Opioids interfere with pain signals in the brain, but they also have unwanted effects. Long-term opioid use can cause changes to your brain that make it harder to stop using them.

Opioids are a class of drugs that includes prescription pain relievers and illegal substances such as heroin. They work by binding to opioid receptors in your brain and body. This can cause a number of effects, including a decrease in your ability to feel pain and a sense of euphoria.

Prescription opioids such as oxycodone and hydrocodone aren’t inherently dangerous or bad for you. Doctors rely on them to help you manage severe pain resulting from an injury, surgery, or illness.

But when people use opioid drugs for too long, misuse them, or get them illegally, they can pose serious risks. This includes the risk of dependence, addiction, and accidental overdose.

Long-term opioid misuse can change the way your brain works, affecting your ability to think clearly and making it very difficult to quit.

In this article, you’ll learn how opioids can affect your brain and body. You’ll also learn about why opioids have a high risk of dependence and how to use them safely to treat your pain.

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.

At the cellular level

Opioids work by activating three types of opioid receptors (mu, delta, and kappa), which are part of a family of proteins called the G-protein-coupled receptors. Receptors exist on the surface of cells. They help cells receive messages that tell them what to do.

New research suggests that opioids also act on receptors inside of cells — specifically, receptors in the Golgi body, an important area of your cells. This means opioids might actually be changing your cells from the inside out.

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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.

Opioids and sleep disorders

Chronic opioid use can increase your risk of breathing disorders such as central sleep apnea. It can also affect the quantity and quality of your sleep. You may not get enough sleep at night and might be more fatigued during the day.

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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

What to do if you need help

The Substance Abuse and Mental Health Services Administration (SAMHSA) runs a free, confidential hotline that’s available 24/7.

Call 1-800-662-HELP (4357) or text your ZIP code to HELP4U (435748) to start your journey today.

You can also search for a treatment facility near you with SAMHSA’s online resource database.

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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.

How to handle an emergency

Symptoms of opioid overdose include slowed breathing, clammy skin, and unconsciousness. A person’s lips or fingernails may look discolored and they may make gurgling or choking sounds.

It’s always better to be safe than sorry. If you suspect an overdose, act fast:

  • If the person is unconscious, try to stir them by calling out their name or tapping their chest or shoulder with your knuckles (the tap-shout-tap method).
  • Call 911 or local emergency services immediately if the person isn’t waking up or isn’t breathing.
  • Administer NARCAN if you have it. NARCAN (naloxone) reverses the effects of an opioid overdose.
  • Give the person rescue breaths. Rescue breathing is necessary when someone stops breathing — CPR is used when someone’s heart isn’t beating. Pinch the person’s nose and breathe into their mouth every 5 seconds for 30 seconds.
  • Move the person onto their side to prevent choking.
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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.