Opioid Addiction (Opioid Use Disorder): Signs and Symptoms

Opioid addiction or Opioid Use Disorder (OUD medical abbreviation) is a serious condition that occurs when a user becomes compulsively dependent on opioids, which include prescription medications and illicit drugs. Prescription opioids, such as oxycodone, hydrocodone, and fentanyl, are legal when prescribed by a healthcare provider for legal medical purposes like pain management. However, the misuse of opioids, such as taking them without a prescription or using them in ways not intended by a doctor, makes them illegal. Opioids are highly addictive because they stimulate the release of dopamine, a neurotransmitter associated with pleasure. It creates a cycle of dependency as the brain begins to rely on opioids to feel joy, leading to the need for increasing doses over time. Common symptoms of opioid addiction include intense drug cravings, withdrawal symptoms like anxiety and muscle pain, and compulsive drug-seeking behaviors that disrupt daily life. Opioid addiction manifests through physical signs such as poor hygiene, weight loss, or pinpoint pupils and behavioral changes like social withdrawal or doctor shopping.

Opioid addiction is linked to severe health risks, including overdose, which results in death if not treated immediately. Heroin, fentanyl, oxycodone, and hydrocodone are commonly abused opioids. The dangers of opioid use include respiratory depression, which causes the body to stop breathing in extreme cases. Treatment for opioid addiction involves a combination of medications, such as methadone or buprenorphine, and behavioral therapies. Medications help manage withdrawal symptoms and cravings, while therapy addresses underlying psychological issues. Treatment duration varies, requiring the patient to undertake several months to years of recovery, depending on the severity of their addiction and their commitment to the process. Long-term recovery involves continuous care, including counseling and peer support, to help prevent relapse and manage the emotional and social challenges of recovery.

What is Opioid Addiction?

Opioid addiction is a serious medical condition that involves a compulsive and uncontrollable urge to use opioid drugs despite harmful effects on health, relationships, and daily responsibilities. Opioid addiction affects how the brain functions, leading to long-term physical and emotional damage. The condition is recognized as a form of addiction that interferes with work, school, and home life.

Opioid Use Disorder (OUD) is the medical term for opioid addiction. OUD is a chronic disease that develops from repeated opioid use, whether from prescription drugs like oxycodone or illegal drugs like heroin. Intense drug cravings, the need for higher doses to feel the same effect, withdrawal symptoms when stopping, and continued drug use even after serious health or life problems are common symptoms of opioid addiction. Treatment for opioid use disorder involves medications like methadone or buprenorphine combined with behavioral therapy and counseling.

The terms “opiate” and “opioid” are used interchangeably, but they have different meanings. An opiate refers specifically to naturally occurring drugs made from the opium poppy plant, such as morphine, codeine, and heroin. An opioid is a broader term that includes natural opiates as well as synthetic or semi-synthetic drugs like fentanyl, oxycodone, and hydrocodone. Opiates and opioids bind to opioid receptors in the brain and body, producing pain relief, euphoria, and a high risk of addiction. The misuse of either type leads to a form of addiction known as opiate addiction or opioid use disorder, depending on the drug involved and the pattern of use.

How do Opioids Affect the Brain?

Opioids affect the brain by binding to opioid receptors, which block pain signals and release endorphins, creating euphoria. Chronic use disrupts dopamine transmission, impairing cognitive functions like attention, problem-solving, and impulse control. Key brain regions such as the locus ceruleus and prefrontal cortex are affected, disrupting alertness, breathing, decision-making, and impulse control. The body experiences widespread effects, including slowed breathing, low blood pressure, slow heart rate, and gastrointestinal issues like constipation, nausea, and vomiting. Regular opioid use leads to tolerance and physical dependence. Long-term use causes cognitive deficits that persist after recovery, increases pain sensitivity through opioid-induced hyperalgesia, and results in addiction, which causes social, financial, and interpersonal problems. Chronic use leads to structural brain changes, such as reduced brain volume.

Why are Opioids So Addictive?

