When patterns of opioid use cause significant distress or impairment, you may be experiencing opioid use disorder. While anyone who uses opioids can develop this condition, certain risk factors increase its likelihood.

Opioid use disorder (OUD) is a mental health condition that occurs when problematic behaviors of opioid use lead to impairment in functioning. Opioid tolerance, continued use despite negative consequences, and rearranging life to use opioids are all core symptoms.

Opioids, which include opiates, are substances like morphine and heroin that work by binding to the natural opioid receptors in your brain. Opioids are used primarily for pain management, but they can also induce pleasure and calm, affecting the brain’s reward system and reinforcing the behavior of use.

Because all people have opioid receptors in their brains, using opioids can cause OUD in anyone. However, certain factors and circumstances can increase your risk of this specific type of substance use disorder (SUD).

Factors and circumstances that increase the likelihood of an outcome are called risk factors. Risk factors can raise your chance of developing OUD, but they aren’t a guarantee you’ll experience OUD if you take opioids. OUD can occur even when you have no risk factors.

Usage-related risk factors

How often you take opioids, their dose, and how long you use them all matter. Usage-related risk factors that can influence OUD development include:

  • taking opioids at high doses (even if under medical guidance)
  • long-term opioid use
  • using opioids without a healthcare professional’s guidance
  • taking opioids too often or in higher quantities than prescribed (opioid misuse)
  • using opioids with the highest potential for addiction, such as fentanyl or heroin
  • multiple-opioid use or mixing opioids with other substances

Personal risk factors

Individual risk factors are unique to you. They can include aspects of your personality, your past experiences, current health conditions, and your genetics. Personal factors that can influence OUD risk include:

  • being between the ages 18 to 25 years
  • living with a mental health disorder
  • personal and/or family history of alcohol or substance misuse
  • living with a chronic pain condition
  • experiencing childhood trauma
  • starting opioid use at an early age
  • having prominent personality traits of impulsivity or novelty-seeking (new experiences)
  • unhelpful coping styles or lack of coping skills

Environmental risk factors

Environmental factors refer to external forces in the world around you that can influence daily life, including decisions you make. OUD environmental risk factors include:

  • peer pressure
  • poverty
  • unemployment
  • housing instability
  • lack of supportive relationships
  • limited access to quality and culturally relevant healthcare
  • growing up in a culture supportive of opioid use

An opioid risk model (ORM) is a broad term that collectively refers to various risk assessment tools and models doctors use to determine opioid misuse risk.

Within many ORMs is the Opioid Risk Tool (ORT), a brief, self-reported screening test to help evaluate your personal risk level for OUD. It was developed in 2005 for adult patients in primary care settings, to be used before starting any opioid treatment.

The ORT consists of five categories that represent highly influential risk factors in OUD. Each risk factor is broken down, if possible, and scored from 0 to as high as 5. Males and females are scored separately to account for risk factors that might be elevated by sex.

Altogether, the ORT looks like this:

Risk factorFemaleMale
Family history of substance misuse
Alcohol13
Illegal drugs23
Prescription drugs44
Personal history of substance misuse
Alcohol33
Illegal drugs44
Prescription drugs55
Age between 16 and 45 years11
History of preadolescent sexual abuse30
Psychological disorders
ADHD, OCD, bipolar, schizophrenia22
Depression11

Scores of 3 or below suggest a low risk of future opioid misuse. Scoring 4 to 7 indicates moderate risk. If you score 8 or higher, you’re considered to be at high risk for opioid use behaviors that might lead to OUD.

The ORT is not definitive. It cannot prove someone will or will not develop opioid misuse behaviors, but it can provide insight to prescribing doctors who may want to consider other pain management options or additional monitoring procedures.

Your ORT score is combined with other factors, such as patient characteristics, clinical history, and psychosocial influences to determine your overall ORM. Talk with your doctor to better understand your risk levels.

Opioid misuse in gender-diverse populations

While there is less research on opioid use in transgender and gender-diverse people than in the cisgender population, the current literature indicates that trans people are at a higher risk for opioid misuse.

One study from 2021 showed not only that transgender participants had a higher rate of opioid misuse but also that they lacked access to treatment programs. The research also indicated that opioid misuse was tied to unmet mental health needs.

Learn about how social stigma and lack of support can cause a higher risk of drug misuse in the LBGTQ+ community in this article.

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In the late 1990s and early 2000s, pharmaceutical companies aggressively marketed opioid medications, particularly OxyContin (oxycodone) and Vicodin (hydrocodone), as safe, effective pain management options.

During that time, the addictive properties of these products were downplayed and concealed from prescribers, and direct-to-consumer advertising campaigns targeted patients rather than the medical community. Healthcare professionals were also offered financial incentives based on opioid prescribing volume, which promoted over-prescribing.

Opioid use was normalized, and by 2009, more than 1 million emergency department visits were directly related to the misuse and abuse of these prescriptions.

How to get help for opioid misuse or addiction

Recovery from opioid misuse and addiction is possible. Support is available in a variety of forms, from confidential phone conversations to supervised recovery in care facilities. You can connect with OUD resources by:

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Opioid use disorder, or OUD, is defined by impairing patterns of opioid use that negatively affect everyday life.

While anyone who takes opioids can develop OUD, certain risk factors can increase your chances of experiencing this type of SUD. Opioid use behaviors, personal factors and circumstances, and environmental influences can all impact your individual risk for OUD.