What is the Difference Between Opioid Dependence vs. Addiction?

Know the Difference Between These Often Misused Terms and Why It Matters

Opioids, sometimes called narcotics, are a type of drug generally used to alleviate pain. While they can be effective in managing pain, unfortunately, opioids and their synthetic variants can be highly addicting. According to the U.S. Department of Health and Human Services, in 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year. Specifically, 9.7 million people misused prescription pain relievers, and 745,000 people used heroin.1

With such staggering numbers of opioid misuse, it’s crucial to get this crisis under control and understand the warning signs when someone may become dependent on opioids. While often used interchangeably, opioid addiction and dependence are not the same. The distinction is essential for patients and healthcare providers to understand so they can recommend the best treatment options. 

Below, we’ll describe the difference between opioid dependence and addiction and detail the risk associated with using the class of narcotics.

What Are Opioids?

To understand the differences between opioid dependence and addiction, it’s first important to understand what opioids are. Below, we’ll discuss how opioids are defined.

Opioid Definition

According to Medline Plus, opioids are a class of drugs which include strong prescription pain relievers, such as oxycodone, hydrocodone, and tramadol. Heroin, an illegal drug, is also an opioid. Some opioids, such as morphine, are made from the opium plant, and others, like fentanyl, are synthetic.

Synthetic opioids are created in a laboratory and target the same areas in the brain as natural opioids (e.g., morphine and codeine) to produce pain-relieving effects. In contrast, natural opioids are extracted from the seed pod of certain varieties of poppy plants.

While natural and synthetic opiates may work similarly, certain synthetic opioids, like fentanyl, can be 50 to 100 times more potent than morphine. Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59% of opioid-related deaths involved fentanyl, a dramatic increase when compared to 14.3 % in 2010.

Opioid Dependence vs. Addiction: Definition

Both opioid dependence and addiction, the preferred term is opioid use disorder, are substance use disorders (SUD), with opioid use disorder representing the most severe form. However, both consists of an overpowering desire to use opioids, increased opioid tolerance, and withdrawal syndrome when discontinued. While both fall under the umbrella of substance use disorders, there are some important differences.

What is Opioid Dependence?

According to the Agency for Healthcare Research and Quality, opioid dependence is defined as a pattern of using illicit or prescription opioids which leads to at least three significant impairment or distress issues within a 12-month period. Opioid dependence can include physical dependence, tolerance, taking opioids in larger amounts or for more extended periods than intended, desiring to cut down or control use, dedicating a significant amount of time trying to get opioids or recovering from their effects. People who are opioid dependent may also give up activities that were once important to them because of their use and continue to use opioids despite knowing they are harmful.

Physical dependence on an opioid is just one of the seven criteria for the diagnosis of opioid dependence. Patients not physically dependent on opioids can still have opioid dependence if they meet some of the criteria.

According to John Hopkins Medicine, a person can be physically dependent on opioids without being considered unhealthy. For instance, a cancer patient with chronic pain may be physically dependent on opioids but not addicted to them.

What is Opioid Addiction?

As mentioned earlier, continued dependence on opioids can manifest into more severe opioid use disorder. According to Medline Plus, opioid use disorder is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. People who become addicted to opioids may make getting and using these opioids their primary goal over other activities. Many people who become addicted to opioids can experience negative impacts on both their professional and personal relationships. It is unknown why some people are more likely to become addicted than others.

Opioid Dependence vs. Addiction: Causes

The causes of dependence and addiction are an important part of understanding how opioid users reach these circumstances and can vary between individuals. Below we’ll discuss the differences between causes for dependence and addiction.

What Causes Opioid Dependence?

You may have begun taking opioids because your doctor prescribed them for severe pain or because you wanted to experience them through recreational drug use. Regardless of why some people start taking opioids, it can be hard to stop once dependence has developed. According to the Mayo Clinic, when you take opioids repeatedly over time, your body produces fewer endorphins. Endorphins are hormones released when your body feels pain or stress. Endorphins are produced to help relieve pain, reduce stress, and improve mood. The longer you take opioids, the more likely you are to build a tolerance to them, meaning that you need to increase the amount you take to achieve the same effects.

