Opioid Abuse and Addiction

What Are Opioids & How Do They Interact With the Brain?

Opioids are potent analgesics commonly used for their pain-relieving and relaxing effects. They include prescription painkillers, such as oxycodone, and illicit drugs, such as heroin. When opioids are taken in any form, they attach to certain chemical receptors in the brain, spinal cord, and other areas throughout the body. This produces an upsurge of feel-good chemical messengers, such as dopamine, leading to intense feelings of pleasure and reward. Repeated exposure to opioids further reinforces their potential to lead to compulsive drug-seeking behavior. (1)

Can Taking Opioids as Prescribed Cause Addiction?

While recreational misuse of opioids is more likely to result in addiction, even opioids taken as directed for medical purposes can lead to physical dependence and compulsive drug-seeking behavior. This is because opioids activate the brain’s reward system, and prolonged use can cause the body to adapt to the drug and experience withdrawal symptoms upon cessation. This effect is no less true when opioids are taken for legitimate purposes.

How Addictive Are Opioids?

Opioids are highly addictive, and some individuals have reported becoming psychologically dependent on them after just a few uses. However, each person can experience addiction differently because it is a complex disease that results from the interaction of many factors. Factors That Influence Opioids’ Addictive Potential Include:

• Type of drug used.
• Whether taken as prescribed or misused.
• The duration of use.
• The dosage used.
• Frequency of use.
• Genetic predisposition.
• Existence of co-occurring mental disorders.

How Does Opioid Addiction Develop?

Opioid addiction develops over time, but how long this may take varies significantly between individuals. It typically emerges due to repeated or prolonged use of opioids and is characterized by various phases and factors. Aspects of Opioid Development Include:

• Initial use, which may consist of having a legitimate prescription or misusing an opioid illicitly.
• Increased tolerance and escalating use, as the body reduces the impact of opioids and an individual requires increasing amounts to achieve the desired effects. (2)
• Psychological dependence, consisting of drug cravings and strong emotions perceived as positive associated with the use of opioids.
• Physical dependence due to altered brain chemistry, leading to withdrawal symptoms. (3)
• Persistent neurochemical changes, such as impaired decision-making and self-control, due to opioids’ effect on the brain’s reward system.
• Compulsive use and addiction, consisting of a complete loss of control and continued use of opioids despite adverse consequences.

Causes & Risk Factors for Opioid Misuse & Addiction Development

Opioid addiction is typically the product of many risk factors, such as genetic predisposition, trauma history, or early exposure to substance use. Some individuals have a greater susceptibility to using substances due to innate personality traits, such as impulsivity and pleasure- or thrill-seeking tendencies.  Those with mental health disorders, such as depression, anxiety, and PTSD, may also be more prone to drug use as a means of self-medication. Furthermore, these psychiatric conditions often have underlying risk factors that overlap with those that contribute to addiction. Early exposure to opioids, other drugs, or alcohol can put a person at a higher risk of developing addiction because psychoactive substances alter the brain’s function. This is especially problematic for teens and young adults whose brains are not fully developed and may lack the decision-making skills they need to make healthier choices. Social and cultural environments also play a role in opioid and substance use. For example, people who grow up in families that condone or encourage the use of drugs or alcohol may be more likely to experiment with substances earlier and adopt them as a normal part of their lives.

Demographics Most at Risk of Opioid Misuse

Age, gender, socioeconomic status, and geographic location can increase a person’s risk of opioid misuse. Prior use of prescription drugs and other substances can also contribute to this risk.  Demographics at a Heightened Risk of Opioid Misuse Include:

• Young adults aged 18–25 may be more susceptible to misusing opioids and other substances than other groups due to their increased levels of impulsivity and risk-taking behaviors. However, older adults, particularly those aged 45–64, were found to have the highest rates of prescription opioid misuse. (4)
• Men have historically experienced higher rates of addiction to opioids and other substances. Still, opioid use among women has increased in recent years due to higher rates of chronic pain conditions and potential hormonal factors.
• Individuals from lower socioeconomic backgrounds also face a higher risk of opioid misuse due to income disparities, limited access to mental health care services, and a higher incidence of trauma.
• Residents of certain geographical locations and communities may have a greater likelihood of engaging in opioid misuse due to factors such as higher rates of opioid prescribing, economic challenges, and limited access to healthcare.
• Finally, people with a history of misusing prescription drugs or other substances, such as alcohol, may be at an elevated risk of opioid misuse, suggesting that some individuals have a greater vulnerability to addictive behaviors.

Opioid Use & Its Effects on Mental Health

Substance use has a complex and cyclical relationship with mental health. As those with psychiatric disorders are more likely to use substances, the use of those substances tends to worsen their condition over time rather than improve it. Opioid misuse itself can trigger a range of emotional issues, including depression and anxiety, sometimes leading to severe symptoms, such as paranoia and suicidality.