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10 Silent Signs You May Be Developing a Pain Pill Addiction

Only one in three Americans can recognize the symptoms of addiction. Our experts reveal how to recognize the signs you may have a problem with prescription drug addiction.

The prescription problem

An estimated 18 million Americans ages 12 and older have misused prescription drugs at least once in the past year, according to the National Institutes of Health. Yet nearly one-third of 4,600 people polled in a 2017 Michigan State University study were unable to correctly identify the signs of drug addiction. The use of prescription drugs in a way that's not intended by a doctor can lead to drug abuse.

Our experts discuss how to recognize the signs and symptoms of prescription drug abuse and how to seek professional help.


You may be in denial

It's not uncommon to be able to see when other people are headed for trouble, but be oblivious to your own potential hazards. This blindness can often crop up when it comes to addiction. Denial makes it even harder to see it when you are the person with the disease, according to Marc Myer, MD, CEO and co-founder of Hyperion Health, Inc, in Minneapolis-St. Paul. (He is the previous medical director of the Hazelden Betty Ford Foundation.)

"It's difficult to see the picture when you're the frame," Dr. Myer explains. Recognizing denial in yourself can be challenging. What may be easier to recognize is the "story" that seems all too familiar in addicts.


You may have had a gateway event

The story may sound familiar: You injure your back and the doctor prescribes you intermittent doses of opiate-based pain medication. Examples of opioid-based medications include Percocet (oxycodone and acetaminophen), Demerol (meperidine), Dilaudid (hydromorphone), Ultram (tramadol), Vicodin (hydrocodone and acetaminophen), and OxyContin (oxycodone), among others.

Dr. Myer explains the most common path to addiction: "Unfortunately, the pain doesn't go away, and maybe it even gets worse. So your doctor now prescribes a long-acting opioid. Weeks and months go by, during which you're throwing in the originally prescribed pills along with the long-acting pills in an attempt to stay ahead of your pain."

At this point, you're still dealing with pain management—as opposed to addiction—but if this story sounds even vaguely familiar, then you need to be on alert. (Check out the 24 secrets pain doctors won't tell you.)

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You have signs of increasing tolerance

Pain management doesn't reach addiction until you've begun to experience pain despite taking the highest medically acceptable dosage. That's what's called tolerance, according to Dr. Myer.

Tolerance occurs because the use of opioid painkillers slows the brain's production of endorphins, which are the body's own painkillers, explains Beverly Hills-based psychotherapist, Fran Walfish, PsyD. Your body doesn't know or care how you began taking your meds, she says. It doesn't matter if you obtained them legally or illegally. The fact remains that your body is now becoming increasingly incapable of coping with pain without an external supply of opiates.

The first sign that you're reaching a critical tolerance level may be that you find yourself running out of pills before your refill is available, according to Shanthi Mogali, MD, board-certified psychiatrist in general and addiction psychiatry at Columbia University in New York City. You might feel anxious about whether you'll be able to obtain more pills. You might also find that your doctor is unwilling to "cooperate" in prescribing your refills or the dosage you believe you need in order to get relief. It's important at this point to understand that it's not that your doctor is trying to hurt you, but that you've reached a critical level of tolerance to your meds.

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You may be asking for more prescriptions

Once someone has reached the highest dosage a doctor is willing (and ethically permitted) to prescribe, some people start to seek out additional sources of medication, according to Dr. Mogali. You may be developing an addiction if you feel the need to go to different doctors or visit hospital emergency rooms in order to obtain the meds your body has started to be dependent on to feel "normal." (One study suggested that women aged 40 to 59 were more likely to get prescribed opioids—and get addicted.)

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You are not taking medication as prescribed

A serious warning sign is feeling like swallowing your meds won't get you relief fast enough. According to Dr. Mogali, as access to these meds becomes increasingly limited, people who might be addicted may begin to change the way they use them, such as by crushing and snorting or injecting them.