When the feeling the opioids produced begins to subside, you may want the euphoric feeling again. This is one of the first indicators of potential addiction.

How Long Does It Take To Become Dependent on Opioids?

It may surprise you, but you can become addicted to opioids after only a few days of using them. According to the Centers for Disease Control and Prevention (CDC), in a representative sample of cancer-free adults who used opioids for the first time and received a prescription for opioid pain relievers, the likelihood of chronic opioid use increased with each additional day of medication. Beginning on the third day of use, the sharpest increases in chronic opioid use were observed after the fifth and thirty-first day of therapy.

Many factors are involved, but some people may develop an opioid dependency after only five days of use.

Who is Most at Risk of Opioid Dependence?

As noted above, opioid dependency can happen to anyone who takes opioids for even a few days. However, other factors could increase the likelihood of developing opioid dependence. 

Opioid dose, duration and the formulation of opioids can play a factor in developing dependency, such as:

  • Increased Dose: The higher the opioid dose, the higher the risk for misuse and overdose death. Higher doses, such as ones greater than 100 morphine milligram equivalents (MME), have over twice the risk relative to lower doses. However, even low doses (such as 20-50 MME) can present a risk.
  • Duration: The longer you use opioids, the higher the risk of developing a dependency. Physical dependence and addiction to opioids may occur in as little as a few days. As many as one in four people receiving prescription opioids long-term in a primary care setting struggles with opioid addiction.
  • Formulation: There are more significant risks of overdose and death associated with extended-release and long-acting opioid formulations versus immediate-release formulations.

However, there are other factors, such as health conditions and physical characteristics, that may make some people more prone to developing an opioid dependency than others, such as:

  • Older adults (65 years and older)
  • Respiratory conditions (Sleep Apnea, Asthma, or Chronic Obstructive Pulmonary Disease)
  • Wasting syndrome (Cachexia)
  • Impaired energy or strength (Debilitated Patients)
  • Younger adults (18-25 years old)
  • Mental Health Disorders (Depression, Anxiety, Post-traumatic Stress Disorder)
  • History of alcohol or substance abuse

It’s important to realize that even if you don’t have any of the health issues mentioned above, you can still develop an opioid dependency. 

What Causes Opioid Addiction?

Unfortunately, there is no single cause for opioid use disorder. The causes of opioid use disorder are complex and are a combination of genetic, environmental and lifestyle factors.

Your genes may play a role in whether or not you become addicted to opioids. One study in Current Psychiatry Reviews determined that after reviewing classical genetic studies of opioid use, they found a significant heritability of drug use behavior. However, the same study also noted that external factors played an important role.

Several non genetic factors also may play a critical role in opioid addiction. Some factors that have been shown to increase the risk of opioid addiction include a history of substance abuse, such as people who binge drink. Other factors include depression or other psychiatric disorders, childhood abuse or neglect.

Certain personality traits, including impulsivity and sensation-seeking, can also influence whether you may develop an opioid addiction. Socioeconomics and your location, such as living in poverty or a rural area, may also be influencing factors, as are, associating with others who abuse opioids or other substances.  Easy access to prescription or illegal opioids may also contribute to a person’s risk of developing an opioid use disorder.

Opioid Dependence vs. Addiction: Symptoms

The symptoms of dependence and addiction can overlap in certain cases, but the two conditions differ in many ways. Understanding whether an individual is addicted or dependent on opioids can help determine treatment to help patients become opioid free.

What Are the Symptoms of Opioid Dependence?

There are some signs and symptoms of opioid dependence. You don’t have to exhibit all the warning signs to be dependent. According to the University of Arkansas for Medical Science, a person who shows three or more of the following behaviors over 12 months is most likely opioid-dependent.