Opioids are so addictive because they trigger a significant release of dopamine, a neurotransmitter linked to pleasure and motivation. The surge in dopamine reinforces the behavior, making the brain associate opioid use with pleasure, which leads to repeated use. The brain becomes dependent on the constant dopamine release, a process known as “dopamine addiction.” The brain adapts by reducing its natural dopamine production, requiring opioids to achieve normal levels of pleasure, increasing dependence.

Opioids cause rapid tolerance, meaning higher doses are needed to achieve the same effects, leading to fast dependence. Chronic use results in lasting changes in brain regions that control reward processing and motivation, fueling compulsive drug-seeking behavior. Withdrawal symptoms like pain, anxiety, and cravings occur due to decreased dopamine levels when opioids are not used. The withdrawal cycle acts as negative reinforcement, where the discomfort encourages the users to use opioids again to relieve the symptoms, strengthening the addictive pattern.

What are the Most Commonly Abused Opioids?

The most commonly abused opioids are listed below.

• Heroin: Heroin is an illicit opioid with highly addictive properties. It causes respiratory depression, overdose, and long-term health issues, such as heart problems and infections.
• Fentanyl: Fentanyl is a synthetic opioid, used illicitly, and is highly potent. It carries a high risk of overdose and death, especially since it is frequently mixed with other drugs without the user’s knowledge.
• Oxycodone: Oxycodone is a prescription opioid known for causing euphoria, constipation, drowsiness, and respiratory depression. Abuse of oxycodone leads to addiction and overdose.
• Hydrocodone: Hydrocodone is another prescription opioid, similar to oxycodone, with risks of addiction, constipation, drowsiness, and respiratory depression. Misuse of hydrocodone leads to harmful effects and dependence.
• Morphine: Morphine is a prescription opioid that causes drowsiness, constipation, and respiratory depression. Long-term use leads to physical dependence and addiction.
• Codeine: Codeine is a prescription opioid used for mild pain and coughs. The drug is less potent, but overuse leads to dependence and addiction. It causes respiratory issues if abused.
• Hydromorphone (Dilaudid): Hydromorphone (Dilaudid) is a highly potent prescription opioid. It carries a risk of overdose and addiction and causes severe respiratory depression if misused.
• Meperidine (Demerol): Meperidine (Demerol) is a prescription opioid that causes dependence and addiction. Overuse causes seizures and other neurological issues, making it particularly risky when misused.
• Methadone (Dolophine): Methadone (Dolophine) is a prescription opioid used in the treatment of opioid addiction. However, it is addictive and carries a high overdose risk due to its long-lasting effects if not used as prescribed.
• Oxymorphone (Opana): Oxymorphone (Opana) is a prescription opioid that is highly addictive. It poses risks of overdose and severe respiratory depression, making it dangerous when misused.

How do Prescription Opioids Lead to Opioid Dependence?

Prescription opioids lead to opioid dependence through mechanisms such as tolerance and physical dependence, where the body requires increasing amounts of the drug to achieve the same effect, and withdrawal symptoms occur without it. Opioids activate the brain’s reward system, releasing dopamine and creating euphoria, which drives psychological dependence and addiction. Chronic use leads to lasting brain changes, particularly in areas responsible for decision-making and impulse control, promoting compulsive drug-seeking behavior. Prescriptive opioids, such as oxycodone, hydrocodone, and fentanyl, manage moderate to severe pain. They are abused or misused by patients who take more than prescribed, use them for non-medical purposes, share or sell their prescriptions, or combine them with other substances like alcohol, increasing the risk of dependence and overdose.

What Causes Opioid Addiction?

The causes of opioid addiction are listed below.

• Biological Factors: Genetic predisposition contributes to opioid addiction. Specific genetic variations affect how the brain processes opioids, making the nervous system more vulnerable to addiction. Brain chemistry is another key factor because opioids trigger the release of dopamine, a chemical that creates feelings of intense pleasure. The reward response encourages repeated drug use. Neurobiological changes caused by long-term opioid use alter brain structures, leading to lasting changes in brain function and increasing the risk of addiction.
• Psychological Factors: Mental health conditions contribute to opioid addiction. Disorders like depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) increase the likelihood of opioid misuse as patients with these conditions use drugs to self-medicate. Certain personality traits, such as impulsivity and a craving for excitement or risk, raise addiction risk among drug users. Stress and difficulty managing emotions drive opioid users to rely on opioids as a coping mechanism for emotional pain or stressful life situations, increasing their dependence over time.
• Medical Exposure: Medical exposure to opioids is another major cause of addiction. Prescription opioids used for pain management lead to dependence, especially when not closely monitored by healthcare providers. Chronic pain conditions require long-term opioid use, which increases the risk of addiction over time. Lack of proper medical supervision leads to opioid misuse, as patients take higher doses than prescribed or use the drugs longer than necessary, resulting in physical and psychological dependence.

