This information is intended for people who have been taking prescribed opioid pain medicines (such as oxycodone, morphine, fentanyl, hydromorphone, or codeine) and who may be concerned about dependence. It aims to explain what opioid use disorder means, how it can develop even with prescribed medicines, and what help is available. This sheet is not a substitute for a conversation with your doctor.
What are opioids?
Opioids are a class of medicines derived from or modelled on the opium poppy. They are widely prescribed for pain. Common prescribed opioids include:
- Oxycodone (OxyContin®, Endone®)
- Morphine (MS Contin®, Kapanol®)
- Fentanyl (Durogesic® patches, lozenges)
- Hydromorphone (Jurnista®, Dilaudid®)
- Buprenorphine (when used for pain, e.g. Norspan® patches)
- Codeine (in various formulations)
- Tapentadol (Palexia®)
Opioids are powerful medicines that work well for some types of pain in the short term. However, when used over a longer period, they can cause significant physical and psychological changes in the brain and body.
What is physical dependence?
After taking opioids regularly for some weeks, the body adapts. This is called physical dependence — and it happens to almost everyone who takes opioids for more than a few weeks, regardless of the dose. It does not mean you are "addicted" or have done anything wrong. It simply means your body has adjusted to the presence of the medication.
Physical dependence means that if the medication is stopped suddenly, the body reacts with withdrawal symptoms:
- Sweating, chills, and goosebumps
- Muscle aches and restless legs
- Nausea, vomiting, or diarrhoea
- Anxiety and agitation
- Yawning, teary eyes, and runny nose
- Difficulty sleeping
Physical dependence is managed by reducing (tapering) the opioid gradually, often with additional support — not by stopping it suddenly.
What is opioid use disorder (OUD)?
Opioid use disorder (OUD) is a medical condition in which a person continues to use opioids in a way that is causing significant harm — despite wanting to cut down or stop. It is not a moral failing or a character weakness. It is recognised internationally as a chronic medical condition with effective treatments.
An important distinction: OUD can develop even in people who have only ever taken opioids as prescribed. The brain changes associated with long-term opioid use do not discriminate between prescribed and non-prescribed use.
Signs that may suggest opioid use disorder
A doctor may consider an OUD diagnosis if several of the following are present:
- Taking more opioid than prescribed
- Inability to cut down despite wanting to
- A great deal of time obtaining, using, or recovering from opioids
- Strong cravings or urges to use
- Opioid use interfering with work, relationships, or responsibilities
- Continuing use despite knowing it is causing problems
- Needing more opioid to get the same effect (tolerance)
- Withdrawal symptoms when the dose wears off
- Taking opioids to relieve or avoid withdrawal, rather than for pain
- Difficulty functioning without opioids
A formal diagnosis requires assessment by a medical professional — not all of these need to be present, and a diagnosis does not require any particular severity.
How does OUD develop in people taking prescribed opioids for pain?
This is one of the most common and least well-understood forms of OUD. It can happen gradually, often without the person realising. Contributing factors include:
- The brain's natural reward and adaptation systems respond to opioids in ways that promote continued use
- Physical dependence (withdrawal avoidance) becomes a reason for taking the medication, separate from pain relief
- Increasing tolerance means the same dose provides less pain relief over time — leading to dose escalation
- Psychological factors such as anxiety, depression, trauma, or catastrophic pain thinking can amplify both pain and dependence
- The original pain condition may have resolved or changed, but opioid use continues
What treatments are available?
There are several evidence-based treatments for OUD. The right treatment depends on individual circumstances and should be guided by your doctor.
- Supervised tapering: Gradual dose reduction under medical supervision, often with additional support for withdrawal symptoms and psychological distress.
- Buprenorphine (Suboxone®, Buvidal®, Sublocade®): A partial opioid agonist that reduces cravings and withdrawal, significantly reduces overdose risk, and allows people to stabilise and recover functioning. This is the most effective first-line treatment for moderate-to-severe OUD.
- Methadone: A full opioid agonist used in closely supervised pharmacotherapy programs. Effective for people with severe OUD or those who have not responded to buprenorphine.
- Psychological therapies: Counselling, motivational interviewing, and other therapies help address the psychological aspects of OUD and support recovery.
- Treatment of co-occurring conditions: Addressing underlying depression, anxiety, PTSD, sleep disorders, or chronic pain is an essential part of OUD care.
A note about shame and stigma
Many people feel ashamed when they first realise they may have developed an opioid problem — especially if the opioids were prescribed for pain. This shame is understandable but is not warranted. OUD is a recognised medical condition that responds to treatment. Many people who develop it are hardworking, responsible individuals who were simply prescribed opioids for legitimate pain and found themselves trapped.
Early assessment and treatment leads to better outcomes. There is no benefit in waiting.
What about pain management?
If you are experiencing significant pain alongside opioid dependence, this can be complex — but it is not unmanageable. Pain and OUD often need to be addressed together, with a plan that reduces opioid-related harm while maintaining quality of life. This may involve collaboration with pain specialists, psychologists, physiotherapists, and other health professionals.
Overdose is a real risk. If you or someone you know is at risk, ask your doctor about carrying naloxone (Nyxoid® nasal spray), which can reverse an opioid overdose. Naloxone is available without a prescription from many pharmacies in Australia.
Next steps
If any of this resonates with you, the most important step is to speak with a doctor. You can start by speaking with your GP, who can refer you to a specialist if needed. Your doctor is not there to judge you — they are there to help you.
Please also feel free to raise concerns at your next appointment with Dr Kenchaiah. You can contact the rooms on 03 9834 3600. For urgent concerns or crisis, call 000 or the National Alcohol and Other Drug Hotline on 1800 250 015 (24/7, free).
Clinical content informed by: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, American Psychiatric Association); and the Australian Government Department of Health Clinical Guidelines for the use of Medications in Opioid Dependence. Publicly available at health.gov.au.