How opioid use disorder occurs

Opioid use — even short term — can lead to addiction and, too often, overdose. Find out how short-term pain relief leads to life-threatening problems.

By Mayo Clinic Staff

People who take opioids are at risk of opioid use disorder, often called opioid addiction. Personal history and how long people use opioids play a role. But it’s impossible to tell who could become dependent and misuse opioids. The misuse of opioids — legal, illegal, stolen or shared — is the reason 90 people die in the U.S. every day on average, according to the American Society of Anesthesiologists.

Addiction is a condition where something that started as pleasurable now feels like something you can’t live without. Drug addiction is defined as an out-of-control feeling that you must use a medicine or drug and continue to use it even though it causes harm over and over again. Opioids are highly addictive, largely because they trigger powerful reward centers in your brain.

Opioids trigger the release of endorphins. They tell your brain that you feel good. Endorphins make it less likely that you’ll feel pain. They also boost feelings of pleasure. This creates a sense of well-being that is powerful but lasts only a short time. When an opioid dose wears off, you may find yourself wanting those good feelings back as soon as possible. This is how opioid use disorder can begin.

Short-term versus long-term effects

When you take opioids again and again over time, your body doesn’t make as many endorphins. The same dose of opioids doesn’t make you feel as good. This is called tolerance. One reason opioid use disorder is so common is that people who build up tolerance may feel like they must raise their doses to keep feeling good. They also may start having cravings for opioids. If they don’t raise their doses, they may start having withdrawal symptoms, including worsening pain, goosebumps, anxiety, yawning and diarrhea.

Because of the risk of opioid misuse, it’s often hard to get your healthcare professional to raise your dose or renew your prescription. Some opioid users who believe they need a bigger supply find illegal ways to get opioids or start using heroin. Some street drugs are laced with contaminants or much more powerful opioids such as fentanyl. The number of deaths from using heroin has gone up since more heroin now contains fentanyl.

If you’re taking opioids and you’ve built up a tolerance, ask your healthcare professional for help. Other safe choices are available to help you make a change and keep feeling well. Don’t stop opioid medicines without help from a healthcare professional. Quitting these medicines suddenly can cause serious withdrawal symptoms, including pain that’s worse than it was before you started taking opioids. Your healthcare team can help you gradually and safely reduce the amount of opioids you take.

Risk factors for opioid use disorder

Opioids are most addictive when you take them in a way other than how they were prescribed — for example, crushing a pill so that it can be snorted or injected. This life-threatening drug misuse is even more dangerous if the pill is effective for a longer period of time. Rapidly delivering all the medicine to your body can cause an accidental overdose. Taking more than your prescribed dose of opioid medicine, or taking a dose more often than prescribed, also increases your risk of opioid use disorder.

How long you use prescribed opioids also plays a role. Researchers have found that taking opioid medicines for more than a few days raises your risk of long-term use. This makes it more likely that opioids will become addictive. After only five days of taking an opioid medicine, the chances increase that you’ll still be taking opioids a year after starting a short course of the medicine.

Genetic, psychological and environmental factors also play a role in addiction, which can happen quickly or after many years of opioid use.

Risk of opioid addiction is greater for people who:

Are younger, specifically in their teens or early 20s.
Have a personal or family history of substance misuse.
Are living with stress, including being unemployed or living below the poverty line.
Have a history of problems with work, family and friends.
Have a history of taking part in crimes or having legal issues, including DUIs.
Have serious depression, anxiety or post-traumatic stress disorder.
Have a history of physical or sexual abuse.
Take part in risky or thrill-seeking behavior.
Perform poorly in school and do not value education.
Use tobacco heavily.

In addition, women have a unique set of risk factors for opioid use disorder. Women are more likely than men to have long-term pain. Compared with men, women also are more likely to be prescribed opioid medicines, to be given higher doses and to use opioids for longer periods of time. Women also may be more likely than men to become dependent on prescription pain relievers.

