Signs and symptoms of opioid use disorder

Family members usually see the behavior before they see anything physical. None of these proves opioid use. Together, over weeks, they form a pattern.

• Money going missing, unpaid bills, or borrowing with vague reasons.
• Prescriptions running out early, or visits to more than one prescriber.
• Pulling away from family, old friends and things they used to enjoy.
• Missed work, missed school pickups, or plans dropped at the last minute.
• Secrecy about where they have been, and long spells in the bathroom or bedroom.
• Mood that swings between drowsy and calm, then restless and irritable a few hours later.

The lying that often comes with this is hard to live with. Hiding use usually comes from fear and shame, not from a lack of love.

Opioids slow the body down. Soon after use, a person may be very drowsy, drift off mid sentence, and have very small pupils. Breathing can become slow.

When the drug wears off, the picture flips. MedlinePlus lists the early signs of withdrawal as anxiety, agitation, muscle aches, a runny nose, watery eyes, sweating, yawning and trouble sleeping. Later come stomach cramps, diarrhea, nausea, vomiting, goosebumps and wide pupils.

So a person who seems to get “the flu” again and again, and then is suddenly fine, may be cycling in and out of withdrawal. Our withdrawal symptoms guide covers this in more detail.

Some signs point to an emergency, not a pattern. If someone cannot be woken, is breathing very slowly or making gurgling sounds, or has blue or gray lips, treat it as an overdose.

Call 911 if someone is not breathing or cannot be woken. Call or text 988 for a crisis or thoughts of suicide. For a free referral at any hour, the SAMHSA National Helpline is 1-800-662-4357.

From the inside, it rarely feels like a disorder. It feels like a run of reasonable decisions.

You take an extra pill because the pain is bad today. You buy a few from a friend because the refill is a week away.

A few honest checks cut through that:

• You have set yourself a limit and gone past it more than once.
• You plan your day around when you can next take something.
• You feel unwell or panicky when your supply is low.
• You are using to feel normal, not to feel good.
• You are hiding how much you take from people you trust.

If several of those fit, that is useful information, not a verdict on you. It means your brain and body have adapted to the drug, which is what opioids do.

You do not need to meet a set number of signs before you talk to someone. If opioid use is worrying you, that is reason enough.

A primary care doctor, nurse practitioner or telehealth prescriber can do an assessment. It is a conversation, and it is confidential under federal health privacy rules. If you are the one using, ready to stop lays out first steps for this week.

Get help quickly if any of these apply:

• There has been an overdose, or a time someone was very hard to wake.
• Pills or powder are coming from anywhere other than a pharmacy. They may contain fentanyl.
• Opioids are being mixed with alcohol or anxiety medicines such as Xanax or Valium.
• You are pregnant. Do not stop suddenly. Talk to a prescriber first.

If you are worried about someone else, our guide on how to talk to someone about their opiate use can help you start. The treatment directory lists providers in every state.