Who is at The Highest Risk of Developing Opioid Use Disorder?

The highest risk of developing opioid use disorder occurs among groups with specific psychiatric, genetic, environmental, behavioral, and demographic factors. Patients with a history of mental health conditions, such as depression or anxiety, and a history of substance use disorders face a higher risk. A family history of addiction increases vulnerability due to genetic predisposition. Environmental exposure, such as peer pressure, early exposure to drug use, and lack of family support, raises the likelihood of opioid misuse. Involvement in criminal activity and residing in areas with poverty or high socioeconomic deprivation contribute to addiction risk. Patients using prescription opioids, especially for long periods or in high doses, are more prone to dependence, particularly when opioids are injected rather than taken orally. Poly-substance use, such as combining opioids with alcohol or benzodiazepines, heightens the danger of overdose and addiction. Demographic factors influence risk, with males, older adults, and others from lower socioeconomic backgrounds facing a greater chance of developing opioid use disorder.

What are the Signs and Symptoms of Opioid Addiction?

The signs and symptoms of opioid addiction are listed below.

• Physical Symptoms: Physical symptoms include changes in appearance, such as weight loss, poor hygiene, or a lack of grooming. Scabs or sores appear, particularly from injecting opioids, and poor coordination or motor skills become evident. Digestive issues, such as vomiting, diarrhea, nausea, and constipation, are common. Opioid use leads to pupil constriction, or “pinpoint pupils.” Respiratory depression occurs in severe cases, with shallow breathing, especially in overdose situations.
• Behavioral Symptoms: Behavioral symptoms include doctor shopping, where a user visits multiple doctors to acquire various prescriptions. Misrepresenting pain levels to obtain opioids is another sign. Performance at work suffers, marked by absenteeism or decreased productivity. Social withdrawal is common, with the affected user isolating themselves from friends and family. Stealing medications from others occurs to satisfy opioid cravings.
• Cognitive Symptoms: Cognitive symptoms are marked by slowed thinking, such as difficulty concentrating or making decisions. Impaired judgment leads to poor decision-making and problem-solving. User experience a sense of detachment, feeling disconnected from their surroundings or reality.
• Psychosocial Symptoms: Psychosocial symptoms include sudden mood swings, irritability, or depression. Paranoia develops, with a suspicious outlook or feelings of being watched. Co-occurring mental health conditions, such as anxiety disorders or depression, are present alongside opioid addiction.
• Withdrawal Symptoms: Opioid users experience early and late withdrawal symptoms. Early symptoms include anxiety, agitation, yawning, sweating, and a runny nose. More severe symptoms emerge as withdrawal progresses, such as nausea, vomiting, diarrhea, abdominal cramps, and goosebumps.
• Overdose Symptoms: Life-threatening symptoms occur in an opioid overdose, including respiratory distress (shallow or difficulty breathing), cardiovascular issues (slow heartbeat, low blood pressure), and neurological symptoms (confusion, loss of consciousness, seizures). These signs indicate a severe health risk and require immediate medical attention.

What are the Short-Term and Long-Term Effects of Opioid Use?

The short-term and long-term effects of opioid use are listed below.

