Why is everyone addicted to opioids? A five minute primer.

Unless you’re the masochistic type, you likely manage life’s extreme aches and pains with medications. But sometimes Tylenol and a few ibuprofen just won’t cut it, and you need something more powerful.

All medical students take an oath to do no harm. But have healthcare professionals inadvertently been harming patients with opioid medications? And how can you know if taking one Percocet will lead to full-blown addiction?

What are opioids?

Opioids are a class of medications that includes fentanyl, oxycodone, morphine, hydrocodone, hydromorphone, codeine, and methadone, as well as the illegal drug heroin. All mimic the effects of opium, which is derived from the flowering plant known as the opium poppy. These drugs bind to areas of the brain that control pain and trigger the release of a chemical called dopamine, which causes feelings of euphoria.

Unfortunately, their euphoric and pain-relieving effects make opioids a slam-dunk for abuse.

Opioids come in many different forms – including pills, sublingual tabs, transdermal patches, and intramuscular and intravenous solutions. Some pills are formulated to slowly release their contents over time, rather than all at once; the most popular example is Oxycontin (oxycodone + continuous release).

Some opioids are much more potent than others. For instance, fentanyl is much more potent than oxycodone, which is more potent than morphine, which is more potent than codeine.

Hydromorphone, oxycodone, and codeine also come in combination pills with aspirin, Tylenol, and ibuprofen. (For example, Percocet is the combination of oxycodone and Tylenol, while Vicodin is hydrocodone and Tylenol.) Take care when using these pills, as you could inadvertently overdose on Tylenol (>4000 milligrams per day) if you’re also taking it separately. Unfortunately, Tylenol overdose can cause liver failure and be just as deadly as opioid overdose.

When is it appropriate to take an opioid?

Prescription opioids are ideal for relieving pain related to cancer or surgery. Mild opioids are sometimes prescribed for cough suppression and the treatment of acute diarrhea (since opioids cause constipation).

Opioids are generally safe when prescribed by a physician at a low dose for a short time period. Before starting an opioid, you should tell your doctor if you have any family or personal history of substance abuse; in these cases, you may consider an alternative medication class. Also, inform your doctor of all your other medications, as opioids can have dangerous interactions (e.g., with sleeping pills and antidepressants).

Obviously, you should never take an opioid that was prescribed for a different problem in the past, or was prescribed to someone else.

How addictive are opioids?

People who use opioids for weeks or months can develop a tolerance, meaning they need higher doses to achieve the same pain reduction and euphoria. People can also become dependent, meaning their bodies have become so habituated that stopping will cause withdrawal (e.g., sweating, diarrhea, vomiting, rapid heart rates, tremor, sleep disturbance). Finally, individuals can develop addiction, which refers to continued drug use despite adverse outcomes.

Can prescription drug use lead to heroin addiction?

Yes. In many areas, heroin is cheaper and easier to obtain than prescription opioids. Indeed, most heroin users were previously hooked on opioid pills.

Can you die from an opioid overdose?

Yes. High doses of opioids can suppress the breathing reflex so much that it stops altogether. Some opioids, like fentanyl, are so powerful that only a small amount is needed to cause overdose.

What does an overdose look like?

The main findings are pinpoint pupils, slow breathing, and confusion / sleepiness.

What’s naloxone / Narcan, the opioid “antidote”?

Naloxone is a medication that blocks opioids from triggering receptors in the brain, reversing their effects. It can be obtained over the counter and should be urgently administered to anyone suspected of overdose. Many police officers and paramedics carry naloxone with them at all times.

What should you do if you or someone you know are addicted to opioids?

Get help. There are many effective treatments, including group counseling, individual counseling, and inpatient rehab. Several medications, such as methadone and buprenorphine, can also help reduce withdrawal symptoms and facilitate the road to recovery.


Marc Eisenberg, M.D., F.A.C.C.

Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at Columbia University Medical Center and an attending cardiologist at NewYork-Presbyterian Hospital.

Christopher Kelly, M.D., M.S.

Christopher Rehbeck Kelly, M.D., M.S., is a cardiologist at North Carolina Heart and Vascular and UNC Rex Hospital in Raleigh, North Carolina.