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You have mood swings

You may experience depression or irritability with limited access to your meds, says Dr. Mogali. And you may also find that you're no longer just craving the meds for physical pain relief, but in order to obtain emotional relief, adds Stephen F. Grinstead, a chronic pain and addiction specialist at Grinstead Consulting, Training & Coaching in Camarillo, California.

"You start thinking of the feeling you get more than the pain relief," observes recovered addict, Todd Crandell. He spent 13 years addicted to opiates before turning his life around, becoming an addiction specialist and founding Racing for Recovery in Holland, Ohio. "Your mindset changes. You find yourself waiting for the next time you're supposed to take your pills. You're excited and eager. Your thoughts start to gear toward a feeling of euphoria you'll get when you take them," he says.

You may at this point be willing to acknowledge to yourself that it would be a good thing if you cut down on your usage, according to Dr. Mogali. But there's the rub. You will have significant difficulty in doing so, leading to further drug-seeking behavior. Read this hopeful firsthand account of a former opioid addict.

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You may exhibit drug-seeking behavior

Maybe your insurance company is onto your doctor-shopping, and now you're paying out-of-pocket for your meds. Or maybe you're contacting friends and family members who might have some leftover opiates lying around in their medicine cabinets. Eventually, as Dr. Myer points out, your drug-seeking behavior is going to rise to a level where it becomes more important than those family and friends. Maybe you'll go as far as stealing meds from them. Maybe you won't show up for work because you're out trying to find pills.

Maybe you've considered trying other non-prescription drugs, not because you want to, but because it's readily available, cheap, and, as users attest, "provides a better high," according to the National Institute on Drug Abuse.

According to Matt Feehery, CEO, Foundations Recovery Network in Brentwood, Tennessee, 80 percent of first-time heroin users began using as a way of coping with withdrawal symptoms from prescription pain medication.


You may experience withdrawal

Withdrawal may first present as agitation, according to Feehery, but you may not notice it because inherent drug-seeking has already taken a toll on your sense of well-being. "The sudden cessation of drugs can cause significant physical symptoms," Dr. Mogali says. According to MedlinePlus, symptoms of withdrawal include:

  • anxiety
  • muscle aches
  • insomnia
  • runny nose
  • sweating
  • yawning

Later symptoms include:

  • abdominal cramping
  • nausea
  • vomiting
  • diarrhea

Find out the 10 ways to safely use prescription drugs.

Longer-term symptoms of addiction

You may feel increasingly lethargic and less motivated to do the things you used to do and enjoy, says Scott Dehorty, LCSW-C, a psychotherapist specializing in substance use disorders and chronic pain in Columbia, Maryland. "Your primary relationships are no longer with your friends and family but with the drugs," says Dr. Myer. "Overall wellness suffers as you begin to ignore all your physiological needs, including food, exercise, and hygiene, with the primary focus being obtaining your drugs."

It can happen to anyone, but some are at greater risk

Although anyone can become addicted to opioids, Dr. Mogali says, there is a greater risk for those with a history of mental illness such as anxiety, depression, or post-traumatic stress disorder. In addition, you're at a higher risk if you have a family history that includes addiction, Dr. Myer says.

"We worry especially about teens," says Sara Anderson, national board master addiction counselor in Atlanta, because they can easily access leftover pain meds from their parents' and grandparents' medicine cabinets. For that reason, it's important to dispose of painkillers when you no longer need them. It may be hard to see addiction in yourself, but if you see the signs in your teen or in any other family member or close friend, don't be afraid to bring it up.

"Start by addressing the observations you have made with your loved one," Dr. Mogali advises. "Sometimes this is all that is needed to start addressing the problem." When there is resistance to entering treatment, a professional interventionist can be helpful. (Here are some more secrets about addiction that addiction counselors need you to know.)

If you think you might have an addiction or be at risk for one, you can call the helpline at the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP (4357) or use their treatment services locator to get help.

Medically reviewed by Michael Spertus, MD, on February 10, 2020