Opioids are pain relief drugs that carry the risk of causing a person to develop physical and psychological dependence and addiction. The risk of developing opioid use disorder (OUD) varies across people.
Opioids are drugs that treat pain by interacting with opioid receptors on nerve cells.
Some people take opioids recreationally, without a doctor’s authorization or against their instructions. Taking opioids regularly increases a person’s risk of developing physical dependence, where the body needs the medication to function.
This article discusses possible risk factors and treatments for OUD. It also provides a personal account from Joe Tlustos, a peer coach who previously had the condition.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5-TR) describes OUD as a problematic pattern of opioid use that leads to problems or distress.
Joe’s story: How it all started
“It was early 1985, and I was working as a morning show radio host. I participated in stunts that were often physical.
During one instance, I went flying, crashed on the floor, and injured my back. At the emergency room, I was given my first injection of Demerol to address the pain. I remember my reaction: “Where have you been all my life?”
[The] pain was greatly reduced. I was on my feet and felt like a million bucks. At the time, I thought it was simply great.”
According to DSM-5-TR criteria, OUD may cause a person to experience at least two of the following within a 12-month period:
- a strong desire or urge to take opioids
- taking larger amounts than intended or taking them for a longer period
- spending lots of time obtaining or taking opioids or recovering from their effects
- having a persistent desire or making regular efforts to cut down but being unable to do so
- continuing to take opioids despite experiencing social or personal problems related to them
- giving up activities due to opioid use
- taking opioids in dangerous situations, such as while driving
Joe’s story: Developing OUD
“It’s difficult to nail down [how long it took to develop an addiction] for certain. I had experimented with alcohol and cannabis before that, but I was very naive about opiates and pain medication.
I remember [the doctors] switched me to oral pain medications, which worked very well to cut pain for 3 weeks. After that, I just kept taking them as often as they would refill them. I seemed to be able to work, drive a car, and otherwise function without anyone noticing.
When did addiction set in? I can’t really tell you because they kept filling the prescriptions, and I kept taking them for several months. My back was never the same. I experienced pain every day but had a terrific work ethic and pushed through it.
For the next 20 years, I had acute back episodes, which kept me on bed rest for 4–6 days, two or three times a year. Somewhere in there, I crossed a line. I can’t remember exactly, but it was probably [after] around 2 months when I decided I liked and needed them and would tell a doctor whatever I thought he wanted to hear to get the refills.”
Over time a person can develop a tolerance for opioids due to the
This tolerance can cause a person to take more opioids to get the same results, increasing their risk of developing OUD.
OUD can also cause a person to experience withdrawal if they stop taking the drug. Opioid withdrawal can be life threatening.
Symptoms of opioid withdrawal
- a flow of tears and a runny nose
- goosebumps on the skin
- muscle pain
- nausea and vomiting
- dilated pupils
- light sensitivity
- symptoms of anxiety, such as rapid breathing and a fast heart rate
- excessive sweating
- high blood pressure
Read more about opiate withdrawal.
Joe’s story: Escalation
“It took me a long time to realize that when my nose was running, when I felt like I had the flu with body aches, when it took every ounce of will I had to drag my butt out of bed and into work — and my work consisted of sounding bright, entertaining, informative, smart and in control — I was not sick from overwork but from withdrawal.
The lightbulb probably went on around 1992, some 8 years after it all started. I started getting pretty good at going to a doctor and squeezing out some prescriptions and more powerful painkillers, regardless of if the pain was average or above average.
This was before you could purchase Naproxen over the counter, which would have provided at least some relief from the pain of the back injury, but it wouldn’t have helped with what I still didn’t understand were mental health issues.
When I couldn’t get an Rx [prescription], I would experiment and try whatever I could get to see if it made anything “better” — all the while doing 3.5 hours on air live every Monday to Friday, and managing 10–12 people staffing a 24-7-365 news organization, representing the company on nonprofit boards and fundraisers, etc.
It may sound incredible, but I was so busy juggling all of this and a wife and later a daughter that I didn’t have much time to think about it. I didn’t think of myself as an exception because I had no reason to believe this [was different] from how everyone experienced the world every day.”
Several things may increase a person’s risk of developing OUD,
Untreated psychological conditions
These may include:
Social and environmental factors
The following may also increase a person’s risk of developing OUD:
- childhood abuse
- stress and trauma
- peer pressure
- younger age
Circumstances and experience of drug taking
These factors may include the following:
- reward circuitry
- having other medical conditions
- a history of substance misuse
- the mode of administration
- maintenance, which produces tolerance, dependence, and brain adaptations associated with cravings
- experiencing withdrawal and negative reinforcement during withdrawal and abstinence
Genetic factors that may increase a person’s risk of developing OUD include:
- a family history of substance misuse
- personality disorders
- certain genes associated with risk-taking and impulsivity
- atypical stress responsivity
Common variations in the OPRM1 gene may also increase a person’s risk of developing OUD by influencing how a person’s body responds to these medications.
