Opioid addiction manifests in a range of symptoms. Some of the features of opioid dependence that clinicians take into consideration include:

• The potency of the opioid in causing dependence. While some of the prescription opioids may lead to low rates of dependence, drugs such as heroin may rapidly become highly addictive, especially the injected form. Around 2 to 10 days of continued use can make a person dependent on heroin.
• There is an intense craving and strong overpowering desire to take the substance.
• With repeated use, the pleasurable effects of opioids get blunted (eg, tolerance develops) and the addict is forced to increase the dose to achieve the same high as before.
• An addict may continue to use the opioid in the full knowledge that it can harm their wellbeing as well as that of their family members and friends.
• There may be a history of family problems, divorce, financial problems, unemployment and homelessness.
• If the drug is withdrawn abruptly, there is a risk that the addict will develop withdrawal symptoms. These symptoms are unpleasant and can cause an intense craving among addicted individuals to alleviate the symptoms by taking more of the drug. Withdrawal syndrome usually manifests as follows:
  • Increased sweating
  • Watering eyes and nose
  • Hot flashes followed by cold flashes giving rise to goose bumps
  • Cough
  • Dilated
  • Nausea, vomiting, and stomach cramps
  • Diarrhea and flatulence
  • Tremors and anxiety
  • Sleep deprivation and irritability
  • High blood pressure and heart rate
  • Whole body aches and pains

Acute symptoms may last for 6 weeks to 6 months or longer and are accompanied by intense cravings for the drug. Once the acute phase is over, there may be intense tiredness and sleep deprivation.

Other risks

• There is a risk of over dosing on opioids due to impaired judgement or attempts to overcome tolerance.
• There is also a risk of being infected with HIV and hepatitis B or C, especially in cases where an addict injects.
• Long-term opioid dependence is associated with criminal activities, gambling, and homelessness, as the sole focus of an addict's existence becomes obtaining the substance of abuse. A person who is physically dependent on an opioid or other substance may have a previous history of custodial sentences, probation or community service.
• There may be presence of other psychiatric conditions including depression, anxiety, panic disorder, post traumatic stress disorders, chronic pain conditions, psychosis, delusions, hallucinations and confusion.
• Examination may reveal features of malnutrition, dental decay, poor hygiene, skin infections, needle marks, confusion, memory loss and signs of drug intoxication.