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7 Most Common Risk Factors for Opioid Use Disorder

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Sep 15, 2023 • 13 cited sources

In the United States, over 2.1 million individuals struggle with opioid use disorder, also known as opioid addiction.[1] This epidemic has ravaged communities, families and individuals across the nation. Even though opioid use disorder can affect anyone who misuses opioids, certain biological and environmental risk factors make an individual particularly susceptible to developing this condition.

Let’s delve deeper into each of these 7 opioid use disorder risk factors to better understand what they are and what it means for you. 

1. Method of Consumption

In predicting the risk of developing an opioid use disorder (OUD), how fast and how often opioids reach the brain can be more important than how much a person consumes.[2] 

Misusing opioids like prescription painkillers or heroin by snorting, injecting, or smoking them can produce a faster onset of effects and a more intense high than taking them orally.

Unlike a swallowed tablet, snorted and injected opioids bypass the digestive system and enter directly into the bloodstream. Injections are especially risky as the effects are felt immediately and all at once. This increases the risk of opioid use disorder and overdose.  

Smoking is the fastest route to the brain, followed by injecting. The effects are immediate, highly potent, and short-lived. When smoked, the euphoric effects of the opioid fade as quickly as they come on. Thus, smoking and injecting opioids tend to increase the frequency of use. 

Smoking and injecting opioids cause more intense and short-lived highs, which can increase the risk of developing opioid use disorder.

2. Genetic Predispositions

Among the more prominent risk factors for opioid use disorder is a person’s genetic background and family history. However, the science of genetic predisposition in the context of OUD is not entirely clear yet. 

About 40 to 60 percent of a person’s vulnerability to addiction is determined by their genes.

Nevertheless, a family history of substance misuse is common among individuals struggling with OUD. Genetic predispositions can be considered within an assessment tool when gauging an individual’s risk of developing an OUD. 

Studies suggest that 40 to 60 percent of a person’s vulnerability to addiction is determined by their genes.[3] 

3. Young Age

A person’s age often plays a role in their vulnerability to opioid misuse. As of 2021, individuals between the ages of 25 to 44 years old were particularly vulnerable to opioid addiction and overdose.[4] 

Moreover, two in every three adults with OUD report first using opioids before the age of 25.[5] 

In fact, teenagers and young adults are more likely to try, use and misuse opioids than any other age bracket. 

4. Past Substance Misuse

Opioid use disorder risk factors include an individual’s history of substance misuse. Past addictions to certain substances can help predict a person’s susceptibility to similar substances. 

In the context of OUD, researchers reported that approximately 80 percent of people who misuse heroin first misused prescription opioids like Percocet or OxyContin.[6] Prescription opioid use is a strong risk factor for progression to heroin addiction, as evidenced by data.     

5. Social Factors

Social and environmental factors can heighten the risk of developing OUD. For example, if you live in an area where prescription and illicit opioids are easily accessible, you are at increased risk of exposure and potential use. 

Other environmental risk factors include the following circumstances: 

  • Growing up in a household that normalized drug and alcohol use
  • Belonging to a peer group that uses drugs or alcohol
  • Having easy access to addictive substances

Emotional trauma is also among the many risk factors for OUD. They may increase one’s susceptibility to opioid use include: 

  • Exposure to sexual, emotional, or physical abuse
  • Loss of a loved one or divorce

6. Psychological Factors

Mental health disorders and psychological issues can increase susceptibility to developing OUD. Physical pain is one of the most common symptoms of diagnosed mental health disorders. 

In some cases, opioids are prescribed to treat this symptom. Studies have found that adults with mood and anxiety disorders are more likely to be prescribed opioids and remain taking them long-term.[7][8] 

Additionally, some people may misuse drugs like opioids in order to self-medicate symptoms of undiagnosed mental health conditions, which increases their risk of co-occurring disorders.

Some of the most common mental health disorders seen in Medication for Addiction Treatment (MAT) programs include[9]:

  • Anxiety and mood disorders
  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder
  • Conduct disorders
  • Post-traumatic stress disorder
  • Attention deficit hyperactivity disorder

7. Chronic Pain Conditions

Chronic pain conditions tend to be a high risk factor for OUD. Opioids have long been a legitimate medical treatment for moderate to severe pain. Some opioids are prescribed to treat acute pain like among postoperative patients, for example. These prescriptions are taken only as needed and only last for a short period. They are not long-term treatment plans. 

Historically, long-term opioid prescriptions were used to treat the pain and discomfort of advanced chronic illness. Opioids were typically prescribed to patients in active cancer treatment, palliative care, and end-of-life care. 

More recently, there has been a significant increase in opioid prescriptions to treat moderate, non-cancer chronic pain conditions, such as back pain or osteoarthritis. This was a concerning trend and one of the most prominent risk factors for prescription drug misuse. 

There is a strong relationship between legitimate opioid prescriptions and reported misuse, dependence, and addiction. In fact, research indicates:[10]

  • About 21 to 29 percent of patients prescribed opioids for chronic pain misuse their medication.
  • Between 8 and 12 percent of people who take prescription pain medications develop an addiction to them.

Given these concerning statistics, it is critical that patients understand opioid use disorder risk factors and discuss them with their doctor, who may want to use the Opioid Risk Tool to weigh pros and cons.

Protective Factors for Opioid Use Disorder

Just as there are risk factors for substance use disorder, there are also many protective factors that can help prevent someone from developing an addiction to opioids or other drugs. They may reduce the risk of substance use disorder by counteracting risk factors or decreasing their impact. 

Some protective factors may include:[11],[12]

  • Strong relationships with community, school, and family
  • Recognition for achievements and positive behaviors
  • Positive social involvement
  • High parent involvement
  • High self-esteem
  • Adequate problem-solving skills
  • Spirituality
  • Resiliency
  • Access to after-school activities and faith-based resources
  • Academic competence 
  • Self-control

Some protective and risk factors are fixed and don’t change, while others, such as environmental influences, may change over time. 

Treatments for OUD

Medications for opioid use disorder (MOUD) are a critical tool for individuals struggling with opioids. Research has repeatedly shown the efficacy of this pharmacological component in treatment. 

While behavioral therapies address the psychology of opioid use disorder, MOUDs address many of the physical and neurological discomforts. For example, MOUDs provide relief from cravings, the painful symptoms of withdrawal and block the euphoric effects of opioids. 

To date, three medications are recommended by the World Health Organization (WHO) and approved by the US Food and Drug Administration (FDA) to treat opioid use disorder:[13]

All brand-name MOUD prescriptions include one, or a combination, of these three medications. Common brand names include Bunavail, Belbuca, Subutex, Suboxone, Naltrexone (Vivitrol), Sublocade, and Zubsolv.

Learn More About Bicycle Health

Reach out to Bicycle Health if you or someone you know is struggling with an opioid use disorder. We use Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.


Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

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  9. Co-occurring disorders and other health conditions. Substance Abuse and Mental Health Services Administration. Updated August 19, 2020. Accessed October 1, 2021.
  10. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576.
  11. Risk and protective factors for substance use. Indiana State Government. Accessed June 23, 2023.
  12. Risk and Protective Factors. Substance Abuse and Mental Health Services Administration. Accessed June 23, 2023.
  13. Medication-assisted treatment (MAT). Substance Abuse and Mental Health Services Administration. Updated 10/07/2021. Accessed October 1, 2021.

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