Painkiller Addiction: Signs, Symptoms, Risks, and Treatment Resources

In most cases, painkillers are prescribed to alleviate the symptoms of injury, illness, surgery, and chronic pain. However, even prescription medications that are legally obtained can still lead to misuse and substance dependence.

The lack of pain and rush of dopamine experienced when taking prescription painkillers is what often leads to misuse, addiction, and, ultimately, more dangerous substances. Nearly 80% of heroin users report prescription painkiller misuse as the beginning of their substance use disorder.[1]

What are painkillers?

Different from NSAIDs and anti-inflammatories, prescription painkillers are opioid analgesics or narcotics legally prescribed to alleviate moderate to acute physical pain. They’re commonly administered to treat conditions such as fibromyalgia, arthritis, migraines and headaches, post-trauma or surgery pain, and chronic pain.

Prescription opioids act on the central nervous system (CNS) primarily as analgesics, affecting pain perception, though they also have depressant effects on the CNS. They block nerve receptors to reduce the feeling of pain and stimulate dopamine hormone production to induce a sense of calm and relaxation. Taking prescription opioids for long periods of time or in increasing dosage amounts can increase the risk of dependence, overdose, and even fatality. According to the 2021 National Survey on Drug Use and Health, more than 16,000 overdose deaths were related to prescription opioid use.[2]

Common prescriptions include hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®)

oxymorphone (Opana®), morphine (Kadian®, Avinza®), methadone, codeine, and in extreme cases, drugs such as fentanyl. Street names for some prescription painkillers include:[3]

• Cody
• Schoolboy
• Doors & Fours
• Loads
• Pancakes and Syrup
• Vike/Vikes
• Juice
• Smack
• Chocolate Chip Cookies
• O.C.
• Oxy
• Hillbilly Heroin
• Percs
• Apache
• Goodfella
• Jackpot

Effects Of Painkillers

Immediate or Short-Term Effects of Painkillers

When opioid painkillers enter your bloodstream, they activate opioid receptors in the central nervous system and other organs in the body that regulate sensations of pleasure and pain. As a result, pain signals are blocked, and large quantities of dopamine flood the body.

Patients taking prescription painkillers typically experience pain relief and may also feel calm. Some individuals might experience euphoria, particularly at higher doses.[4]

Side Effects of Painkillers

Common side effects of prescription opioids include:[5]

• Sedation
• Dizziness
• Nausea
• Vomiting
• Constipation
• Physical dependence
• Substance tolerance
• Respiratory depression or hypoxia

Long-Term Effects of Painkillers

Prolonged use of prescription painkillers, often defined as use beyond the initially prescribed period or over several months, can increase the risk of developing physical and psychological health issues, including:[6]

• Depression
• Anxiety
• Increased risk of overdose
• Serious fractures
• Impotence and infertility
• Osteoporosis
• Sleep disorders
• Dry mouth and tooth decay

How are painkillers taken?

Most painkiller prescriptions come in tablet form and are intended to be taken orally with food and water. The onset and duration of pain relief from prescription painkillers can vary depending on the specific medication, dosage, and individual patient factors, with some medications acting quickly and others designed for extended-release.

In a hospital setting, opioid painkillers are administered in several more invasive routes, including skin patches, intravenous injection, epidural, and rectal.[7]

Misused painkillers are often chewed, liquified, or crushed before being swallowed, smoked, or injected. This can lead to an increased release of the substance all at once, overloading the nerve-blocking powers and increasing the euphoric effect of dopamine release.

PainKiller Quick Reference

Learn About Specific Painkillers

• Fentanyl Addiction: Signs, Symptoms, Risks, and Treatment Resources
• Heroin Addiction: Signs, Symptoms, Risks, and Treatment Resources
• Suboxone Addiction: Signs, Symptoms, Risks, and Treatment Resources

Statistics On Painkiller Use, Misuse, And Addiction

According to the US Department of Health and Human Services, the opioid epidemic is still considered a public health emergency, a state in effect since 2017. Recent studies in 2019 revealed that over 10 million people misused prescription opioids within the last year, and 1.6 million people were diagnosed with Opioid Use Disorder (OUD).[8]

According to the Tennessee Bureau of Investigation, approximately 70,000 residents are currently addicted to opioids, which ranks Tennessee as third in the US for prescription drug abuse.[9]

New Jersey faces a similar opioid abuse crisis, reporting 3,000 deaths from opioid overdose in 2018.[10] It is an issue that cannot be ignored.

