Signs of Opioid Addiction

Opioid Abuse Warning Signs

How do you know if someone is abusing opioids? A popular stereotype of an opioid addict is that of a homeless, unkempt heroin junkie shooting up in an alleyway downtown or a condemned drug house. Contrary to this perception, many who abuse opioids do a good job of hiding their use. An opioid addict can be much harder to spot than an abuser of alcohol or other drugs. With an alcoholic, the smell of booze on their breath is a dead giveaway. So what are the signs that tell you someone is abusing opioids? There is no way to know for sure other than to ask the individual if they are using or to get him or her to take a drug test. The issue with this is that many addicts will downplay or deny their abuse, and some addicts may lash out if confronted about their drug use.

Below you can find a list of some of the common warning signs to look out for that could indicate that someone you know may be abusing opioids. Remember that many addicts hide their addiction well, and just because an individual don't display any obvious signs does not necessarily mean he or she isn't using. The reverse of this is also true though — many of these signs could have an innocent explanation and many may actually be symptoms of another unrelated medical issue. Just because someone takes frequent naps does not automatically mean that he or she is abusing opioids.

  • Small or pinpoint pupils. Opioids cause the pupils, the black dots in the center of the eye, to shrink considerably while intoxicated. Pupils normally react to the amount of light in the environment. In a dimly lit room the pupils will become larger and in a brighter room the pupils will become smaller. Someone who has recently used an opioid drug may have very small or pinpoint sized pupils in a room with very little light.
  • Withdrawal symptoms set in if an opioid addict does not use any opioids for a period of time. These symptoms often mimic those of a cold or flu. It doesn't take too long for withdrawal symptoms to begin to appear, and many addicts frequently experience withdrawal symptoms between doses and on days where they may be unable to obtain any drugs. Administration of an opioid drug will cause the symptoms to disappear. Often claiming to be 'sick,' or suddenly coming down with the flu but spontaneously feeling better in the same day may be a sign that someone is addicted to opioids.
  • Nodding out or temporarily falling sleep during inappropriate times. Since opioids act as a depressant on the central nervous system, someone who is intoxicated may appear less alert and sleepy. This is commonly called 'nodding,' and some long-term addicts who have, over time, built up a tolerance to the sedative effects of opioids may not experience nodding at all.
  • Needle marks on the arms or elsewhere may be present on addicts who administer their opioids by intravenous injection. Some IV users may always wear long-sleeved shirts and long pants to conceal track marks.
  • IV paraphernalia such as used syringes, or spoons with residue in them or burn marks on the bottom may be hidden or left lying around by addicts who administer their opioids by intravenous injection.
  • Empty bottles for prescription opioid drugs such as Percocet or Vicodin. If you or any of your relatives recently had surgery and were prescribed opioids for pain control, you may find that some pills go missing.
  • Social signs of opioid addiction include withdrawing from normal activities, neglecting work and other responsibilities, and problems maintaining relationship with family and friends. Opioid addiction causes a person to spend more and more time and effort into finding and using drugs, and to neglect all other aspects of his or her life.


  • Prescription Drugs: Abuse and Addiction. National Institute on Drug Abuse, 2001. [PDF]
  • Tommasello AC. Substance abuse and pharmacy practice: what the community pharmacist needs to know about drug abuse and dependence. Harm Reduction Journal 2004; 1:3. [PubMed] [PDF]
  • Prescription drug abuse - Symptoms. Mayo Clinic, 2012. [Link]
  • Torpy JM, Lynm C, Glass RM. JAMA patient page. Opioid abuse. The Journal of the American Medical Association (JAMA) Sep 2004; 292(11):1394. [PubMed] [PDF]
  • Identifying Dependence. Reckitt Benckiser Pharmaceuticals, 2013. [Link]

Related Pages

  • Opioid Addiction
    Learn the factors that contribute for the complex disease of addition and how opioid addiction differs from opioid dependence.
  • Opioid Dependence
    Read about how prolonged opioid abuse leads to physical and psychological dependence, and what that means for the user.
  • Methadone Maintenance
    Methadone Maintenance Treatment (MMT) has been proven to be a safe and effective treatment for opioid dependence and addiction. Read about the history of methadone and how a methadone treatment program works.
  • Buprenorphine Treatment
    What is buprenorphine (Suboxone, Subutex)? How does buprenorphine treat opioid addiction? Why is buprenorphine combined with naloxone? Learn about buprenorphine treatment, a relatively new method of medication-assisted treatment.
Call To Find a Methadone Clinic 800-865-3138
Who Answers?