How to tell if a loved one is abusing opioids

Signs of opioid abuse may be hard to see clearly, especially in someone you love.

By Mayo Clinic Staff

How to tell if a loved one is misusing opioids

Is your family member or friend using opioid medicines in a harmful way? It may not be easy to tell, especially in the early stages of addiction. Maybe you've seen changes in your loved one's moods or behavior. Or maybe you have a feeling that your loved one is misusing opioids, even if you're not sure. If you're right, speaking up could save the life of someone dear to you.

Ask yourself some questions about your loved one's personal risk of opioid use disorder and the changes you've seen. Reach out to your loved one's healthcare professional if your answers point toward a possible addiction. The healthcare professional is an important partner if you decide it's time to take action.

What are the chances my loved one could be addicted?

When taken as directed for a limited time, opioids are not likely to lead to addiction. But taking them for a long time and not following directions raises the risk of misuse and opioid use disorder.

Your loved one also is at greater risk of opioid use disorder if they get opioids without a prescription. And using opioids illegally increases the risk of drug-related death. Illegal drugs taken without a prescription may include substances that could be deadly. These drugs also may contain opioids that are much more powerful than medicines prescribed by a healthcare professional, such as fentanyl and carfentanil. People who use opioids illegally often turn to heroin and street fentanyl. They are often cheaper and have similar effects.

Some factors raise the risk of opioid use disorder, even before people start taking these drugs. The risk is greater if your loved one:

  • Is younger, especially in the teens or early 20s.
  • Has a personal or family history of alcohol or other substance misuse.
  • Is living with stress, including being unemployed or living below the poverty line.
  • Has a history of problems with work, family and friends.
  • Does poorly in school and doesn't value education.
  • Has had legal problems in the past, including being cited for DUI.
  • Struggles with serious depression, anxiety or post-traumatic stress disorder, also called PTSD.
  • Has a history of physical or sexual abuse.
  • Takes part in risk-taking or thrill-seeking behavior.
  • Uses tobacco heavily.

Opioid use disorder also is due to other issues: genes, physical health, mental health and surroundings. It can happen quickly or after many years of opioid use. Anyone who takes opioids is at risk of becoming addicted. This is true no matter your age, social status or ethnic background.

What changes have you noticed?

People who are addicted to opioids still may hold down jobs and seem stable at work and home. But over time, the opioid use disorder is likely to lead to serious problems. When addicted to a drug, a person will continue to use the drug even when it makes life worse.

Watch for these common signs of opioid use disorder:

  • Regularly takes an opioid in a way not meant by the healthcare professional who prescribed it. This includes taking more than the prescribed dose or taking the drug for the way it makes a person feel.
  • Takes opioids "just in case," even when not in pain.
  • Focuses daily activities on how to get opioids.
  • Changes in moods, including extreme swings from joy to anger.
  • Borrows medicine from others or "loses" medicines to get more prescriptions written.
  • Seeks the same prescription from multiple healthcare professionals to have a "backup" supply.
  • Makes poor decisions, including putting self and others in danger.

If a relative or friend is addicted to opioids, you're also likely to change your thoughts and behaviors. You may:

  • Worry about your loved one's drug use. You could have long-term anxiety or full-blown fear that your loved one is going to die.
  • Lie about or make excuses for your loved one's behavior.
  • Stay away from your loved one so you don't have to confront the person or deal with their mood swings.
  • Think about calling the police or call them when your loved one uses illegal drugs.

It's common not to talk about your concerns because you fear that your relationship or family will fall apart. You may convince yourself that you'd know it was time for action if your loved one's addiction was truly serious. Even healthcare professionals may overlook common signs of opioid misuse if they feel they know the person and don't look for signs in an objective way.

Some opioid use disorder experts now recommend that healthcare professionals interview family members as part of routine follow-up care for a person taking opioids. But don't wait to be asked before you voice your concerns. A person addicted to opioids — or any substance — is much more likely to recover if the family doesn't ignore the issue. If you think your loved one may be addicted to opioids, talk with their healthcare professional right away. Together, you can come up with the best next steps.

Mayo Clinic Minute: The face of prescription opioid addiction

Vivien Williams: The face of addiction is changing. What once seemed relegated to desperate souls hiding in the shadows now impacts our friends, families and coworkers. More people are addicted to opioid painkillers than ever before.

Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): I believe that in the past 20 years, the indication and the setting in which opioids are provided has changed dramatically.

Vivien Williams: Mayo Clinic pain management specialist Dr. Michael Hooten says that's good and bad. People are able to get relief from severe pain, but they're also able to get prescriptions for opioids when less addictive options such as ibuprofen may work just as well.

Mike Hooten, M.D.: If they are predisposed to develop addiction, either neurobiologically or from a behavioral perspective, then all of a sudden, we are selecting the individuals who may go on to have long-term problems.

Vivien Williams: And with addiction comes the possibility of accidental overdose. Every day 78 people in the U.S. die from opioid-related overdoses.

Vivien Williams: Dr. Hooten says educating people about the dangers of opioid misuse may be an important step in managing this public health crisis. For the Mayo Clinic News Network, I'm Vivien Williams.

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Jan. 19, 2024 See more In-depth

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