Effects Of Painkiller Abuse

Misusing painkiller medications can temporarily increase their positive effects as well as negative effects, which could be dangerous or fatal. Significant effects of abuse include:

• Respiratory depression
• Low blood pressure
• Reduced memory
• Painkiller tolerance (requiring increased doses)
• Depression
• Coma
• Overdose
• Death

Can You Overdose On Painkillers?

Yes. Painkillers can lead to a potentially fatal overdose, especially when misused or mixed with other substances.

Signs And Symptoms Of Painkiller Overdose

If you or a loved one are experiencing one or more of the following signs of a potential opioid overdose, immediately call 911 to receive rapid medical attention.[11]

• Pale face
• Clammy
• Limp limbs or body
• Blue extremities
• Vomiting or gurgling
• Unconsciousness
• Slowed breathing
• Slow heartbeat

Resources for Painkiller Overdose

In addition to developing awareness of the signs of overdose, knowing how to help in extreme circumstances is empowering. Administering naloxone in the event of a painkiller overdose, which has been made more widely available in the US, can potentially save lives.

New Jersey has a naloxone distribution and training program. Tennessee has Regional Overdose Prevention Specialists throughout the state who provide overdose awareness training and naloxone distribution.

Mixing Painkillers With Other Drugs

Prescription painkillers are CNS depressants that slow brain activity, breathing, and heart rate. Taking them with other CNS depressants like benzodiazepines, barbiturates, sleep medications, or alcohol can increase the effects of both and lead to dangerous symptoms or overdose.

Painkiller Addiction and Abuse

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), addiction to painkillers, officially labeled Opioid Use Disorder (OUD), at least two of the following criteria must be present within 12 months:[12]

• Taken in more significant amounts or for longer
• Unsuccessful efforts to control opioid use
• Time spent getting, using, or recovering from painkillers
• Strong cravings
• Failure to fulfill obligations at work, school, or home
• Continued painkiller use despite consequences in physical health or life
• Neglecting formerly beloved activities
• Use in physically hazardous situations
• Continued painkiller use despite consequences to psychological health
• Painkiller tolerance
• Painkiller withdrawal symptoms

Signs of Addiction to Painkillers

Identifying painkiller addiction can be identified by the following indicators:

• Itchy skin
• Poor coordination
• Frequent laxative use due to chronic constipation
• Erratic behavior
• Paranoia
• Pinpoint pupils
• Mood swings
• Regularly running out of medication early
• Taking medication in off-label routes (chewing, crushing, etc.)

Painkiller Withdrawal Symptoms

Once your brain and body have developed a physical dependence on painkillers, you may experience the following withdrawal symptoms if you stop taking them suddenly:[13]

• Flu-like symptoms (fever, chills, runny nose, etc.)
• Goosebumps
• Muscle aches and pains
• Diarrhea
• Vomiting
• Dilated pupils
• Sensitivity to light
• Insomnia and yawning
• Physical anxiety symptoms (sweating, heart palpitations, dry mouth, etc.)

Painkiller Withdrawal Management and Addiction Treatment

Substance use treatment services offer withdrawal symptom Management in the earliest stages of addiction recovery. Practical support and assistance are available from medical detox placement and Partial Hospitalization Programs (PHP) to Intensive Outpatient Treatment and aftercare. During treatment, you will learn valuable coping skills, build healthier habits, and restore your life to what it was always meant to be.

Therapies Used In Painkiller Addiction Treatment

Both individual therapy and group therapy offer a wealth of benefits that are essential for painkiller addiction recovery. Some common therapeutic modalities include:

• Eye Movement Desensitization and Reprocessing (EMDR)
• Cognitive Processing Therapy (CPT)
• Dialectical Behavior Therapy (DBT)
• Cognitive Behavioral Therapy (CBT)
• Narrative Therapy

Drugs Used In Painkiller Addiction Treatment or Withdrawal Management

There are several medications prescribed to ease painkiller withdrawal symptoms, reduce cravings, and advance recovery. While not everyone is a good fit for medication-assisted treatment (or MAT therapy), it can increase the likelihood of ongoing sobriety.

Treatment Drugs Used In Painkiller Addiction Treatment or Withdrawal Management Include:

• Methadone
• Naltrexone
• Buprenorphine
• Buprenorphine/Naloxone
• Lofexidine
• Naloxone[14]