Steps to prevent opioid use disorder

Opioids are safest when used for three or fewer days to manage serious pain, such as pain that follows surgery or a bone fracture. If you need opioids for severe pain, work with your healthcare professional to take the lowest dose possible, for the shortest time needed, exactly as prescribed. Also, be sure to ask if drugs other than opioids are available or if other types of treatment can be used instead. And don’t share your opioid medicines or take other people’s opioids.

If you’re living with lifelong pain, opioids aren’t likely to be a safe and effective long-term treatment option. Many other treatments are available, including less addictive pain medicines and therapies that don’t involve medicines. If possible, aim for a treatment plan that allows you to enjoy your life without opioids.

Help prevent opioid misuse in your family and community by storing opioid medicines securely while you use them. Get rid of unused opioids properly. In the U.S., find the closest Controlled Substance Public Disposal Locations on a website the Drug Enforcement Administration (DEA) maintains. Or contact your local law enforcement agency or your trash and recycling service for information about local medicine takeback programs. If no takeback program is available in your area, ask your pharmacist for help.

Everyone plays an important role in breaking the grip that opioids have on communities and their residents.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which
information is beneficial, we may combine your email and website usage information with
other information we have about you. If you are a Mayo Clinic patient, this could
include protected health information. If we combine this information with your protected
health information, we will treat all of that information as protected health
information and will only use or disclose that information as set forth in our notice of
privacy practices. You may opt-out of email communications at any time by clicking on
the unsubscribe link in the e-mail.

Nov. 29, 2023

Opioid use disorder. American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder. Accessed June 26, 2023.
Opioid abuse. American Society of Anesthesiologists. https://www.asahq.org/madeforthismoment/pain-management/opioid-treatment/opioid-abuse/. Accessed June 26, 2023.
Opioid abuse and addiction. Agency for Healthcare Research and Quality. https://effectivehealthcare.ahrq.gov/health-topics/opioid-abuse-and-addiction. Accessed June 26, 2023.
Prevent opioid abuse and addiction. Department of Health and Human Services. https://www.hhs.gov/opioids/prevention/index.html. Accessed June 26, 2023.
Prescription opioids. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/basics/prescribed.html. Accessed June 30, 2023.
Elsevier Point of Care. Clinical Overview: Opioid use disorder. https://www.clinicalkey.com. Accessed June 28, 2023.
Hoffman KA, et al. Opioid use disorder and treatment: Challenges and opportunities. BMC Health Services Research. 2019; doi:10.1186/s12913-019-4751-4.
Prescription opioid drug facts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/prescription-opioids. Accessed June 30, 2023.
Signs and symptoms of prescription pain reliever abuse. Narconon. http://www.narconon.org/drug-abuse/signs-symptoms-pain-relievers.html. Accessed June 26, 2023.
Risk factors for opioid misuse, addiction and overdose. Office of Workers’ Compensation Programs. https://www.dol.gov/agencies/owcp/opioids/riskfactors. Accessed June 28, 2023.
Strang J, et al. Opioid use disorder. Nature Reviews Disease Primers. 2020; doi:10.1038/s41572-019-0137-5.
Rosenquist R. Use of opioids in the management of chronic noncancer pain. https://www.uptodate.com/contents/search. Accessed June 26, 2023.
Oesterle TS (expert opinion). Mayo Clinic, Nov. 9, 2023.
Taylor JL, et al. Opioid use disorder. Annals of Internal Medicine. 2022; doi:10.7326/AITC202201180.
Lai B (expert opinion). Mayo Clinic, Nov. 10, 2023.
Substance/medication-induced mental disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022; https://dsm.psychiatryonline.org. Accessed June 28, 2023.
Warning signs of addiction. Recovered.org. https://recovered.org/addiction/warning-signs-of-addiction. Accessed June 28, 2023.
Shah A, et al. Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006-2015. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w. Accessed Nov. 10, 2023.