Can addiction happen with a prescribed opioid medication?

Navigate the fine line between opioid dependence & addiction. Understand the crucial distinctions, risks, and how to ensure safe prescription practices.

Ophelia team
Prescription opioid pills
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Fact checked by
Erica Lyons, DNP, MS, APRN, FNP-BC

Many people are hesitant to take prescribed opioids for pain following surgery or a major injury. Even when taken properly and medicinally, there is still a risk associated even with a prescribed opioid dosage. Opioids are widely known to be addictive; however, how can someone tell the difference between addiction and dependency?

This guide discusses the differences between the body’s response to opioids as addictive or dependent, as well as ways to help decrease the potential for either circumstance to occur.

Why is understanding the distinction between dependence and addiction important?

According to the Centers for Disease Control and Prevention, over three-quarters of overdose-related deaths in 2021 involved opioids, for a total of over 80,000 fatalities. The opioid crisis is a clear and present danger across the country, and accurate information is crucial to help both individuals and institutions make informed decisions about the use of prescription opioids. 

The conflation of physical opioid dependence and addiction can have serious consequences in an individual’s life. When taking longer treatments, it’s not unusual for a person to experience dependence without experiencing true addiction. Mislabeling the former as the latter may cause the patient to face loss of access to necessary medication and treatment, and even loss of work or housing. This destabilization of a patient’s life in the middle of treatment can be disastrous. 

Dependence vs. addiction: What is the difference?

Opioid dependence

As with many substances – whether taken medicinally, illicitly, or recreationally – the human body has a tendency to develop an increasing tolerance to opioids during periods of prolonged usage. In effect, this means that a static dosage of a prescription opioid will become less and less effective at managing pain when used for more than a few weeks in a row. 

To continue managing symptoms, healthcare providers may increase the dose of a patient’s prescription. While this is safe when managed properly by a healthcare professional, it does mean that patients may be responsibly taking a much stronger prescription by the end of their treatment than they were at the beginning.

While such treatment is ongoing, the body begins to understand that the presence of opioids is consistent and reliable. Eventually, the body begins to rely on opioids to help regulate everyday processes. This is what’s known as opioid dependence — the body’s physical need to maintain an opioid in the system to function normally. If a patient discontinues the use of their opioid prescription during this time, they are likely to experience the symptoms of withdrawal, which can be particularly uncomfortable and even unsafe with opioids.

Opioid addiction

Despite the fact that the body is now physically dependent on opioids, a patient in this situation isn’t necessarily addicted to their prescription medication. Addiction involves a psychological component that makes opioid use much riskier. 

People who are experiencing opioid addiction as a result of ongoing prescription opioid use are likely to have stronger cravings for opioids, feel the need to take their prescription more frequently, and exhibit changes to their personality, such as irritability and mood swings, especially between doses.

Opioid addiction is also much more likely to occur if a patient has a pre-existing risk factor. In particular, children, young adults, and the elderly are more likely to develop addiction when using prescription opioids. The same is true of people with a personal or family history of mental health problems, people who are prone to other addictions such as alcohol or tobacco, and people experiencing poverty, unemployment, or homelessness.

How can healthcare providers reduce the risk of opioid addiction?

Despite a prevailing belief that opioid addictions are maintained primarily through illicit acquisition and use of the drugs, the truth is that many addictions start with prescriptions and are maintained by them. People with opioid use disorder (OUD) often get their opioids directly from a doctor or through family and friends who acquire the drugs through a prescription. However, healthcare providers can still take steps to mitigate this risk and prescribe safely.

Perhaps the most important action healthcare providers can take is to critically evaluate the need for such strong medications for pain management and try other methods first. Opioids are not the only painkillers available, and it’s possible that a portion of patients who receive prescriptions could manage pain effectively without the need for opioids. Instead of being a default, these drugs may be better used as a last resort. 

When a healthcare provider does decide to prescribe opioids, they should do so carefully and be closely involved in the process. By carefully calculating a dosage and scheduling regular checkups with patients to evaluate the need for continued treatment, a healthcare professional can help patients reduce the risk of unintentional addiction. They can determine an appropriate stopping point for the treatment, and they can also gather patient feedback and identify potential addiction sooner.


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