Signs Of Early Opioid Abuse That Family and Friends Can Look Out For

Family and friends are essential in noticing the signs that point to abuse.

Opioid addiction is too often initiated by prescribed opioid medications. Many patients do not struggle with addiction and can cease taking these medications once the pain subsides. Unfortunately, some patients advance to a state where they start using opioid analgesics for effects of euphoria. Mood altering medications carry this risk, and it is essential for family and friends to be aware of the signs of opioid abuse, which may be subtle at the beginning and then more apparent as time goes by. Any patient prescribed an opioid should attempt to follow the prescriber’s orders regarding the dose, frequency, and maximum daily use. In most cases, patients on opioids for less than two weeks tend not to develop an addiction, but there are always exceptions. Regardless, it is vital that those around the patient try to identify changes in behavior compared to baseline that cannot be justified by only increased pain.

A patient who uses these medications to satisfy other symptoms other than pain is immediately at risk. Opioid analgesics come with side effects of constipation, nausea, and drowsiness. However, if they are now causing euphoric effects that make a person high, these could be early indications of potential abuse. To satisfy this feeling, the patient requires more pills or decreases the frequency, which is automatically an indication of early abuse. Mood altering drugs are always going to have the potential of leading to abuse and addiction, and one of the best ways to detect this potential trajectory is to have the ability to recognize and identify these behavioral manifestations. Some of the signs may seem more evident than others, and sometimes noticing the most minimal behavioral changes can make a difference.

  • Signs of increasing anxiety can include nail-biting or twirling hair that was not present prior. Simple things like the patient moving their legs more, being more fidgety, talking faster, restlessness, not sleeping well, and pacing more than baseline can be early signs of opioid addiction. Opioids change brain chemistry and can manifest early on in the process.
  • Sings of aggression are often common in those patients who start to abuse opioid analgesics. As the brain adapts to more opioids, some of the natural producing neurotransmitters are not released in some patients. Signs of anger and aggression also often occur during the gaps when the patient does not take the opioid, which may be consistent with small phases of withdrawal. Family members may notice these changes early on, as they know the patient’s response before taking the drug. Now, suddenly, the person is agitated by something which was not the case in the past.
  • The opposite of aggression may also be true; the person is now calm and not irritated about something that used to bother them. This happens as the opioid numbs the individual’s feelings and use the medications as a solution to calm down from something that generally agitates them.
  • Behavioral changes, such as fluctuations in mood can occur during the initial phases of opioid abuse. One may have an elated mood one moment followed by lower spirits. Patients frequently will ruin relationships, whether professional or personal, during these times. Other changes include a lack of commitment to work, which can seem related to physical pain, but this can also be due to the medications.  Signs of secrecy, sneaking out, hiding things, and being dishonest on the smallest matters can also manifest during opioid abuse.

The above changes in behavior, personality, and deviations from baseline are just some real-life examples of what to look out for when a loved one is on opioids. The family members and friends have a unique role that healthcare providers do not have privy to. Patients often blatantly hide these changes in front of the office staff when asked these questions, and that is all that is available to them and the providers. Controlled substance prescribing is complicated and challenging, and this subjectivity is what makes it so. There are so many subtle signs of early abuse missed in the office visit, as they do not have the luxury of knowing the person and noticing even the smallest of behavior changes. Obviously, there are transparent signs of abuse such as doctor shopping, filling scripts early, paying for opioid medications by cash even though the patient has health insurance, which can mostly be identified on a thoroughly detailed PDMP. When given the opportunity, healthcare providers should really attempt to talk to family members if allowed by the patient, which often can provide clarity and insight into the patient’s behavioral changes.

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