Some of the possible symptoms of opioid dependence are:

  • Needing to take more opioids to get the same effect, or getting a lesser effect from the same amount
  • Experiencing withdrawal symptoms when not using opioids, or needing to take other drugs to help relieve withdrawal symptoms
  • Taking larger amounts of opioids than prescribed and for longer than necessary
  • Wanting to quit or trying unsuccessfully to quit
  • Spending time and effort to obtain, use, and recover from taking opioids
  • Working less, missing work, or, if unemployed, not actively looking for a job
  • Spending less time seeing friends who don’t use opioids
  • Ceasing hobbies or skipping out on activities that you recently enjoyed
  • Continuing to use opioids despite negative consequences

Remember, you don’t have to be experiencing all of these. Just three or more within a year could signal opioid dependency. 

What Are the Symptoms of Opioid Addiction?

Opioid use disorder is a type of SUD characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. People addicted to opioids, like fentanyl, can experience severe withdrawal symptoms as early as a few hours after the narcotic was last taken.

Some symptoms of opioid addiction include:

  • Muscle and bone pain
  • Problems sleeping
  • Diarrhea
  • Vomiting
  • Cold flashes with goose bumps
  • Uncontrollable leg movements
  • Severe cravings for opioids

While some symptoms are similar between opioid use disorder and dependency, addiction symptoms are characterized mainly by an uncontrollable craving and severe physical reaction when no longer taking opioids.

If you are looking for more information on the signs and symptoms of opioid addiction, click here for a more in depth description on behavioral, physical, cognitive and psychosocial signs and symptoms.

What are the Dangers of Opioid Dependence and Addiction?

When one becomes dependent or addicted to opioids, it can become more and more difficult to experience the effects of the drug. When this rise in tolerance occurs, individuals may consume an increased dosage to compensate. This can result in a dangerous situation that increases the chances of an accidental overdose. On the other hand, if an individual stops their use of opioids, their tolerance could become lower. If one were to take the same high dosage that they did before lowering their tolerance, this could also be a dangerous situation where the body cannot handle the large dose of opioids.

To stay safe when dependent on opioids, it’s important to take safety precautions to avoid an accidental overdose. Informing family or friends of opioid use, always following doctor’s prescribed dosages, and not mixing opioids with other drugs are key. In addition, using modern technology like the Masimo Opioid Halo™, an opioid overdose monitoring and alert device, can help prevent individuals from experiencing an accidental overdose.

How to Treat Opioid Dependence

While going “cold turkey” or immediately quitting a drug may work for substances like nicotine, for opioids, going cold turkey can be potentially life-threatening. Sometimes, tapering off opioids is possible if you have taken them for more than a couple of weeks. The proper length of time of an opioid taper varies with each individual and each opioid. Your doctor should prescribe an opioid taper schedule that addresses your medical needs while minimizing risks to your health.

If tapering is not possible, other more aggressive treatment options have been proven effective, such as ones commonly used in opioid use disorder treatment centers. May such centers use a combination of medicine and cognitive behavioral therapies to treat SUDs, called Medication-assisted treatment (MAT). Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are designed to meet each patient’s needs.

Other opioid use disorder treatments may include harm prevention or harm reduction, which are designed to reduce the risk of overdose and decrease the transmission of blood-borne viruses associated with needle drug use. According to the US Department of Health and Human Services, harm reduction or prevention helps decrease the negative effects of substance use, and reduce stigma related to substance use and overdose. Harm reduction and prevention methods could include supplying people with fentanyl testing strips (FTS) and widening access to opioid reversal treatments.

In some cases, other drugs may be needed to help treat opioid addiction. According to John Hopkins Medicine, methadone is one drug commonly used to help treat opioid addiction. Methadone, when appropriately administered, is included with treatment with counseling and is always provided in a clinical setting. Methadone can help relieve opioid withdrawal and address cravings.  Another medication often used to help reduce opioid cravings is Buprenorphine which doesn’t give the same euphoric effects as other opioid drugs. These medications are prescribed by physicians in a clinical setting and can be taken orally or as a once-a-month injection lasting up to six months.

