The Opioid Epidemic


What is addiction?

Addiction is marked by a loss of control, by cravings, and by unpleasant outcomes, all caused by the use of a substance. Addiction is different from physical dependence or tolerance:

  • In cases of physical dependence, the person has withdrawal symptoms if he or she suddenly stops using a substance.
  • Tolerance occurs when the original dose of a substance loses its effectiveness over time.

Addiction and physical dependence often occur together. However, addiction can be present without physical dependence and vice versa.

With time, people who take addictive pain medications may develop tolerance and even physical dependence. This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when pain medications are used for short periods under proper medical supervision.

Which pain medications are addictive?

When the doses of addictive pain medications increase, the side effects and risks also increase. When those medications are combined with other depressants, the risks can become even greater:

  • Depressants:
    • Barbiturates like phenobarbital, butalbital (Bupap®, Fioricet®, Esgic®), and carisoprodol (Soma®, Vanadom®)
    • Benzodiazepines like lorazepam (Ativan®), alprazolam (Xanax®), diazepam (Valium®), and clonazepam (Klonopin®)
    • Other medicines and substances that make people drowsy, like alcohol
  • Opioids and morphine derivatives:
    • Codeine
    • Morphine
    • Fentanyl (Duragesic®, Subsys®, Abstral®)
    • Oxycodone HCl (Oxycontin®)
    • Hydrocodone (Vicodin®, Norco®, Lorcet®)
    • Hydromorphone (Dilaudid®, Dilaudid-5®, Exalgo®)
    • Oxymorphone (Opana®, Opana® ER)
    • Meperidine (Demerol®)
    • Propoxyphene (Darvon®, Darvon-N®, PP-Cap®)
    • Tramadol (Ultram®, ConZip®)
    • Tapentadol (Nucynta®, Nucynta ER®)

Who is at risk for addiction?

Signs of addiction are loss of control, cravings, and unpleasant outcomes from the use of a substance. Most people who take their pain medicine as directed do not become addicted, especially if they take the medicine at the same dose for a long time.

You may be addicted to painkillers if:

  • You feel like you are losing a sense of control over their use.
  • You need the medicine more times per day than it was prescribed.
  • You need the medication for something other than pain. For example, you take it when you are depressed or when you have had a bad day.
  • You are abusing a medication that was prescribed for another person.

Recovery and Outlook

How can addiction be overcome?

Chronic (long-time) pain is a common reason that people develop a dependency to prescription medications. Once the addicted person has completed addiction treatment, his or her family, friends and caregivers must all work together to watch the patient for signs of relapse. Taking part in a relapse support group and a 12-step recovery program can help people stay on track.

Last reviewed by a Cleveland Clinic medical professional on 10/25/2017.


  • National Institute on Drug Abuse. Commonly Abused Drugs Charts. Accessed 4/10/2018.
  • National Institute on Drug Abuse. Misuse of Prescription Drugs. Accessed 4/10/2018.
  • American Society of Addiction Medicine. Definition of Addiction. Accessed 4/10/2018.
  • Covington EC, Bailey JA. Pain and addictive disorders. In: Rathmell JP, Wu CL, Turk DC et al. Practical Management of Pain. Elsevier Health Sciences; 2013.

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