How Does an Opioid Addiction Start?

Understand the physical and mental factors at play—and why overdose deaths are on the rise.

Medically reviewed in March 2021

In 2019, the most recent year for which we have data, the number one cause of accidental death in the United States wasn’t drownings, falls or even car accidents. It was drug overdoses.

There were more than 70,000 drug overdose deaths that year, according to the Centers for Disease Control and Prevention (CDC), with nearly 50,000 related to opioid painkillers. About 36,000 of those deaths involved synthetic (man-made) opioids like fentanyl.

The problem likely worsened during the COVID-19 pandemic, too. As of early 2021, the CDC estimates that over 81,000 people died of a drug overdose in the 12 months ending in May 2020. The surge was primarily driven by an uptick in synthetic opioid use.

How opioid addiction starts
The road to opioid addiction often begins with a painkiller prescription from a healthcare provider (HCP), says Mark Cardillo, LCSW, program director for behavioral health and addictions at Tampa Community Hospital in Tampa, Florida. In a 2014 study published in JAMA, three quarters of the 1,600 participants who began abusing opioids in the 2000s—and two thirds of the 286 who began using between 2010 and 2013—started with a prescription.

Healthcare providers wrote 255 million opioid prescriptions in 2012, according to the CDC—enough for every adult in the U.S. They have been urged to prescribe fewer painkilling narcotics since then and, as a result, in 2019, prescriptions fell to about 153 million.

“There may be some genetic predisposition,” adds Cardillo. “You also have a segment that may turn to drugs and alcohol because they have some issue, like trauma or their upbringing. In order to escape they turn to drugs. Another group has some sort of mental disorder and use drugs to deal with that. Usually there’s some component in their lives that pushes them to addiction.”

Why opioids are so addictive—and deadly
Snorting, swallowing or shooting heroin or another opioid not only dulls the sensation of pain, but also causes a feeling of intense euphoria. At the same time, opioids affect parts of the brain that influence a number of body functions beyond pain sensation and pleasure, including the breathing instinct. If you take too many opioids, you may stop breathing.

Your body naturally produces opioids, but when you flood it with opioids from an outside source, it adapts to having that extra influx. Then, when you stop putting outside opioids into your body, the body’s natural levels of opioids are no longer enough, and you go through withdrawal. This process is known as dependence.

Withdrawal symptoms include agitation, anxiety, muscle aches, insomnia, diarrhea, nausea and vomiting, among others. Many people, even those with the best of intentions, will go back to using opioids once withdrawal symptoms hit.

Getting clean and staying clean
According to Cardillo, the first stage of recovery is detox, which involves withdrawal. “You just have to get the drug out of your system, so you can think clearly,” he says. Detox takes between five and seven days, says Cardillo, but it could take up to a month before you start feeling normal.

“Once you tackle that, you work on the psychological part,” Cardillo says. Treatment is vital to dealing with an opioid addiction, and behavioral therapy is widely acknowledged to be an effective approach—especially when it’s combined with prescription medications. Treatment may also involve altering aspects of a person’s environment that may trigger their drug use.

In fact, Cardillo says that the biggest mistake people recovering from an opioid addiction make is “not changing the people, places and things that will put them in situations where they’re going to use again.” Not embracing therapy is another stumbling block. “Therapy can be painful, so the first instinct is to go back to using,” he says. “The reality is that drugs and alcohol work. You take them and you don’t have to think about your trauma.”

"You have to be extremely diligent to maintain sobriety,” says Cardillo. “Most people say you go ‘into recovery,’ not necessarily that you’re cured. People may have been in recovery for 30 years, but they’re not cured. Any day something could trigger them and make them start using again. They have to take it one day at a time.”

Sources:

Centers for Disease Control and Prevention. “Drug Overdose Deaths in the United States, 1999–2019.” December 22, 2020. Accessed March 4, 2021.
Centers for Disease Control and Prevention. “Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019.” February 11, 2021. Accessed March 4, 2021.
Centers for Disease Control and Prevention. “Overdose Deaths Accelerating During COVID-19.” December 17, 2020. Accessed March 4, 2021.
National Institute on Drug Abuse. “Opioid Overdose Crisis.” February 25, 2021. Accessed March 4, 2021.
Centers for Disease Control and Prevention. “U.S. Opioid Dispensing Rate Maps.” December 7, 2020. Accessed March 4, 2021.
TJ Cicero, MS Ellis, et al. “The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years.” JAMA Psychiatry. 2014;71(7):821–826.
National Institute on Drug Abuse. “Misuse of Prescription Drugs Research Report: How do opioids affect the brain and body?” June 2020. Accessed March 3, 2021.
National Institute on Drug Abuse. “Misuse of Prescription Drugs Research Report: Understanding Dependence, Addiction, and Tolerance.” June 2020. Accessed March 3, 2021.
MedlinePlus. “Opiate and opioid withdrawal.” February 26, 2021. Accessed March 3, 2021.
National Institute on Drug Abuse. “Why is there comorbidity between substance use disorders and mental illnesses?” April 2020. Accessed March 8, 2021.
Centers for Disease Control and Prevention. “Rx Awareness: Recovery Is Possible.” August 12, 2020. Accessed March 8, 2021.
SAMHSA. “MAT Medications, Counseling, and Related Conditions.” August 19, 2020. Accessed March 8, 2021.

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