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

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 11, 2023 • 4 cited sources

How do you know if you have opioid use disorder? How do you know if one of your loved ones might be struggling with an opioid use disorder?

While each person is different, some signs of opioid use disorder are pretty universal.

When you see those signs in yourself or someone you love, it’s time to seek help. Treatment programs that combine medications and therapy tend to work best than either alone. Your doctor can help you find the program that’s right for you.[1] 

Dependence, Tolerance, or Addiction? 

Many people use the terms dependence, tolerance, and addiction interchangeably. It’s important to know how they differ so you can find the right kind of solution.

As Dr. Brian Clear, Chief Medical Officer of Bicycle Health explains, “It is important to distinguish the difference in some of these medical terms. Dependence and tolerance are not the same as addiction.”

What Is Dependence?

Dependence if physical. Your body is accustomed to the constant presence of opioids and will feel sick without them. If the drug is removed, you will experience withdrawal symptoms like these:

  • Muscle pain
  • Diarrhea, vomiting, or abdominal cramping
  • Restlessness, sweating, and yawning
  • Depression or anxiety
  • Dilated (big) pupils
  • Goosebumps on your skin
  • Insomnia
  • Tremors

Dr. Clear says, “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.”

What Is Tolerance? 

Your body becomes used to the opioid. The dose that made you feel good is no longer enough, so your body needs higher and higher amounts to feel the same effects you previously felt.[2]

Dr. Clear says, “Your body might get used to the dose you initially got, 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 need 10 mg three times a day to get the same pain relief, this is tolerance.”

What Is Addiction?

“While patients struggling with addiction may have dependence and tolerance, what makes addiction a separate category is the dysfunction and resulting consequences,” Dr. Clear says.

Dr. Clear uses the “The 4 C’s of Addiction” to explain common addiction signs:

  • Craving
  • Loss of Control
  • Compulsive use
  • Consequences

Dr. Clear explains, “What we often see is that when patients develop an addiction to opioids, it starts to take over their lives. While the medication might have initially been prescribed for pain, patients often start taking it for other reasons (like stress or depression). Soon, they are constantly craving 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).”

Signs of Opioid Addiction

If you suspect that you or a loved one has developed an “addiction” to opioids (now more commonly called a “use disorder”), here are some signs to look for:

Physical Signs 

When the person is in withdrawal, the following may be present:

  • Irritability
  • Enlarged pupils
  • Nausea or vomiting
  • Muscle pains or overall soreness
  • Sweating

When the person has opioids in their system, they may experience the following:

  • Slowed thinking
  • Pinpoint (tiny) pupils
  • Impaired coordination as if sedated or intoxicated
  • Injection marks if injecting drugs

Mood-Related Signs 

You may notice mood related changes such as:

  • Slowed thinking or problem-solving
  • Seeming detached from others and their surroundings
  • Poor concentration
  • Mood swings
  • Difficulty sleeping
  • Depression
  • Paranoia (worried about being caught and trying to conceal use)

Behavioral Signs 

The way a person acts can also change when they have an opioid use disorder.[3] Changes include the following:

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

How to Help Someone Who Is Struggling With Opioid Addiction 

“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 also helping patients to get back to leading fulfilling and meaningful lives.”

How to Help Someone Else

If a loved one is struggling with opioid addiction, the most important thing you can do is be direct and supportive. Follow these tips:

  • Let them know you are concerned about them and are there to help.
  • Do not judge them. People struggling with addiction are often ashamed of their struggles. They need someone by their side as their ally.
  • Embrace compassion and patience. Know that even when patients are in recovery, they can relapse. That is part of this lifelong 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 disorder. 

How to Help Yourself 

If you are concerned that you are struggling with opioid addiction, reach out to your doctor and get the help you need. Together, you can find a program that’s best for you, your addiction, and your lifestyle. 

Treatment Options for Opioid Dependence or Misuse

The best form of treatment involves two components: medications and behavioral therapies. 

Medication for Addiction Treatment (MAT)

Proven medications like Suboxone, methadone, or naltrexone (Vivitrol) reduce cravings, treat withdrawal symptoms, and prevent overdoses.[4] These medications can be lifesaving in helping someone to maintain abstinence from opioids. 

Behavioral Therapies

While medications can ease your path to sobriety, you’ll also need behavioral therapy. In a treatment program, you can learn more about why you started using drugs, and build up skills to resist the temptation to use drugs in the future. 

Support Groups

Support from others going through the same thing could give you a deep feeling of community and understanding. Good options include the following:

Resources for Addiction Support

The Substance Abuse and Mental Health Services Administration (SAMHSA) has several resources you might appreciate, including these:

An Opioid Addiction Treatment Guide for Patients, Families, and Friends from the American Society of Addiction Medicine may also be beneficial.

Header Photo by Zach Vessels on Unsplash


Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition). National Institute on Drug Abuse. January 2018. Accessed August 2022.
  2. Analysis of Opioid Efficacy, Tolerance, Addiction and Dependence From Cell Culture to Human. British Journal of Pharmacology. October 2011. Accessed August 2022.
  3. Opioid Misuse and Addiction. MedlinePlus. Accessed August 2022.
  4. Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal. Spring 2018. Accessed August 2022.

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