Opioid Addiction

Overview

When people think of opioid use problems or addictions, they may think of street-obtained, or "street" opioids, such as heroin or fentanyl. However, problematic opioid use can also include improperly taking prescribed opioid medications such as oxycodone, morphine or codeine, or taking an opioid medication that was not prescribed for you.

Opioids are a class of powerful drugs that are usually prescribed to treat severe pain. If opioids are abused, they can create feelings of intense pleasure or euphoria, but they can also lead to fatal overdose. Opioids are an effective medication when used as prescribed, but they carry a risk of addiction because of their powerful effects.

Both street-obtained and prescription opioids can be misused. Heroin is a common street opioid that can be snorted or smoked, though it carries the greatest risks when injected. These risks include spreading HIV or hepatitis B or C by sharing needles, skin infections, collapsed veins, bacterial infections and overdoses. People can also misuse prescription medication by crushing the pill and then chewing, snorting or injecting it.

Fentanyl is an opioid that is prescribed as a skin patch. It is 100 times more powerful than morphine and used to treat severe pain. Most street fentanyl in Canada is produced illegally as a powder and is being increasingly found in street drugs such as heroin and cocaine, and used to make tablets that look like prescription medications. Many overdoses have occurred because people did not know that what they were taking was contaminated with fentanyl.

If you or someone you know uses opioids, it is a good idea to have a free naloxone kit. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive.

If someone is overdosing, call 911 right away! You can then use your naloxone kit  while you wait for medical help.

Signs & Symptoms

Opioid addiction is defined by a group of signs, symptoms and behaviours that indicate a person is both physically and psychologically dependent on the substance. These include:

• using over a longer period or using more than planned
• wanting to quit or cut down, or trying unsuccessfully to quit
• spending a lot of time and effort getting, using and recovering from opioids
• experiencing cravings
• failing to fulfil responsibilities at work, school or home as a result of opioid use
• continuing to use opioids despite the negative social consequences caused by opioid use
• giving up activities that were once enjoyable
• using opioids in dangerous situations
• needing to take more of the drug to get the same effect (tolerance, a sign of physical dependence)
• feeling ill when opioid use suddenly stops (withdrawal, a sign of physical dependence)
• crushing, snorting, smoking or injecting opioids
• running out of prescription medications early
• drawing on many sources for opioids (e.g., prescriptions from two or more physicians or both a prescription and street opioids)
• showing signs of opioid intoxication (e.g., nodding off, pinpoint pupils).

Opioid addiction involves more than just physical dependence. For example, a person with cancer who is prescribed opioids for severe pain may experience withdrawal symptoms when they stop taking the medication, but is not addicted. Opioid addiction also involves psychological dependence. This means that the drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows that using is harmful.

Cravings and increasing tolerance may lead the person to buy drugs on the street or go to more than one doctor to get the same drug. They may smoke, snort, crush or inject the drug in order to feel high faster and more intensely. This could affect their relationships with family members or friends, or cause a person to neglect their responsibilities.

Causes & Risk Factors

Opioid addiction is caused by a combination of physical and psychological factors. They include:

• access to opioids, whether from legal or illegal sources
• physical tolerance to opioids
• the need to use increasing quantities
• compulsive use
• withdrawal symptoms.

Risk factors for developing opioid addiction include:

• personal history of substance use issues involving any substance, including alcohol
• family history of substance use problems or addiction
• history of pre-adolescent sexual abuse
• history of psychiatric problems.

Diagnosis & Treatment

Two main treatment options are available for opioid addiction:

• opioid agonist therapies using methadone or buprenorphine 
• addiction treatment counselling (e.g., withdrawal management, day treatment, mutual aid groups such as Narcotics Anonymous).

Methadone and buprenorphine are opioid medications that do not cause intoxication at the correct doses. When they are prescribed, they eliminate a person's withdrawal symptoms, which may help them stabilize their life. Opioid addiction treatments usually involve a combination of opioid agonist therapies and addiction treatment counselling.

Sources:
Fundamentals of Addiction: A Practical Guide for Counsellors © 2014 Centre for Addiction and Mental Health
Straight Talk: Fentanyl © 2017 Centre for Addiction and Mental Health
About opioids © 2017 Government of Canada
Opioid crisis in Canada © 2018 Government of Canada
What is fentanyl? © 2017 Royal Canadian Mounted Police

Related Programs and Services

• Treatment at CAMH: Access CAMH
• Help for families from CAMH 
• ConnexOntario
• Kids Help Phone at 1 800 668-6868

Additional Resources

• 5 Steps to Save a Life (PDF)
• Opioid Agonist Therapy: Information for Clients  (PDF)
• Making the Choice, Making It Work: Treatment for Opioid Addiction  (PDF)
• Straight Talk: Oxycodone  
• Straight Talk: Street Fentanyl  (PDF)
• Straight Talk: Street Methadone  
• Do You Know. . . Methadone  (PDF)
• Do You Know. . . Prescription Opioids  (PDF)
• Best Advice for People Taking Opioid Medication - Dr. Mike Evans (video)