Painkiller Addiction: Signs and Side Effects of Painkiller Abuse

The term “painkillers” refers to several types of medications, but this guide focuses on prescription opioids and explains how misuse can lead to addiction. Although opioid painkillers are used for legitimate pain management, they can also cause sedation and euphoria, increasing the risk of misuse.

Common names for prescription painkillers include:

• Opioids
• Narcotics
• Pain medications
• Oxycodone
• Hydrocodone
• Morphine
• Codeine
• Tramadol

This comprehensive guide explains painkiller addiction, including why opioids are addictive, potential warning signs and common withdrawal symptoms. Since it focuses on the signs and health effects of painkiller abuse, it doesn’t include information about addiction treatment options or rehab centers.

Opioid painkillers are central nervous system (CNS) depressants, so they activate the reward pathways in the brain. Once a painkiller binds with your opioid receptors, it relieves pain rather quickly. Opioids may also produce a sense of euphoria, reinforcing repeated use.

Some people start using painkillers to ease pain caused by surgery, auto accidents and chronic medical conditions. Eventually, they may start using opioids to numb unpleasant emotions, relieve stress or improve their mood.

It’s also possible to develop painkiller tolerance, which occurs when your body adjusts to the effects of a medication over time. This causes you to need higher doses of opioids to get the same level of pain relief or euphoria.

In some people, withdrawal discomfort also drives continued drug use. If you experience withdrawal symptoms when stopping or cutting back on opioid painkillers, you may return to your usual dose to avoid feeling sick or anxious.

The risk of painkiller addiction increases with:

• Frequent dosing
• Extended-release tampering
• Higher doses
• Risky mixing

Addiction as a Chronic Disease

Although many people use terms such as drug abuse and substance abuse to describe any use of opioids that falls outside the prescribing guidelines, clinicians have started using substance misuse instead.

This positions substance use as a medical condition rather than a personal choice. Clinicians have also started using substance use disorder (SUD) in place of addiction.

A substance use disorder is characterized by compulsive use with:

• Loss of control
• Intense cravings
• Continued use despite harm

Common Misuse Patterns

Painkiller misuse often involves:

• Using higher doses than recommended by a healthcare provider
• Taking opioids more often than prescribed
• Using painkillers without a prescription (e.g., taking someone else’s leftover pills)
• Crushing or snorting pills
• Mixing painkillers with alcohol or sedatives
• Using opioids to cope with stress

There are also some safety concerns associated with opioid drug addiction. For example, a prescription painkiller overdose can slow or stop your breathing. If you take counterfeit pills, you may be exposed to fentanyl or other harmful substances without even realizing it.

Once someone is addicted to painkillers, they might start buying them from nonmedical sources. Slang varies by region and pill type.

Common street names include:

• Perks (short for Percocet)
• Vikes (short for Vicodin)
• Roxies (short for oxycodone)
• Hillbilly heroin

Painkiller abuse refers to any use of opioids that falls outside medical guidance, such as:

• Taking higher doses
• Using painkillers more often than prescribed
• Taking someone else’s medication
• Using painkillers to get high
• Taking opioids longer than directed by a medical professional

In contrast, painkiller addiction is compulsive use accompanied by loss of control, cravings and continued use even after experiencing harmful consequences. Misuse may start as a desire for extra pain relief, but it can shift into using painkillers to avoid withdrawal or manage intense emotions.

If misuse crosses over to addiction, you might:

• Run out of pills early
• Buy pills from nonmedical sources
• Hide your use from loved ones
• Engage in doctor shopping
• Continue using painkillers despite problems with your health or interpersonal relationships

Doctor shopping involves asking for painkiller prescriptions from multiple healthcare providers. This increases the risk of overdose, as each doctor doesn’t know you’re getting painkillers from the others.

Over time, you may develop opioid dependence, which is when your body adapts to regular use. Physical dependence causes you to experience withdrawal symptoms if you try to cut back or stop using painkillers.

You may also develop a psychological dependence on opioids. This is when you don’t feel calm, motivated or emotionally steady unless you take a painkiller. Dependence risk increases with higher doses, extended use and relying on opioids to cope with strong emotions.

While dependence isn’t the same as addiction, it may be a warning sign that your misuse is becoming more serious.

Painkiller addiction affects the body in several ways, so it can cause changes in mood, behavior and cognitive function.

There are also some physical signs of opioid addiction, including:

• Pinpoint pupils
• Slowed breathing
• Heavy drowsiness
• Nausea
• Constipation
• Itching

Medication-Use Signs

Once misuse shifts to compulsive use, you may change your behavior around taking painkillers. For example, some people request early refills, take higher doses or use pills that aren’t prescribed to them. Lost prescriptions and multiple prescribers may also indicate that someone has a prescription painkiller addiction.