This gene produces the
Joe’s story: Possible causes
“I finally required back surgery in 2003, which opened up a brand new level of pain medication. I learned you could ration the pain meds if you supplemented them with alcohol, so the use of that drug also escalated.
[The opioid medications] made the pain bearable. They made me feel warm and happy. Along with the back pain, I suffered from severe anxiety, depression, and bipolar II disorder.
It would be nearly 20 years before someone put two and two together. Still, over those years, [opioid use] was the only thing that would allow me to “keep it together” just enough to carve out a very successful career in media, handle operating as a public figure, become a husband and father, and run 150 miles an hour all day every day.
I would take whatever was on hand if I thought it would get me through the next few hours. Along with legitimate back pain, I was self-medicating everything else in a fast-paced, 24-7, high stress, and high profile environment.”
There are medications that the Food and Drug Administration (FDA) has approved for treating OUD. These do not provide a cure but help improve safety and prevent withdrawal symptoms.
This is important as withdrawal symptoms can lead to recurring or continued drug use.
Medications for OUD include:
- buprenorphine (Subutex)
- long-acting injectable naltrexone (Vivitrol)
- buprenorphine-naloxone (Suboxone)
- long-acting injectable buprenorphine (Sublocade)
Joe’s story: Realisations
“Some idea of mental illness came into the picture around 2002, and I immediately found a doctor whose main appeal was that I could walk to her office. She prescribed a bunch of prescriptions I dutifully took, but I didn’t stop everything I consumed.
I quit my job and moved to South Dakota for a lower stress job. That’s when I tried to stop the insanity but was shocked to find out I couldn’t stop by myself.”
Counseling and support
Alongside these medications, a person may also wish to try counseling and behavioral therapies to help treat OUD and any underlying mental health conditions they may have.
These treatments generally aim to help a person adjust behaviors. They also involve education about treatment and preventing the recurrence of misuse. People may also wish to participate in certain mutual-aid organizations, such as Narcotics Anonymous.
Joe’s story: Treatment
“[O]n Monday, November 17, 2008, I finally told myself I couldn’t do this anymore, and it wasn’t possible to stop everything by myself.
That day I called the only area inpatient treatment facility I knew of, and a week later, I began 30 days of inpatient treatment. I finally detoxed in a semi-controlled environment, experienced hell for 3 or 4 days, and came out feeling like death but not under the influence.
My psychiatric medications were somewhat adjusted, but they didn’t get organized until a couple of years later, with the help of my psychologist. [With] my brain chemistry more in line, my cravings for other substances went away.
During treatment, I started to understand that I was using all of these substances as a “treatment” for other “whys” going on under the surface. I also understood that “treatment” wasn’t working well and had terrible side effects.
Without actually hearing the words, I concluded that what I needed most was a change in the way that I thought about myself, work, home, injury, and stress, and becoming honest with myself and with others as to my problems.
People ask me how I’ve put together 14+ years in recovery. I tell them once I went through all of this, changed my thinking, and came to terms with who I am, […] staying sober has not been super hard.”
To prevent developing OUD, it is best for a person to work closely with their doctor
If a person has unused prescription opioids at the end of a period of pain treatment, experts recommend they find their local drug take-back program or pharmacy mail-back program.
Joe’s story: In the long term
“My ultimate challenge came in 2021 with major back surgery […]. With COVID-19 delays, it took me 5 months to get on the surgery table. Pain, both before and after surgery, was intense and needed medication.
What was different this time? No secrets with my doctor. We were completely honest about the pain I was experiencing before the surgery and afterward […]. We also were honest before surgery that there would be new nerve pain after, which was likely not manageable with opiates.
We both kept a close count of the opiate medications I was taking throughout 10 months. And when it was time to stop postop opioid meds, I contacted my primary care physician and told him it was time for me to be done. And it was done, without a lot of drama, by following directions and weaning off until I was sober in a month.
Amazingly, [I did not experience any long-term effects] – at least nothing negative. Positive long-term effects continue to proliferate every day.
I also know a great deal more about my mental health situation. While challenging, my symptoms are generally manageable with medication and changes in thinking and behavior, which has been amazing.
Finally, going through all of this has allowed me to become a coach who helps others. I understand where they’re at, how they have gotten there, how they can change their habits and thinking, that alcohol and other drugs make things worse, not better, and that, most importantly, they have hope of getting off that roller-coaster.”
Opioids are drugs that carry the risk of creating physical and psychological dependence. People may develop opioid use disorder, which can harm their health. The time it takes to develop OUD varies from person to person.
A person can treat OUD with medications that help prevent withdrawal symptoms. They can also use behavioral therapies to help with overcoming addiction over time.