Both methadone and Buprenorphine activate opioid receptors in the body that suppress cravings. 

Another medication shown to be effective in treating OUDs is Naltrexone. Unlike methadone or Buprenorphine, you must be completely free of all opioids before beginning naltrexone. It can be taken in a tablet form orally or as a once-a-month injection called Vivitrol.

Drug-Free Opioid Withdrawal

More recently, there have been some treatments for opioid dependency that don’t require the use of drugs, and some of these drug-free opioid withdrawal treatments have been shown to be effectiveOne such drug-free treatment is Bridge™. A qualified healthcare professional in a non-surgical in-office procedure attaches the device behind the ear. Once connected, Bridge™ sends gentle electrical impulses through wires to nerves around your ear and provides up to five days of continuous relief from opioid withdrawal symptoms. Bridge™ has been demonstrated in a clinical setting to reduce withdrawal symptoms and may provide relief as soon as 20 minutes.

Opioid Dependence Recovery

There’s no timetable for opioid dependency recovery, and the recovery journey can be a long process. 

You may encounter relapses during your recovery journey, but this isn’t an indication that you failed. Over 90% of patients go through opioid withdrawal and relapse one month later. Effective treatment should also include cognitive-behavioral therapies, such as coping and recognizing situations that could lead to opioid use. A thorough treatment plan may also include motivational enhancement therapies that help change the behaviors that lead to SUDS and make it more likely that you will willingly enter treatment programs.

Frequently Asked Questions

What are opioids? 

According to Medline Plus, opioids are a class of drugs which include strong prescription pain relievers, such as oxycodone, hydrocodone, and tramadol. Heroin, an illegal drug, is also an opioid. Some opioids, such as morphine, are made from the opium plant, and others, like fentanyl, are synthetic.

What is opioid dependence?

According to the Agency for Healthcare Research and Quality, opioid dependence is defined as a pattern of using illicit or prescription opioids which leads to at least three significant impairment or distress issues within a 12-month period.

Why do people become dependent on opioids?

According to the Mayo Clinic, when you take opioids repeatedly over time, your body produces fewer endorphins. Endorphins are hormones released when your body feels pain or stress. Endorphins are produced to help relieve pain, reduce stress, and improve mood.  The longer you take opioids, the more likely you are to build a tolerance to them, meaning that you need to increase the amount you take to achieve the same effects.

How long does it take to become dependent on an opioid?

According to the Centers for Disease Control and Prevention (CDC) you can become dependent on opioids in as little as five days of use.

What are the symptoms of opioid dependence?

Some of the possible symptoms of opioid dependence are:

  • Needing to take more opioids to get the same effect, or getting a lesser effect from the same amount
  • Experiencing withdrawal symptoms when not using opioids, or needing to take other drugs to help relieve withdrawal symptoms
  • Taking larger amounts of opioids than prescribed and for longer than necessary
  • Wanting to quit or trying unsuccessfully to quit
  • Spending time and effort to obtain, use, and recover from taking opioids
  • Working less, missing work, or, if unemployed, not actively looking for a job
  • Spending less time seeing friends who don’t use opioids
  • Ceasing hobbies or skipping out on activities that you recently enjoyed
  • Continuing to use opioids despite negative consequences

What is a drug-free opioid withdrawal device?

Bridge™ is a drug-free opioid withdrawal device that is attached behind the ear by a qualified healthcare professional in a non-surgical in-office procedure. Masimo Bridge™ has been demonstrated in a clinical setting to reduce withdrawal symptoms and may provide relief as soon as 20 minutes.

Final Thoughts

Opioid use disorder affects millions of people in the United States yearly and can lead to long-lasting mental issues, health issues, and even death. It’s important to remember that opioid dependency can happen in as few as five days and that multiple internal and external factors can lead you to become dependent on opioids. If you are anyone you know is struggling with opioid use disorder or dependency or call the SAMHSA hotline to learn how you can start the path to recovery.