Opioid dependence and addiction have two slightly different meanings. “Dependence” refers to physical reliance, while “addiction” refers more broadly to both physical and psychological reliance. While timelines vary greatly depending on individual makeup and extent of use, both dependence and addiction can occur as soon as immediately after first use and as late as weeks to months after first use.
How Do People First Encounter Opioids?
Often times patients are first exposed to an opioid from a doctor’s prescription, although of course sometimes patients first use can be illicit use of a non-prescribed opioid or even of an illegal opioid such as heroin or fentanyl. As many as one in four people who get a prescription for opioids will misuse them in time.
Stages of Opioid Addiction
While the course of physical addiction varies widely for different individuals, a typical OUD timeline looks like this:
- First week: Therapeutic: a patient uses the prescription medication as prescribed, and does not usually have any physical dependence
- First month: Tolerance: Your body becomes accustomed (tolerant) to the drug, and you may need bigger doses to feel the same effect.
- Second month: Dependence: If you stop taking the drug abruptly, you develop physical withdrawal symptoms. While withdrawal symptoms are not dangerous or life threatening, they can be extremely uncomfortable. Symptoms include nausea, rhinorrhea (runny nose), chills, vomiting, diarrhea, tremors, headaches, anxiety and restlessness.
- Anytime within the timeframe: Addiction
To qualify for an OUD diagnosis, you must have both a physical dependence as well as a “psychological” dependence on the drug. This can be diagnosed in a number of different ways: For example, you spend a lot of time looking for or using opioids, your use negatively impacts your quality of life, you continue using even when you know it isn’t right for you, etc.
Some people need months of ongoing habits to develop these symptoms. Others can develop them in mere days. Your timeline may look different from the example above. The type of opioid itself may influence the speed at which an OUD develops. For example, fast-acting, high-dose opioids can cause dependence faster than lower-dose or slower-acting formulations. Your age and mental health can play a role too. But in general, most people develop OUD within months of regular use.
What Does Opioid Addiction Look Like?
Doctors can diagnose OUD by asking you a series of questions. You don’t need a blood test or brain scan to determine if opioids are a problem for you.
Doctors will determine if at least two of the following traits have applied to you within the last year:
- You’ve taken more than your doctor prescribed.
- You want to cut back, but you can’t.
- You spend a lot of time maintaining your opioid use.
- You feel cravings for opioids.
- Your use makes it hard for you to perform at school, at work, or at home.
- You keep using even when it causes you problems in life.
- You give up social or recreational opportunities to use.
- You use drugs in hazardous situations.
- You are tolerant to the medication and need more to feel the same effect.
- You experience uncomfortable physical symptoms when you try to stop using opioids.
If you show these symptoms, your doctor should refer you to a qualified treatment program.
What Should You Do Next?
You’re reading through these symptoms, and you recognize them in yourself. What should you do next? Talk with your family or friends about the issue, and work together to make an appointment to get help. If your family doctor can see you right away and refer you to a professional, that’s great. But if you must find your own treatment team without your doctor’s help, that might be helpful too.
The important thing is to get help as soon as you can. OUDs don’t resolve without treatment and support!
Can You Have Opioid “Dependence” Without “Addiction”?
Yes, absolutely. You can become physically dependent (aka, experience withdrawal) from opioids even without a psychological reliance on them.
A good example of this may be someone who has taken a regular prescription appropriately and consistently for a long time. The patient is not misusing the medication – in fact, he or she is taking them as prescribed – but may still experience the need for higher doses to achieve the same effect, or may experience withdrawal symptoms if they abruptly discontinue the medication. If you have been taking opioids as prescribed and don’t meet the above criteria for opioid use disorder, you likely aren’t “addicted” to them, but your body may still be physically dependent on them.
Don’t stop taking opioids suddenly if you believe physical dependence has formed. Talk to your doctor about how to safely taper off use, if appropriate. They will guide you through the process so you can avoid dangerous withdrawal symptoms. This will generally involve a decreasing schedule of use over a period of weeks or months. It may also involve the use of MAT (either methadone, suboxone, or naltrexone) for assistance while coming off of these medications.
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
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