What Are The Signs of Opioid Abuse?

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

One of the effects of receptor activation is blocking the body’s perception of pain. Opioids also impact certain neural processes occurring within the brain’s reward center, which can lead to an intense and rewarding euphoria especially when taken at higher doses.1 This so-called “high” increases the likelihood for abuse, and even patients who take their medication as prescribed are at an increased risk of substance use disorder.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 Opioids are the most commonly abused type of prescription medications in America, and the survey estimates that 1.6 million Americans aged 12 or over struggled with an opioid use disorder in the past year.2 “Opioid use disorder” is the diagnostic term used when a person is struggling with any type of opioid addiction, whether it involves heroin or prescription pain medications.

Recognizing Opioid Misuse

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

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

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

The signs and symptoms of opioid misuse, as well as associated behavioral changes that are experienced alongside an individual’s opioid addiction, will vary. 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.

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 Dependence, Withdrawal, and Addiction

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 on opioids 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. It’s never too late to turn your life around and enjoy fulfilling and long-lasting recovery.


  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.