need or prescription.

Unintentional opioid addiction may happen with regular therapy and over the course of time. As the body gets used to the effects of the painkiller, people who need the medication to manage pain experience that the medication becomes less effective over time (tolerance). It is, in fact, a common occurrence for pain patients to start taking additional doses of their painkiller when their therapeutic doses became ineffective. Although at first you start taking opioids more and more often for pain management, the higher your dosage gets – the more likely you are to become addicted.

Opioid drug abuse for recreational purposes is a dangerous practice and can rapidly lead to addiction, especially if you have a history of substance abuse problems or a mental health condition. If you find that opioid painkillers work well to help you escape from your every-day struggles due to mental health issues, abusing them can lead to a dual diagnosis, as these two conditions are co-occurring and tend to worsen each-other. In addition, when you are abusing opioids without a prescription, or taking them with other substances such as other narcotics, benzodiazepines, alcohol, cocaine, and amphetamine (polydrug use) to feel more intense effects…you are certainly headed down a slippery slope towards addiction.

How to tell if I’m addicted?

Doctors use the following 11 criteria to diagnose an addictive disorder in a patient, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Opioid addiction is diagnosed when you:

  1. Take opioids in larger amounts or longer than intended.
  2. Want to cut down or stop using pain pills but fail to succeed.
  3. Spend a lot of time obtaining, using, or recovering from the use of an opioid.
  4. Experience cravings and an uncontrollable need to use opioid painkillers.
  5. Fail to perform normally at work, home, or at school due to use.
  6. Continue to use the drug, even when it causes problems in relationships with family, friends, and partners.
  7. Give up important social, occupational or recreational activities because of use.
  8. Use opioids again and again, despite being aware of harmful risks and side effects.
  9. Continue to use despite the risk of developing health problems or worsen physical or physiological condition.
  10. Need more pain pills to get the desired effect (tolerance).
  11. Experience withdrawal symptoms which can be relieved by taking more of the opioid.

Additionally, the DSM has a certain number of criteria that should be met for a doctor to diagnose addiction. The severity of any opioid addiction is diagnosed based on the number of criteria observed.

  • 2-3 symptoms indicate a mild disorder
  • 4-5 symptoms indicate a moderate disorder
  • >6 symptoms indicate a severe disorder

So, if you recognize two (2) or more of the statements above in yourself or a loved one…chances are you might be addicted or headed in that direction. Please remember that this is nothing to be ashamed or scared of! Addiction is a medical condition, and as such, it responds well to medical treatment.

Can I cold turkey off opioids?

No…not really!

Going cold turkey off opioids carries potential risks and is not recommended unless absolutely necessary (i.e. an allergic reaction).  Cold turkey withdrawal can provoke serious side effects and it is extremely uncomfortable. On the other hand, medical detox supervision addresses symptoms as they occur, to make the process more humane. Withdrawing from an opioid often includes administration of another drug, such as buprenorphine, methadone, clonidine, or naltrexone.

The treatment for dependence usually starts with a slow decrease in doses according to a tapering schedule. The dose reduction is usually done over a period of weeks, months or longer, depending on:

  1. the opioid drug
  2. the amount of dose used
  3. frequency of dosing
  4. the individual

NOTE HERE: Dose tapering should always be supervised by a medical professional. You can also consult your local pharmacist to learn more about best practices. However, you should seek medical and clinical supervision before attempting any opioid taper regime.

Still have questions?

We hope to have covered most of your questions about dependence vs. addiction. If you have any further questions regarding physical addiction to opioids, please feel free to share them in the comments section below. We give our best to provide personal and prompt responses to all legitimate inquiries.

Reference sources: NCBI: Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective
NIH: Prescription Drug Abuse
NCBI: The Neurobiology of Opioid Dependence: Implications for Treatment
Harvard Health Publications
University of Georgia: Physical dependence
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.


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  1. I have a chronic pain disorder called cervical dystonia and also have hypermobility. I was taking one hydrocodone 5/325mg occasionally for pain. Then began to take it on a regular basis meaning one a day for pain, which greatly reduced my pain. some days I didn’t need it. I began to notice some days or after the dose wore off I would feel tire and run down, get a runny nose, just feel like crap. It took me awhile to put it all together, but determined it was my body reacting to not having the medication. So I went off of it. I was totally run down for days no energy and in pain. Really no other significant symptoms. No trouble sleeping. Just no energy and in pain. I don’t crave the drug. I just can’t function with my pain and it depresses me now that I am back to this pain level and unable to enjoy life. Can you tell me should I never be on it again or should I have been on it on a more regular basis so I didn’t get the breakthrough symptoms? I am also a nurse. As of last week I was also found disabled through social security. I wanted to add that in the fall of 2016 I believe the same thing happened and I took myself off it. That also was during a time I was taking one a day on a more regular basis. In January of 2017 I had a three level cervical fusion so I was on some pain medication for awhile. It wasnt probably until around July or August of 2017 that I started to take the one hydrocodone 5/325 a day on a more regular basis. The breakthrough symptoms just started probably in the last month. I do question if for chronic pain patients should the pain medicine be dosed more frequently. Like I said my internist would only allow one a day under her supervision. That was her comfort level. She said if I needed more she would need to refer to pain management. So I am wondering if I should get a pain management referral. I truly am a chronic pain patient. Cervical dystonia can be a very painful disorder from the constant muscle spasms and twisting. It affects my neck, traps, and into thoracic area and shoulders.

    1. Hi Mary. I suggest that you consult with your doctor as well as a pain management specialist for your concerns.

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