Experts detail the signs a loved one might be addicted to prescription painkillers and what you should do about it.

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Mood swings and drowsiness are two of the signs a friend or loved one could be addicted to opioids. Getty Images

Actress Jamie Lee Curtis managed to hide her opioid addiction for a decade.

“I had a 10-year run, stealing, conniving. No one knew. No one,” the star of “Halloween” said in a recent issue of People magazine.

The admission brings up some important questions.

How does someone hides such a debilitating addiction?

And how do those who love them not notice?

You might think it doesn’t pertain to you, but if you’re a parent, sibling, or friend, it just might.

“Our own research demonstrates that 90 percent of all substance use disorders begin in the teenage years, and the majority of those who misuse opioids first access these drugs from family or peers, not their doctor,” Molly Bobek, director of clinical implementation at the Center on Addiction, told Healthline.

Every day, 115 of those loved ones die in the United States from opioid misuse.

Stopping this pattern means saving lives.

But first, you have to know the warning signs.

Knowing the risk factors and signs is the first step in helping a loved one.

“Substance use often emerges as a coping strategy for traumatic experiences,” said Bobek.

This can perpetuate intergenerational cycles of addiction.

“Substance use can cause trauma for the person using the substances as well as those around them,” Bobek explained.

Dr. Lawrence Weinstein, the chief medical officer at American Addiction Centers, told Healthline he wants families to know opioid addiction “causes people to behave in ways that they would never behave under normal circumstances, and sometimes this behavior can be destructive.”

“This is not who they are, these are symptoms of the disease,” he added. “Addiction is not a moral failing by any stretch of the imagination. It is a disease that must be managed, just like hypertension or diabetes.”

Bobek reminds us that while “families can be profoundly affected by a loved one’s addiction or substance misuse,” they also “play a vital role in supporting a loved one with a substance use disorder, and can contribute to changing the trajectory of the problem by compassionately working to motivate their loved one to seek evidence-based treatment.”

Weinstein said some common signs a loved one may have an opioid addiction include:

  • continued use of the substance even when there are negative repercussions
  • noticeable drowsiness or sedation
  • slowed breathing
  • constricted pupils
  • nodding off intermittently or losing consciousness
  • mood swings
  • extra pill bottles in the trash
  • withdrawal symptoms that can mimic flu symptoms
  • defensiveness if you approach them about your concerns
  • drug paraphernalia in or around the user’s bedroom or living space; things such as vials, needles, rubber tubing, and spoons that are bent or burned on the bottom, could indicate heroin misuse

“There is a difference between a physiological dependence and addiction, in which someone uses opioids compulsively and continues to use despite experiencing negative consequences,” noted Bobek.

“It is important for loved ones to try to distinguish between these two phenomena when they’re worried about a loved one,” she added.

Experts say we should remember that opioids have medical value for many people with chronic pain who don’t misuse them. Not everyone who uses prescription opioids becomes addicted.

“There are some people, such as chronic pain patients, who can take opioids for years to keep their pain at bay, and there are others whose addiction begins after taking opioids for a sprained ankle,” explained Weinstein. “There are others who have an increased risk of suffering from addiction based on their genetic makeup.”

Dr. Anthony Campbell, clinical specialty consultant with the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, told Healthline there’s a distinct difference between addiction and substance use disorder.

A substance use disorder is the “recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe,” Campbell explained.

He added that addiction is defined as the most severe, chronic form of substance use disorder.

This is when the person experiences substantial loss of self-control.

Weinstein said “it can be difficult to tell the difference between the pangs of adolescence and actual drug use, but parents can be proactive in talking to their teen to find out what’s going on.”

These are some of the signs parents can watch for:

  • drop in grades
  • bloodshot eyes
  • laughing for no reason
  • loss of interest in activities
  • poor hygiene
  • diminished personal appearance
  • avoiding eye contact
  • frequent hunger or “munchies”
  • smell of smoke on breath or clothes
  • secretive behavior
  • unusual tiredness
  • missing curfew

“One in five parents who suspect their teen is using drugs do not intervene to prevent further drug use,” Weinstein said.

He advises parents to “ask straightforward questions… in the right tone.” This means with compassion and understanding.

“Simply asking, ‘Have you been using drugs or alcohol?’ or ‘Has anyone offered you drugs recently?’ can be enough to get the conversation started,” Weinstein said.

Weinstein reminds us that “addiction is an indiscriminate, insidious disease that can affect people of all ages, genders, and ethnicity.”

Still, some of us are at greater risks of addiction than others.

Campbell shares that while psychosocial issues and chronic pain are risk factors, genetics account for 40 percent to 60 percent.

Risk factors also rise with the duration of prescription opioid use.

“Research demonstrates that the longer one uses prescription opioids, the greater the risk of developing addiction or a dependence that is problematic for one’s life,” Bobek said.

“We also know that a personal history of substance misuse, stress, trauma history, and mental health and emotional difficulties also function as risk factors,” she added. “People should be in conversation with their health care providers if they believe they are at risk.”

Weinstein outlined some questions to consider when assessing risk from someone taking prescription pain killers:

  • Have they noticed that their prescription doesn’t last as long as it’s supposed to?
  • Have they developed a tolerance?
  • Are more and more pills needed to achieve the desired effect?
  • Do they have issues sleeping?
  • Are they slurring their speech?
  • Are they becoming more forgetful or seemingly lacking coordination?
  • Do they suffer from headaches, nausea and/or general body aches that are only relieved by taking another pill? Those are actually withdrawal symptoms and the person is taking the drug not because of pain, but because the withdrawal is uncomfortable and undesired.

“People should be in conversation with healthcare professionals if they experience themselves at risk of misusing their opioid prescriptions, and should always take their medication as prescribed,” Bobek said.

Another key to keeping safe, Bobek says, is that “if someone is experiencing a non-opioid substance use disorder or mental health problem, they should seek evidence-based treatment to reduce their risk of opioid use disorder.”

Weinstein offers advice for loved ones who are concerned.

“The most important thing to note is that your loved one isn’t bad, weak, or anything of the sort,” he said. “Addiction is a chronic and relapsing disease. Approaching them from this mindset will make them feel cared for rather than judged, blamed and attacked for something they can’t control.”

Then, Weinstein suggests, “Assure your loved one that you care for them,” and “describe to them the behaviors you’ve seen and express your concerns.”

“This conversation must happen in such a way that the loved one does not feel badgered or as if they are being scolded,” Weinstein continued, emphasizing the importance of “allow[ing] them to respond and speak as well” and “encourag[ing] your loved one to seek help.”

Weinstein ended by saying, “Explain to them that you know that they are sick and that you are willing to support them in whatever is needed to get them the help they need.”

And as far as treatment options goes, Bobek says, “There is no one-size-fits-all approach for recovery. Every client has a different journey. Nevertheless, MAT (medication-assisted treatment) is the only scientifically proven treatment for OUD (opioid use disorder), and that’s a fact that can be deadly to ignore.”

If you are concerned about your own opioid use or risk factors, reach out to your doctor and mental health professional.

Early intervention can save lives.

Opioid addiction is a life-threatening disease that doesn’t discriminate, but some people have higher risk factors than others.

Genetics, psychosocial issues, and chronic pain are common risk factors.

Signs of addiction include a decreased capacity to maintain a functional school, work, or home life, and a loss of self-control when it comes to consuming drugs, regardless of any negative consequences.