Behavioral Signs

Behavioral signs of opioid addiction include:

• Taking more than intended
• Repeated failed attempts to cut back
• Spending a significant amount of time getting, using or recovering from painkillers

Mood and Cognitive Signs

Opioids affect dopamine and gamma-aminobutyric acid (GABA) levels in the nervous system. As a result, they can affect your mood and cognitive function.

One of the most common mood or cognitive signs is confusion, but you may also experience:

• Anxiety
• Cravings
• Impaired judgment
• Irritability between doses

Safety Issues

Over time, opioid addiction may become serious enough to cause safety issues. Mixing opioids and benzodiazepines increases the risk of overdose, as does combining opioid painkillers with alcohol.

You may also:

• Use painkillers alone
• Drive while impaired
• Experience overdose scares

Sudden discontinuation of opioid painkillers is associated with opioid withdrawal syndrome, which causes flu-like symptoms accompanied by cravings and restlessness.

Early in the withdrawal process, it’s common to experience:

• Yawning
• Anxiety
• Runny nose
• Sweating
• Watery eyes
• Insomnia
• Muscle aches

As an opioid painkiller works its way out of your system, you may also have these symptoms:

• Diarrhea
• Nausea
• Vomiting
• Chills
• Abdominal cramps
• Goosebumps

The severity of opioid withdrawal symptoms depends on the type of painkiller you’re using, your usual dose and the duration of use. You may experience severe symptoms if you combine opioid painkillers with other substances, such as alcohol or sedatives.

You have opioid receptors in your nervous system and digestive system, so prescription painkiller abuse can cause a variety of side effects.

Common short-term side effects include:

• Sedation
• Dizziness or disorientation
• Slowed reaction time
• Impaired judgment

Some people experience gastrointestinal effects with heavy use. These opioid side effects include nausea, constipation and vomiting.

You may even experience changes in mental function, such as:

• Mood swings
• Low motivation
• Impaired concentration
• Sleep disruption

With long-term use, you’re at risk of tolerance, dependence and overdose. Opioid overdose is a serious concern, as it can cause dangerous breathing suppression. The risk of breathing problems increases when you mix opioid painkillers with alcohol, benzodiazepines or other sedatives.

Some people also experience increased sensitivity to pain. Also known as opioid-induced hyperalgesia, this occurs when long-term use of an opioid painkiller causes your nervous system to amplify pain signals instead of blocking them.

A risk factor is anything that increases the likelihood of developing a particular condition.

The risk of opioid use disorder increases in the following situations:

• Medical factors. Long-term opioid prescriptions, multiple prescribers and high doses can all increase your risk. Some people develop painkiller addictions because they have regular access to opioids with limited monitoring.
• Pain factors. You’re more likely to misuse opioids if you have chronic pain, are afraid your pain will come back or experience repeated injuries. This can increase the risk of opioid use disorder.
• Mental health factors. Some people with anxiety, depression and trauma symptoms self-medicate with painkillers. You may also have an increased risk of painkiller addiction if you regularly encounter high-stress situations.
• Substance use factors. You’re more likely to develop an opioid use disorder if you have a history of polysubstance use, alcohol misuse or opioid misuse.
• Access factors. One of the main risk factors for opioid addiction is access to substances. You may start misusing painkillers if you have leftover pills at home, buy pills from nonmedical sources or share prescriptions with other people. Exposure to counterfeit painkillers is also a concern, as these pills are often contaminated with other substances.

Diagnosing opioid addiction involves evaluating your use patterns over a period of time. Opioid use disorder isn’t characterized by occasional misuse, but by pervasive use of painkillers even when they cause harm.

Signs of addiction include:

• Cravings
• Loss of control
• Withdrawal symptoms
• Risky use patterns
• Tolerance
• Continued use despite harm

An addiction assessment may also include a mental health screening to determine if you have any co-occurring disorders. These mental health conditions can contribute to substance misuse, so it’s important to let your healthcare team know about depression, anxiety and other mental health symptoms.

Your substance use evaluation may also include a medication review and a review of your overdose risk factors. This can help your healthcare provider determine whether any medication factors or use patterns could harm your physical or mental health.

Opioid painkillers show up on some drug panels, but these tests merely confirm exposure. They don’t provide any information about your long-term use patterns, so they’re not helpful for making an opioid use disorder diagnosis.

Opioid misuse can build gradually, especially if you start using painkillers after surgery or some type of accident. It isn’t a personal failure.

You may benefit from structured care if you’ve been taking higher doses, mixing painkillers with other substances or trying to cut back without success. Professional support may also help if you’ve had overdose scares or severe withdrawal symptoms.

Help.org is a confidential treatment finder designed to help you compare treatment centers from the comfort of your home. Use this free resource to find opioid addiction help that matches your location, preferences and clinical needs.