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Early Signs of Opioid Addiction: Symptoms of Opioid Dependence Or Abuse

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By Randi Sokol, MD, MPH, MMedEd
Jan 07, 2021

J.P. struggles with opioid addiction - addiction to pain pills (like oxycodone, percocet, and vicodin) or illicit drugs (like fentanyl and heroin).

After enrolling in a program where he is prescribed buprenorphine/naloxone (Suboxone) - a medication to treat opioid addiction - he has been doing well in recovery for 9 months. He is now back to working full time as an auto mechanic and has plans to go back to school.

J.P. certainly did not predict this journey. “When I was in high school, I had hopes and goals. I did not plan on becoming addicted to opioids.”

Unfortunately, when J.P. was a junior in high school, he tore his rotator cuff while playing football. He had surgery and his doctor gave him oxycodone to help with the pain. J.P. was on oxycodone for 3 months and then things took a turn for the worse.

“After having to take time off from playing football, I became depressed. I soon found myself self-medicating my mood with oxycodone. I started taking more and more-- whenever I felt depressed, anxious, or even lonely. Eventually, my doctor stopped prescribing them to me. When I did not have oxycodone, I would go into withdrawal and feel awful- I would sweat, my muscles would ache, and I would feel super agitated, so I found them on the street. But, the oxys weren’t cheap, so I ended up depleting my bank account and even lying to my family and friends to get money to pay for more oxycodone. I was not in a good place.”

J.P. was lucky in that his family recognized early signs of addiction and encouraged him to seek treatment.

So how do you know if you have an opioid addiction? Or, how do you know if one of your loved ones might be struggling with an opioid addiction?

First, it’s important to understand a few definitions:


Your body has become dependent on the opioid. Since the opioid is always in your body, if it is no longer there, you will experience withdrawal symptoms: 

  • Muscle pain
  • Diarrhea, vomiting, abdominal cramping
  • Restlessness, sweating, yawning
  • Depression or anxiety
  • Dilated (Big!) pupils
  • Goose bumps on your skin
  • Insomnia
  • Tremor


Your body becomes “used to” the opioid. The dose that previously made you feel good is no longer enough so your body needs higher and higher doses to feel the same effects you previously felt.


Dysfunction. The opioid takes over your life-- you crave it, take higher and higher doses, cannot stop. 


Consequences. You suffer the consequences: putting all your time into getting more opioids, putting yourself in dangerous situations because of opioids, losing your job and unable to fulfill other responsibilities, giving up hobbies, wrecking relationships with family and friends & losing their trust 

As Dr. Brian Clear, Chief Medical Officer (CMO) of Bicycle Health, a telehealth company that treats patients struggling with opioid addiction with buprenorphine/naloxone (Suboxone), explains, “It is important to distinguish the difference in some of these medical terms. Dependence and tolerance are not the same as addiction.”

He elaborates, “If I put anyone on oxycodone for several months and then took it away, you would experience withdrawal symptoms like muscle aches, sweating, runny nose, nausea and vomiting- this is dependence. Your body might also get used to the dose I gave you and you might request a higher dose to feel the same sense of relief; if 5 mg of oxycodone prescribed three times a day previously worked to treat your pain and after a year, you are needing 10 mg three times a day to get the same pain relief - this is tolerance.”

He further explains, “while patients struggling with addiction may have dependence AND tolerance, what makes addiction a separate category is the dysfunction and resulting consequences.”

Dr. Clear likes to simplify addiction into “The 4 C’s of Addiction":

  • Craving
  • Loss of Control
  • Compulsive use 
  • Consequences 

“What we often see,” Dr. Clear explains, “is that when patients develop an addiction to opioids, these start to take over their lives. While the medication might have initially been prescribed for pain, patients often start taking them for other reasons - like stress or depression - and they are constantly craving the opioids. We know it’s become an addiction when we see them losing control and the opioids start interfering with their daily functioning - school, jobs, family, friends.”

If you suspect that you or a loved one has developed an addiction to opioids, here is a list of signs and symptoms that imply a possible addiction:


  • Poor (and unexplained) performance at school or work 
  • Isolating from friends and family (concealing drug use from loved ones)
  • “Doctor shopping” - going to many different doctors and medical settings to get opioids 
  • Exaggerating pain symptoms at doctor's appointments
  • Taking opioid medication prescribed to others (unexplained disappearance of opioids in the household). 

Physical Appearance: 

  When the person is in withdrawal (NO opioids are in their system):

  • Irritability
  • Enlarged pupils
  • Nausea/vomiting 
  • Muscle pains/soreness
  • Sweating

  When the person HAS opioids in their system:

  • Slowed thinking
  • Pinpoint (tiny) pupils
  • Impaired coordination as if sedated or intoxicated
  • If injecting drugs, may keep arms covered or show sores or injections marks when arms are uncovered. 

Mood symptoms: 

  • Slowed thinking or problem-solving
  • Feeling detached from others and surroundings
  • Poor concentration
  • Mood swings 
  • Difficulty sleeping
  • Depressions
  • Paranoia (Worried about being "caught"/ trying to conceal use )

“Helping patients enter into treatment is crucial,” Dr. Clear explains. “Untreated opioid addiction has high rates of overdose and death. But we now have evidence-based medication treatments that can make a real difference in people’s lives-not only preventing overdoses but helping patients to get back to leading fulfilling and meaningful lives.” 

So what can you do to get help or to help out someone you are concerned about?

If you are concerned that you are struggling with opioid addiction, reach out to your doctor and get the help you need.

The best form of treatment involves scientifically-proven medications - like buprenorphine/naloxone (Suboxone), methadone, or Naltrexone (aka Vivitrol) - which help reduce cravings, withdrawal, and prevent overdoses coupled with behavioral therapy and support from others going through the same thing.

Your doctor can help you enroll in a program that provides medications and therapy.

If you are a loved one of someone who might be struggling with opioid addiction, the most important thing you can do is be direct and supportive:

  • Let them know you are concerned about them, and that you are there to help
  • Do not judge them; people struggling with addiction are often quite ashamed of their struggles; they need someone by their side as their ally and support 
  • Embrace compassion and patience. Know that even when patients are in recovery, they can relapse. That is part of this life-long chronic medical condition, but you can be there to help them get back on their feet.
  • Direct them to further resources for treatment. Encourage them to seek both medication and therapy to comprehensively address their opioid addiction.

Additional Resources

I.Support groups for family and friends:

  • Al-Anon:
  • Nar-Anon:
  • Families Anonymous:
  • Substance Abuse and Mental Health Services Administration (SAMHSA):

II.How to help your friend/family member you are concerned about (1 pager from SAMHSA): 

III. How to have a conversation with a loved one/friend you are concerned about (1 pager from SAMHSA): 

IV.More videos and audio resources available through SAMHSA to guide families in supporting their loved one who may be struggling with a substance use disorder/addiction:

V. A pocket guide for parents, family, and friends from American Society of Addiction Medicine (ASAM):

Bicycle Health uses buprenorphine/naloxone (Suboxone) in its treatment program to achieve proven success. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

For more information on buprenorphine/naloxone (Suboxone), opioid dependence, and our telehealth treatment model, please visit our FAQ.

Header Photo by Zach Vessels on Unsplash

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