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What Makes Opioids So Addictive?

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 13, 2023 • 7 cited sources

Opioid medications are used for pain control, but are considered highly addictive. The more we learn about opioid addiction, the more we understand that OUD is a chronic disease where one feels compelled to misuse drugs even if they understand that drugs are doing harm.

The Addictive Potential of Opioids

Opioids are a class of medications that bind to opioid receptors in the brain and nervous system, releasing dopamine. Dopamine has a number of roles in the body, including the blocking of pain and the production of euphoria/pleasant feelings. 

With short term use, dopamine release causes euphoria and relief from pain. 

However, with long term chronic use, these opioid receptors are chronically stimulated. This causes changes in the brain over time where it no longer produces dopamine normally in response to naturally pleasant stimuli. Things that normally produce pleasure, such as food, sex, or other happy activities, no longer produce the same dopamine and subsequent happy feelings. The individual eventually needs the opioid medication to stimulate dopamine production just to feel “normal”. [4]

Eventually, the individual requires the opioid just to feel normal and function. With escalating use, they may need higher and higher doses of opioid medications to prevent withdrawal symptoms. When patients can no longer secure adequate prescriptions for these medications, they may purchase opioid pills, which can become very expensive. They may even turn to illicit opioids (heroin, fentanyl, etc) which are cheaper and readily available. 

How Does Opioid Addiction Occur?

Addiction isn’t a moral failing. It is a chronic disease.[2] Once a person has become addicted to an opioid, they will be driven to compulsively use even if they understand their drug misuse is having negative consequences on their physical and mental health as well as their personal relationships and work life.[3] 

While addiction is generally best thought of as a lifelong disease, the dangerous cycle of drug misuse that occurs can be broken with proper treatment. 

What Makes a Person More Likely to Develop an Addiction?

Addiction is extremely complicated, and no two individuals develop their habit in exactly the same way. With that said, there are some known risk factors for developing addiction. 

First, family history of addiction is a known risk factor. Individuals with a first degree relative with an addiction disorder are more likely to themselves develop a substance use disorder. It is unclear whether this is purely biological, or socialized: individuals growing up in a home where they are exposed to substances and where substance use is normalized may be at increased risk of developing a use disorder later in life. [6] 

Second, certain mental health issues seem to strongly co-occur with addiction, such as depression and anxiety disorders, although the exact way these issues interact isn’t fully understood.[5] Individuals with a personal or family history of depression, anxiety, PTSD, or other mental health conditions are at increased risk of addiction.  

It is believed that childhood trauma may play a large role in the development of an addiction disorder. One of the most key periods in a person’s life that can influence their addiction risk is childhood. This is because the brain is developing the most in this period of life. It is well established that individuals with high scores on ACE tests (adverse childhood events) are at much higher risk of developing an addiction disorder. 

It is also generally accepted that the earlier drug use begins, the more likely a person is to develop a drug addiction. This is why efforts to reduce teen drug use are important. Teens are one of the groups most at risk for starting to misuse drugs that may lead to a substance use disorder.[2]

Treatment Options for Opioid Use Disorder

Opioid use disorder is best treated with the help of a professional. A standard part of most opioid addiction treatment is Medication for Addiction Treatment (MAT), which combines the use of medication and therapy.[7] 

Cognitive behavioral therapy (CBT) is a type of therapy where you speak with a treatment professional and work to better understand what type of thinking drives you to engage in certain behavior (in this case drug misuse). In sessions, you’ll learn how to manage those thoughts and avoid triggers prior to repeating the undesirable behavior of drug use. 

The two primary medications used to manage opioid use disorder are methadone and Suboxone (buprenorphine/naloxone). These drugs both help to sharply reduce drug cravings and prevent withdrawal. By taking them on a controlled schedule at the right doses, these medications can significantly improve treatment retention.

Many people also benefit from supplementary treatment resources, like going to support groups or attending family therapy.  

Most individuals can get treated for their addiction through outpatient treatment, where they spend some time at treatment throughout the week but spend most of their time living their normal life. Many people utilize telemedicine addiction treatment, where they can receive therapy sessions from the comfort of home and access prescriptions in this manner as well. While some individuals with severe disease may require inpatient treatment, many patients with OUD can receive outpatient treatment successfully, either in person or virtually. 

If you are interested in virtual/telemedicine treatment for OUD, reach out to Bicycle Health.

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. The Neurobiology of Opioid Dependence: Implications for Treatment. Addiction Science & Clinical Practice. July 2002. Accessed March 2023.
  2. Understanding Drug Use and Addiction. National Institute on Drug Abuse. June 2018. Accessed March 2023.
  3. Alterations in Brain Structure and Functional Connectivity in Prescription Opioid-Dependent Patients. Brain. July 2010. Accessed March 2023.
  4. Dopamine, Behavior, and Addiction. Journal of Biomedical Science. October 2021. Accessed March 2023.
  5. Mental Illness and Drug Addiction May Co-Occur Due to Disturbance in the Brain's Seat of Anxiety and Fear. American Psychological Association. 2007. Accessed March 2023.
  6. Relationship Between Interpersonal Trauma Exposure and Addictive Behaviors: A Systematic Review. BMJ Psychiatry. May 2017. Accessed March 2023.
  7. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. November 2016. Accessed March 2023.

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