The Science Behind Opioid Addiction

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April 18, 2022

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Unfortunately, almost everyone knows a friend or a family member struggling with an addiction to opioids-- like oxycodone, Percocets, Vicodin, Dilaudid, fentanyl, and heroin.  In fact, addiction to opioids has been declared a public health state of emergency in the U.S., with 128 people dying every day from an opioid overdose.(1)  And, opioid overdoses recently surpassed motor vehicle accidents as the most common cause of accidental death.(2,3)

So, what causes addiction to opioids?  Is it “nature” (due to your genetics) or “nurture” (due to your surrounding environment)?

It’s actually both--and more! Addiction is a complex medical diagnosis that it is an interplay of biology + psychological + social & environmental factors.

Does that mean you have to have all these factors to develop an addiction?  

Certainly not!

As chief medical officer (CMO) of Bicycle Health, a telehealth company that treats patients with opioid addiction with buprenorphine/naloxone (Suboxone), Dr. Brain Clear explains, “We see an array of patients who come in struggling with an addiction to opioids and requesting help.  Some patients grew up in a household with substance abuse, others tell me they had ‘the perfect childhood.’ Some personally struggle with mental health conditions like anxiety and depression, while other patients do not have any mental health history.  Some patients’ addiction started off after receiving pain medications prescribed by their doctor after an injury, others started off getting heroin on the street.”

The bottom line is that addiction can affect anyone from any background-- any age, any gender, any ethnicity, any educational background and of any socio-economic status.

Is opioid addiction the same as physical dependence to opioids?

While addiction to opioids does involve dependence, the two are different: Dependence means that someone’s body becomes used to taking opioids daily.  If that person goes without opioids, their body will feel symptoms of opioid withdrawal, like sweating, nausea and vomiting, diarrhea, body aches and agitation.  This could happen to ANYONE who starts taking opioids daily and your body becomes used to it, even if you are taking the medications as prescribed by your doctor.

Dr. Clear explains how addiction is different, “With addiction, there is a level of dysfunction that impedes on one’s life-- patients are spending all their time, energy, and money on getting opioids.  As a result, they might deplete their bank accounts, they might fail to meet their responsibilities like going to work or caring for their families, they might lie to friends and family.  They lose control and the addiction takes over their lives.”

For more information about dependence versus addiction, visit our guide to the early signs of opioid addiction.

Given the complex nature of opioid addiction, how is it treated?

Scientific evidence shows that the most effective way to treat opioid addiction dual approach that includes both medications and behavioral components.  

As Dr. Clear explains, “At Bicycle Health, we prescribe buprenorphine to our patients.  This prevents them from having cravings and withdrawals and blocks other opioids so they do not overdose.  Our providers also support patients in developing healthy behaviors so they are able to manage life’s stressors without using opioids to cope.”

To learn more about different treatment options, check out Online Therapy's helpful compilation of resources or visit our guide to methadone and Suboxone.

Is treatment for opioid use disorder effective?

Yes! In fact, medications such as buprenorphine/naloxone (Suboxone), methadone, and naltrexone, have been proven to cut mortality rates by more than three-fold.(4) 

“What is also gratifying,” Dr. Clear explains, “is to watch patients’ lives improve once they are treating their addiction and enter a life of recovery where they are able to reconnect with their personal values and goals.”

Treating addiction, in fact, has been likened to a “reverse country song”: Patients get their kids back!  They get their truck back! And, they get their dog back!

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.

Header Photo by Hans Reniers on Unsplash

Randi Sokol, MD, MPH, MMedEd

Randi Sokol, MD, MPH, MMedEd, is an Assistant Professor at the Tufts Family Medicine Residency Program and Instructor at Harvard Medical School. She is Board Certified in both Family Medicine and Addiction Medicine. She earned her B.A. at the University of Pennsylvania, her Medical Degree and Masters in Public Health from Tulane University, completed Family Medicine Residency at UC-Davis, and earned a Masters in Medical Education through the University of Dundee.

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(1) Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at

(2) Rudd R, et al. Increases in drug and opioid overdose deaths—United States, 2000–2014. Morbidity and mortality weekly report. 2016.

(3) Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657.

(4) Sordo, L., Barrio, G., Bravo, M.J., et al. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. British Medical Journal. 2017; 57, j1550.

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