How Opioids Affect Your Brain in the Long and Short Term

Opioids work by attaching to and activating opioid receptors in your brain, spinal cord, and other areas of your body. All opioids, whether natural or synthetic, prescription or illegal, target areas of the brain involved in the processing of pain and pleasure.

Opioids work to block pain signals sent between your brain and your body. This is why they have such a significant effect on pain.

Humans have been using various forms of opioids derived from the opium poppy for hundreds of years. Their addictive properties have been recognized for just as long.

Opioids activate the reward circuitry in your brain, flooding your body with dopamine, a feel-good neurotransmitter.

Your body makes its own feel-good chemicals called endogenous opioids. You may know them better as endorphins. They’re produced during certain activities, like exercise and sex, that your brain wants to reward you for. Endorphins make you feel relaxed and happy, which encourages you to repeat these healthy behaviors.

Opioids work in a similar way. Initially, they can provide pain relief and feelings of euphoria that are pleasurable and rewarding. But if you take opioids for too long, your brain will eventually start encouraging you to take more.

When you take an opioid, its effects on your brain and the rest of your central nervous system cause more than just pain relief. They affect areas such as:

• The limbic system: Opioids affect the limbic system, a part of your brain involved in emotions such as happiness and relaxation.
• The brainstem: Your brainstem controls automatic body functions such as breathing and metabolism. Opioids have a depressive effect on this system, which is why toxic levels of opioids can cause you to stop breathing.
• The spinal cord: Opioids may also affect the spinal cord, which is like a central highway for nerve cells traveling throughout your body. These effects may play a role in pain relief.

The immediate effect of opioids on the brain can cause:

• impaired decision making skills
• focus and concentration problems
• slowed reaction times
• euphoria
• sleepiness
• loss of consciousness
• confusion
• loss of awareness

Opioids can also cause accidental overdose and death. Overdoses are unpredictable and can occur regardless of how long you’ve been taking opioids or how high your tolerance is. Your body’s ability to safely metabolize opioids regularly fluctuates.

In the United States, people are more likely to die by opioid overdose than car crashes.

During an overdose, opioids lead to slowed breathing (hypoventilation), slowed heart rate (bradycardia), and low blood pressure (hypotension).

If you use opioids for more than a few weeks, you’ll develop a drug tolerance. This means your body becomes used to the drug, and you start needing a higher dose to achieve the same effects. If you’re regularly using opioids, you’ll eventually develop a tolerance whether you’re using an illegal substance or not.

You’ll eventually develop a tolerance even if you’re using your prescription medication exactly as prescribed.

Long-term opioid use also leads to physical dependence. This means that if you don’t take your regular dose, you’ll experience symptoms of withdrawal such as nausea and muscle aches.

Over time, your brain gets used to the presence of opioids and begins to adapt to their presence. It may reduce the amount of feel-good chemicals it creates on its own or become less sensitive to them, which means pleasurable experiences may no longer feel as pleasurable as they used to.

Instead, your brain will want the dopamine rush that opioid drugs provide. To make that happen, it can change the way you think about opioids, bringing the drugs to the forefront of your attention, and causing you to crave them all the time.

At that point, when you stop taking opioids, it will take some time for your brain to readjust and resume its normal processes. This in-between stage can create significant emotional disturbances such as depression.

Chronic opioid use has been shown to increase your risk of depression in the long term. If you’ve been taking opioids for a long time, you might want to talk with a doctor about a depression screening.

Opioid use disorder affects some 16 million people worldwide. It’s characterized by physical dependence, psychological dependence, or both, on opioids.

Dependency is rated on a scale from mild to moderate to severe based on the number of signs a person has.

Signs of opioid dependence, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria, include:

• taking higher doses over a longer period of time than originally prescribed
• craving opioids or spending a significant amount of time on activities to find opioids
• having issues with family, work, school, or relationships related to opioid use
• experiencing unsuccessful attempts to stop using opioids
• using opioids in situations that are physically dangerous (for example, driving)
• continuing the use of opioids even if they cause physical or psychological problems
• showing signs of either increased tolerance to opioids or exhibiting withdrawal symptoms when not using opioids

If you take your prescription pain medication exactly as directed, and don’t mix it with any other sedating medications, you shouldn’t have any problems. But it’s important to remain aware of the risks.

Here are some tips on staying safe:

• Always take your medications as directed.
• Pay close attention to the dosage and the time intervals between each dose, setting reminders if needed.
• Avoid drinking or taking other mind-altering substances when using opioid medications, as this can create serious drug interactions.
• If you have an acute injury, work with your doctor to transition to another medication once the worst of your pain is over.
• Store your medications out of reach of children and others. Consider putting opioids in either a safe, locked box, or concealed area.
• Don’t share your medication with anyone else.
• If you don’t need it anymore, dispose of your medication properly by taking it to an opioid dropbox.

Stay in close communication with your doctor and care team. If at any point you are concerned about dosage or side effects, reach out to them.

If you have had a bad reaction to, or dependency on, opioid medications in the past, inform your doctor.

Opioids act on your brain by simulating the effects of endorphins, our naturally occurring pain relievers. But opioid medications can quickly cause drug tolerance and dependency.

It’s essential you always take opioid medications as directed by a doctor, never share them with anyone else, and cease usage (or move to another medication) when possible.

Speak with a doctor about the benefits versus risks of taking opioid drugs.