You may have been prescribed opioids to ease pain after surgery, injury or for chronic pain. Over time, you find yourself taking more than prescribed to get relief. Eventually medicine that’s meant to help becomes harmful, and you’re misusing your medication.

Prescription drug use disorder — once called prescription drug abuse — is especially common with prescription pain medicines such as oxycodone, codeine, hydrocodone, morphine and fentanyl.

“Understanding how opioids affect the brain, recognizing early warning signs and finding proven care can change the path forward,” says Kimberly Kabernagel, DO, medical director at Geisinger Marworth Treatment Center. 

Understanding opioid use disorder (OUD)

Opioid use disorder, or OUD, is using opioids even if it causes significant impairment or distress. It can affect anyone, across ages, income levels and backgrounds. If you have OUD, you may use opioids compulsively, have strong cravings and keep using even though it’s harming your relationships, finances or physical body. 

OUD changes how the brain processes reward and pain. People who misuse opioids can build tolerance — a need for more medication to get the same relief. And if they don’t use, they might have symptoms of opioid withdrawal. 

“Opioid use disorder is not a moral failing,” says Dr. Kabernagel. “It’s a medical condition influenced by genetics, environment, trauma and co-existing health issues.”

Talk to your healthcare team if you:

Have opioid withdrawal symptoms
Have cravings
Feel you’re likely to start abusing your medication

What’s the difference between opioid supervised use and misuse?

Prescription use happens when opioids are taken exactly as directed for the shortest time needed to manage acute pain or carefully monitored for chronic pain or end-of-life care.

Misuse includes taking opioids without a prescription, using higher doses than prescribed, taking someone else’s medication or using illicit opioids. Legitimate prescriptions can become a problem if you:

Need to keep taking more
Take opioids with alcohol or other drugs
Have no plan other than opioids to treat your pain 

Signs and symptoms of opioid use disorder

Recognizing opioid use disorder early can prevent emergencies and save lives. 

“If you or a loved one has opioid withdrawal symptoms, strong cravings or patterns of prescription drug abuse, it’s time to talk with a clinician,” urges Dr. Kabernagel. 

Physical signs:

Changes in appetite or weight
Needle marks or skin infections (with injection)
Tolerance (needing more)
Drowsiness or “nodding off”

Psychological and emotional signs:

Intense cravings and preoccupation with obtaining opioids
Mood swings, irritability or depression
Anxiety, restlessness or agitation
Memory problems or difficulty concentrating

Behavioral signs:

Using opioids more often or in higher doses than prescribed
Doctor shopping, early refill requests or reports of lost prescriptions
Taking medications from others
Social withdrawal, secrecy or changes in friend groups
Neglecting responsibilities at work, school or home
Risky behaviors, including driving while impaired

Opioid withdrawal symptoms:

Diarrhea
Nausea or vomiting
Dilated pupils 
Insomnia
Itching, sweating or flushed skin
Runny nose

If you see these signs in yourself or a loved one, Geisinger Marworth can help. Early support increases the chance of a safer recovery path.

Treatment options and strategies

Effective care combines medical treatment, counseling and social support. 

“There’s no one path and your treatment time and modality can vary,” explains Dr. Kabernagel. “Treatment plans should reflect your goals, health needs and daily life.”

The first step is to safely stop using and manage withdrawal symptoms if they develop. You may get help through:

Medications: Methadone, buprenorphine and extended-release naltrexone reduce cravings and withdrawal, stabilize brain chemistry and lower overdose risk.
Counseling and psychotherapy: Therapy tailored to your needs can build skills, address triggers and support change.
Peer recovery and support groups: Find community, accountability and share lived experience.
Integrated care: Treating other mental and physical health challenges like depression, anxiety, PTSD and chronic pain improves outcomes.
Family involvement: Education, therapy and support for the whole family reduces stigma, improves communication and creates a better environment for lasting healing.

Treating opioid misuse with medication

Medications for opioid use disorder (MOUD) — also called medication-assisted treatment (MAT) — are shown to save lives and support long-term recovery. You need close medical supervision and support to have the best chance of success. Commonly used are:

Methadone or buprenorphine which ease cravings and withdrawal symptoms.
Naltrexone — when administered as an extended release injection — dampens the effects of opioids and also helps with cravings. 

There are side effects, and you can still misuse methadone and buprenorphine. With proper support, you can function, work and care for your family while taking MOUD. 

“Research shows these medications aren’t just replacing one addiction for another,” notes Dr. Kabernagel. “When used appropriately and under the guidance of a trained provider, they turn chaotic, high-risk use into safe, controlled treatment .”

Safer pain management: preventing prescription drug abuse

Prevention starts with a thoughtful pain plan. For acute and chronic pain, pairing opioids with other medication can help. 

“If you’ve ever misused pain medication, share this with your health team so they can support other options,” suggests Dr. Kabernagel.

Other types of pain relief

Acetaminophen (Tylenol) and NSAIDs (when appropriate)
Topical therapies, nerve blocks and local anesthesia
Physical therapy, occupational therapy and graduated exercise
Behavioral pain interventions such as CBT, relaxation and biofeedback
Complementary approaches like heat/cold therapy, massage and mindfulness

Safer use options

Use the lowest effective dose for the shortest time.
Understand how long you should use opioids and your provider’s goals. 
Don’t combine opioids with benzodiazepines or alcohol.
Schedule follow-up appointments to check pain, function and side effects.
Store medicines securely in a locked box and dispose of leftovers at take-back sites.
If you’re concerned about prescription drug abuse or noticing opioid withdrawal symptoms, talk with your provider about adjusting your pain plan.

Next steps: 

Learn about addiction treatment at Geisinger Marworth
Geisinger Marworth’s Family program helps the entire family recover
Learn the long-term effects of casual drug use