Opioid Abuse Signs & Symptoms

Opioids are a class of drugs that include prescription painkillers, such as morphine, OxyContin (oxycodone), and hydrocodone, as well as the illicit drug heroin. They work by binding to and activating opioid receptors in the brain and throughout the body.1 The National Survey on Drug Use and Health (NSDUH) estimates that among people aged 12 or older in 2019, 3.7% of Americans (10.1 million people) misused opioids, including both heroin and prescription pain relievers.2

Opioid misuse has many harmful consequences, and risks include severe health problems and the development of opioid use disorder (addiction). Recognizing the signs early can help to prevent serious harm.

How to Tell if Someone Has an Opioid Problem

When someone takes an opioid drug, it slows down some of the autonomic functions of the central nervous system. This means that things like breathing, heart rate, temperature, and blood pressure are all lowered. A person is likely to feel relaxed and free from pain, appear drowsy and may have delayed reflexes and an impaired mental state. Side effects may include nausea, vomiting, constipation, and severe itching.1,3 While these side effects aren’t always signs of opioid abuse, if the person doesn’t have a valid opioid prescription, they may be red flags.

Any use of illicit heroin or illicitly obtained opioid medications is considered misuse. Someone who has a prescription for an opioid painkiller and who increases the dosage or frequency of dosing is also misusing opioids.1 Another example of misuse is bypassing timed release mechanism of extended-release opioid painkiller, such as through crushing the pill. Inhaling the drug via the nose by “snorting” or injecting the drug into the bloodstream for faster, more intense drug delivery also constitutes opioid misuse.1

What Are the Signs of Opioid Abuse? 

There are behavioral signs a person who was prescribed opioids might exhibit when they are misusing them:

  • Continuing to take prescription opioids even when they are no longer deemed medically necessary.
  • Exaggerating or inventing symptoms to obtain more prescriptions.
  • “Shopping” different doctors to get additional prescriptions.

Polysubstance misuse, such as combining opioids with alcohol or other substances in an effort to amplify the high, is also very common amongst those who misuse opioids.4

Signs of Opioid Addiction

Identifying an opioid addiction isn’t always easy. The signs and symptoms of opioid misuse, as well as associated behavioral changes that are experienced alongside an individual’s opioid addiction, will vary. However, a person who regularly misuses opioids, especially at higher doses, is likely to experience the following signs of opioid use disorder:5

  • Strong cravings for opioids.
  • Feeling a persistent desire or experiencing unsuccessful efforts to stop using or otherwise control opioid use.
  • A need to take increasing amounts of opioid drugs in order to feel the desired level of euphoria or opioid intoxication (i.e., tolerance).
  • Experiencing symptoms of opioid withdrawal when reducing the dose or when stopping use of opioids.

Consequences of Opioid Abuse and Addiction

An untreated opioid addiction is likely to adversely impact a person’s life significantly, but is also dependent on several other variables. Some of the potentially negative consequences of opioid addiction include:5-7

  • Difficulty with school, work, or family obligations.
  • A decline in the quantity and quality of social and interpersonal relationships.
  • Loss of income or increased debt due to opioid-related spending.
  • Less time spent doing activities once previously enjoyed.
  • Problems controlling impulsive behaviors.
  • Weight loss and diminished nutrition.
  • Contracting disease (e.g., HIV, hepatitis) or struggling with other IV drug-related health issues (endocarditis, skin and soft tissue infection).
  • Increased risk of overdose or opioid-related breathing issues (e.g., respiratory depression).
  • Chronic constipation.
  • Increased risk of fatal motor vehicle crash involvement.
  • Irritation of the mucosal membranes (for those who snort heroin or crushed up pills), sometimes resulting in perforation of the septum, which is the fleshy wall that separates the nostrils
  • Erectile dysfunction in men; irregular menstrual cycles and problems with reproductive functions.

A life-threatening overdose is perhaps the most serious risk of using heroin or misusing prescription drugs. An opioid overdose occurs when levels of the drug overwhelm the body, causing respiration levels drop, which can make a person struggle to breathe or stop breathing altogether.8 According to the CDC, more than 80% of drug overdose deaths involved opioids.9

Not all overdoses are fatal, and it is possible to reverse an opioid overdose with naloxone, but people who experience a non-fatal overdose are at an increased risk of a later fatal overdose.10 The risk of a later fatal overdose can be reduced by about half if a person starts taking methadone or buprenorphine, two drugs used to treat opioid use disorder.10

Opioid Addiction vs. Opioid Dependence

All opioids, whether heroin or a painkiller prescribed by a doctor, carry with them a potential for abuse, physical dependence and addiction. Prolonged use of any opioid may cause tolerance. Tolerance means that a person has to take higher doses of the drug in order to feel the effects of the drug.11

With continued use, a dependence can form, which means a person may experience uncomfortable withdrawal symptoms should they reduce their dosage or stop taking the drug.11 Symptoms of opioid withdrawal include: anxiety, agitation, insomnia, increased blood pressure and pulse rate, nausea and vomiting, stomach cramps, diarrhea, muscle aches, sweating, cold flashes, gooseflesh, running nose, and excessive yawning.12 A dependence is not an addiction, but it may evolve into addiction, or opioid use disorder.

An opioid use disorder is a chronic medical disease that’s characterized by a compulsive need to take opioids despite negative consequences.11,13 Fortunately, opioid use disorder is treatable. There are several effective drugs and treatment strategies that are used to treat opioid addiction.

What to Do if You Suspect a Loved One Has an Opioid Addiction

If you suspect a loved one has a problem, it’s never easy to know what to do. Often, you’ll need to try repeatedly to have conversations about your concerns for your loved one and about the idea of attending treatment.

Avoid judgment and express your continued support for your loved one and for their health. For more information, you can see our guide to addiction for family members. 

Addiction takes a toll not only on the addicted person but those who love and care about them. Don’t ignore your own needs. Eat well. Get sleep. Do activities you enjoy. You can also take advantage of family support groups like Nar-Anon or Codependents Anonymous. You’ll be better able to support your loved one if you take care of yourself.


  1. National Institute on Drug Abuse. (2020). Misuse of Prescription Drugs Research Report: What Classes of Prescription Drugs Are Most Commonly Misused?
  2. Center for Behavioral Health Statistics and Quality. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  3. National Institute on Drug Abuse. (2018). Heroin Research Report: What are the immediate (short term) effects of heroin use?
  4. Cicero, T. J., Ellis, M. S., & Kasper, Z. A. (2020). Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis. American Journal of Public Health, 110(2), 244–250.
  5. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  6. Substance Abuse and Mental Health Services Administration. (2005). Treatment Improvement Protocol (TIP) Series, No. 43. Chapter 10: Associated Medical Problems in Patients Who Are Opioid Addicted.
  7. Li, G., & Chihuri, S. (2019). Prescription opioids, alcohol and fatal motor vehicle crashes: A population-based case-control study. Injury Epidemiology, 6, 11.
  8. National Institute on Drug Abuse. (2019). Heroin DrugFacts.
  9. Centers for Disease Control and Prevention. (2020). Overdose Deaths and the Involvement of Illicit Drugs.
  10. Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018). Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Annals of Internal Medicine, 169(3), 137–145.
  11. National Institute on Drug Abuse. (2020). Prescription Opioids Drug Facts.
  12. Shah, M., & Huecker, M. R. (2020). Opioid Withdrawal. In StatPearls. StatPearls Publishing.
  13. American Society of Addiction Medicine. (2019). Definition of Addiction.
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