Painkiller Addiction, Abuse, and Symptoms

How painkillers affect the brain

The National Survey on Drug Use and Health groups numerous prescription painkillers together, including methadone, Demerol, and any products containing oxycodone, hydrocodone, codeine, buprenorphine, morphine, oxymorphone, hydromorphone, fentanyl, and tramadol. Any opioid-based painkiller affects the brain similarly.

The brain is full of molecules called receptors that receive signals from other parts of the body. Opioids attach to these receptors and block pain messages being sent to the brain, which is why they’re used in painkillers. They also cause large amounts of dopamine to be released in the brain’s pleasure center, which floods the body with feelings of pleasure, well-being, and euphoria. This reward encourages a person to repeat the behavior to recapture this feeling. Over time, taking opioid-based painkillers can change the brain, leading to dependence and addiction.

Behavioral signs of painkiller usage and abuse

Once a person develops a tolerance and begins taking more painkillers, they’re at risk of becoming dependent on the drug, which can swiftly lead to addiction. Abusing painkillers can also lead to changes in behavior, including an inability to stop using even when the individual knows it’s causing health, psychological, personal, and/or financial problems.

An addicted person may spend an excessive amount of time and money maintaining their drug supply, even when they can’t afford it and/or must get pills illegally. Their preoccupation with using painkillers may lead to frequently missing school or work, causing a drop in grades or work performance. They may cut back on activities due to drug use or completely lose interest in activities they previously enjoyed.

Friends and family members also may notice drastic changes in their behavior, such as being secretive about their whereabouts and/or activities, borrowing money with poor excuses for why it’s needed, and doing things they wouldn’t normally do. The individual may become withdrawn and isolated from people who care about them. Friends and family may also notice that the individual has become more irritable and lost interest in grooming or how they look.

As addiction progresses and a person isn’t able to get enough painkillers through legal prescriptions, they may turn to risky behavior, such as forging prescriptions or borrowing or stealing pills from family or friends. About 51.3% of people who misused pain relievers in 2018 got the last pills they misused from friends or relatives, while about one in 15 bought them from a drug dealer or other stranger. For some people, opioid-based painkillers can be a gateway to illicit drug use, because it affects the body similarly to heroin, and they may be able to get heroin on the street easier than painkillers.

Early physical effects of painkillers

Not everyone has side effects from painkillers, especially when taken appropriately. Misusing painkillers increases the likelihood of short-term physical effects, but these effects heavily depend on the dose, how it’s taken, and previous experience with the drug. Some of the more common side effects include drowsiness, nausea, vomiting, pupil constriction, and flushed face and neck. Some people may also experience dizziness, slow or shallow breathing, itching, confusion, hallucinations, or trouble urinating.

Severe and long-term physical effects of painkillers

Like short-term effects, the long-term physical effects can differ depending on the painkiller being abused and the length of abuse. Chronic users who develop a tolerance may begin taking higher and more frequent doses to achieve pain relief and/or the high they crave. As the dosage increases, the harmful effects become more pronounced.

Chronic use of opioid-based painkillers can adversely impact the person’s gastrointestinal, respiratory, cardiovascular, musculoskeletal, endocrine, immune, and central nervous systems. Some physical effects may be reversed after stopping use, but changes in the brain may be irreversible.

Physical dependence is highly possible with chronic use, and withdrawal symptoms are probable when a person stops taking painkillers. The intensity of the withdrawal symptoms is directly tied to the specific painkiller used, daily intake, time between doses, and length of abuse. Some people’s health and personality can play a role in the severity and duration of their withdrawal process. It can take days or even weeks for most physical symptoms to disappear.

Further Resources

Both the National Institute of Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer in-depth information on both the symptoms and treatment of prescription painkiller addiction.

Use of pharmaceutical opioids remains high globally

Nonmedical use of pharmaceutical opioids is a growing concern globally, but the highest prevalence in 2017 was in North America. Nearly 4% of the population aged 15-64 used opioids for nonmedical purposes, with pharmaceutical opioids, including oxycodone, hydrocodone, codeine, and tramadol, the primary concern. Opioids usage in Australia and New Zealand also remained much higher than the global average, impacting 3.3% of the adult population with nonmedical use of pharmaceutical opioids the top concern. Prevalence was also high in Asia, impacting 1% of the population.

Other notable areas included Afghanistan, where opium was the predominant opioid, but nonmedical use of pharmaceutical opioids was also substantial. Of Pakistan’s estimated 2.7 million opioid users, 1.6 million reported nonmedical use of pharmaceutical opioids. Heroin is the most prevalent opioid used in India, followed by nonmedical use of pharmaceutical opioids, which impacted nearly 1% of the general population. West and Central Africa also had high nonmedical pharmaceutical opioid usage, with 1.9% or about 5 million users and tramadol being the dominant substance.

Prescription painkiller misuse has declined from peak years, but usage remains a concern

Among the 9.9 million people aged 12 or older who misused prescription pain relievers in 2018, an estimated 5.5 million, or 2% of the population, misused hydrocodone products, making it the most commonly misused type of painkiller. These products included Norco, Lortab, Vicodin, Zohydro ER, and generic hydrocodone. Oxycodone products were the painkiller of choice for an estimated 3.4 million people, or 1.2% of the population, which included OxyContin, Percodan, Percocet, Roxicodone, and generic oxycodone. About 718,000 people misused buprenorphine products, 269,000 misused prescription fentanyl products, and 256,000 misused methadone.

OxyContin saw peak usage among 12th graders in 2005, with 5.5% of adolescents aged 17-18 using the drug that year. Peak usage for 10th graders was in 2009, with 5.1% of adolescents aged 15-16 using, and for 8th graders, it was 2006, with 2.6% of adolescents aged 14-15 using. Vicodin saw peak usage among 12th graders in 2003, with 10.5% using. Tenth-grader use peaked in 2009 with 8.1%, and 8th-grader use peaked in 2006 with 3%.

While the number of opioids prescribed peaked in 2010 then decreased annually through 2015, the amount prescribed per person was three times higher in 2015 than in 1999. Prescriptions for opioid-based pain relievers remain high and inconsistent across the country, varying widely from one county to the next.