Opioids: How Addictive Are They Really? (Prescribed & Recreational)

Medically Reviewed

Opioids are among the most addictive drugs, so they must be handled with care. Their abuse can easily lead to a spiral of addiction and health issues.

Potential For Addiction

Opioids are a class of drugs that relieve pain by interacting with the brain’s opioid receptors. This interaction then causes the brain to send signals to the body to numb pain and to feel euphoria (a sense of pleasure).

Prescription opioids are used as painkillers or to carefully wean someone off an addiction to a more powerful opioid.

There are many opioids with legitimate uses, including oxycodone, hydrocodone, methadone, and more.

Heroin is a common opioid with no medically accepted use. It is illegal to own or produce in all but the most tightly controlled lab settings.

Treat opioids with great care, as they can be highly addictive. If you are prescribed them legitimately, take them only as prescribed.

Using Opioids Safely

The oft-repeated piece of advice that applies to all drug use is fairly simple: Listen to your doctor. Opioids are prescription medications for a reason. They can be highly destructive if taken improperly.

Take, for instance, the drug hydrocodone. This is one of many prescription opioid painkillers. It is meant to alleviate moderate to moderately severe pain. If a doctor and patient follow the dosing recommendations for a given drug, which in the case of hydrocodone is generally no more than six pills a day for the most severe cases, there is substantially less risk of abuse.

If you believe you are feeling tempted to abuse an opioid (and any use not prescribed by a doctor qualifies), speak to your doctor about your options. Even if you follow your prescription, you may feel drawn to abuse the painkiller or find that you experience withdrawal symptoms when not on it. A doctor can help you control those symptoms better to avoid abuse.

Opioid Abuse

According to the National Institute on Drug Abuse (NIDA), 130 people in the United States die every day due to an opioid overdose. In addition:

  • 21 to 29 percent of those prescribed opioids for pain management end up abusing them.
  • Eight to 12 percent of those who abuse opioids develop an addiction to the drugs.
  • Four to six percent who abuse prescription opioids eventually switch to using heroin.

Why are opioids so heavily abused?

The first reason is the question of opioids’ addictive properties. The sense of euphoria they evoke in a user can be powerful, especially if the drug is not being carefully dosed and administered cautiously.

By tapping into the brain’s reward centers, the brain more or less gets a signal that the action performed was “good.” This goes beyond making the user generally enjoy the experience; it can rewire the brain.

Opioids make your brain and body crave more opioids. You end up chasing that sense of euphoria they bring even if you logically know taking more opioids might be detrimental.

Worse still, as you take opioids, it may dull your natural ability to feel happy. This can lead to a dangerous cycle where you choose to abuse drugs just to feel something.


After physical dependence has formed, withdrawal is likely if you stop the abuse of the drug (either intentionally or because you no longer have access to a supply).

In the case of opioids, withdrawal can be a terrible experience. Even if you want to quit abusing opioids, your body and brain essentially revolt if you attempt to stop taking opioids once you’ve grown dependent. This is why you should seek professional addiction treatment. Medical professionals can manage this process, so you make it through without severe discomfort.

Intensity and length of use can affect how strongly and for how long withdrawal symptoms are felt. As noted by MedlinePlus, the following are some of the withdrawal symptoms a user may experience when quitting opioids:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Abdominal cramping
  • Nausea
  • Vomiting
  • Diarrhea
  • Mydriasis (dilated pupils)
  • Goosebumps

These symptoms are extremely uncomfortable but generally not life-threatening. However, withdrawal (especially from potent drugs like heroin) can kill people, typically due to dehydration from the massive loss of fluids between the vomiting, diarrhea, and sweating that can come with withdrawal.

Second, to the properties of opioids themselves, much of their abuse stems from the fact they are so widely available. Many opioids are prescription drugs, meaning a person can get them legally even if they are regulated. Once pills are in their hands, they may be tempted to abuse the prescription or to sell the pills to someone else.

Additionally, the drugs are fairly widely available on the black market, at least in part due to inadequate regulations and improperly enforced policies.

In essence, opioids are so widely abused because they are relatively easily obtained, highly addictive, and very difficult to quit without professional treatment.


As discussed by the Substance Abuse and Mental Health Services Administration (SAMHSA), medication-assisted treatment (MAT) uses drugs in conjunction with other treatments to help someone combat drug addiction.

Not every drug that might be chosen for MAT is an opioid, but two are, both serving a similar purpose: to combat withdrawal. These two drugs are methadone, a tightly controlled and potentially quite addictive drug itself, and buprenorphine, a less controlled but still potentially addictive drug.

Buprenorphine specifically is what is called a “partial opioid agonist,” in essence meaning it has a milder (but not totally risk-free) effect than full opioid agonists.

It may seem counterintuitive to fight addiction with a similar drug to the one you are addicted to, especially if the new drug also has a potential for abuse. However, it is important to remember a few things:

  • Not all opioids are equally made. Some, like heroin, are much riskier to abuse than a medication used to treat opioid abuse. For example, the risk of growing dependent on buprenorphine may be determined to be worth the potential to prevent heroin abuse.
  • While these drugs are not without their abuse potential, they have limits in place to help mitigate their abuse.
    • Methadone is tightly controlled and must be administered by a healthcare professional.
    • Buprenorphine is often combined with naloxone in tablets. Naloxone acts as a deterrent to abuse since it precipitates opioid withdrawal.
    • Buprenorphine has a ceiling effect where more intense effects are not felt beyond a certain dosage level.
  • A person’s likelihood to abuse these medications is taken into account when they are prescribed. Doctors do not randomly choose to administer these treatments.

Where Politics Meets Medicine

The United States is in an opioid crisis presently, and there is no easy solution. Exactly what combination of overprescription, poor regulation, toxic drug culture, and more is causing this crisis is hotly debated. There is no clear medical solution to this problem.

Policy needs to be carefully considered. Punishing people for being addicted to drugs, for example, has continually shown to be ineffective at fighting drug abuse.

It is likely some combination of better-enforced regulations on prescriptions, more widely available treatments for people addicted to drugs (at a price they can afford), and assistance for addiction-prone neighborhoods are all necessary to stem opioid abuse.

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