• Short-Term Effects of Opioid Use
  • Drowsiness or Fatigue: Opioids cause users to feel excessively drowsy or lethargic.
  • Euphoria: The release of dopamine creates intense feelings of happiness or euphoria.
  • Nausea and Vomiting: Gastrointestinal side effects, including nausea and vomiting, are common.
  • Constipation: Opioids slow bowel movements, frequently leading to constipation.
  • Slowed Breathing: Respiratory function is depressed, resulting in slowed breathing.
  • Confusion or Altered Mental Status: Users experience confusion or mental status changes.
  • Facial Flushing and Itching: Users notice facial flushing or itching.
• Long-Term Effects of Opioid Use
  • Physical Dependence and Addiction: Prolonged use leads to physical dependence and addiction.
  • Tolerance: Users need higher doses over time to experience the same effects.
  • Constipation and Digestive Issues: Chronic constipation and other digestive problems persist.
  • Liver Damage: Opioid use, especially with acetaminophen, causes liver damage.
  • Respiratory Depression: Chronic use leads to ongoing respiratory issues.
  • Hormonal Dysregulation: Opioids interfere with hormone levels, affecting libido and fertility.
  • Opioid-Induced Hyperalgesia: Long-term opioid use results in increased sensitivity to pain.
  • Mental Health Issues: Depression and other mental health disorders are linked to long-term opioid use.
  • Cardiovascular Changes: High doses cause cardiovascular issues, including heart failure.
  • Immune System Impairment: Opioid use weakens the immune system, increasing the risk of infections.

What are the Dangers of Opioid Overdose?

The dangers of opioid overdose are significant, as it is a medical emergency that results in death if not treated immediately. Symptoms of an overdose include pinpoint pupils, unconsciousness, difficulty breathing, blue or grey lips and nails, cold and clammy skin, dizziness, extreme drowsiness, and choking or gurgling sounds. These signs indicate a severe loss of respiratory function, which leads to brain damage or death if not addressed quickly.

Opioid overdose is hazardous due to the risk of respiratory failure, which causes death if untreated. Certain factors increase the risk, including opioid use disorder, injecting opioids, resuming opioid use after a break, combining opioids with other substances like alcohol or benzodiazepines, using high doses, and having underlying medical conditions such as liver or lung disease. Overdoses require immediate action, such as calling emergency services, administering naloxone if available, providing rescue breathing, and staying with the user until help arrives. Prompt intervention is critical to prevent fatal outcomes.

How Long Does Opioid Withdrawal Last?

Opioid withdrawal lasts for different durations depending on the type of opioid used, the length of use, and personal factors. Early symptoms begin within 6 to 12 hours after the last dose of short-acting opioids like heroin or oxycodone. Symptoms appear 1 to 2 days later for long-acting opioids like methadone. Early symptoms include anxiety, drug cravings, sweating, yawning, tearing, a runny nose, and stomach cramps. The peak symptoms of opioid withdrawal occur within 48 to 72 hours after the last dose for short-acting opioids. The most intense withdrawal symptoms include tremors, muscle twitching, rapid heartbeat, fever, chills, nausea, and diarrhea. Peak symptoms for long-acting opioids tend to be less severe, but they last longer.

Post-acute symptoms subside within a week for short-acting opioids, though long-acting opioids like methadone cause symptoms to persist for 3 to 6 weeks. Lethargy, anxiety, disturbed sleep, and ongoing drug cravings persist for months after acute withdrawal, with cravings potentially lasting for years. The duration and severity of withdrawal depend on factors such as the opioid’s duration of action, the amount and duration of use, and personal health conditions. Treatment options like buprenorphine and methadone help manage symptoms and support recovery.

What are the Best Treatments for Opioid Addiction?

The best treatments for opioid addiction are listed below.

1. Medications: Medications like methadone are used for withdrawal relief and long-term maintenance in opioid treatment. Methadone helps manage withdrawal symptoms and reduces cravings without causing euphoria. Buprenorphine, combined with naloxone (like in Suboxone), treats withdrawal and is used for long-term maintenance. It helps prevent opioid misuse and dependence. Naltrexone is another medication that helps prevent relapse by blocking opioid effects and is taken in pill form or as an injection. Clonidine is used to alleviate withdrawal symptoms such as anxiety and muscle aches.
2. Behavioral Therapies: Behavioral therapies, such as counseling, help address the underlying issues of opioid addiction in opioid treatment. Counseling is done individually, with family, or in group settings, helping to develop coping strategies. Behavioral therapy, including techniques like cognitive-behavioral therapy (CBT), helps manage cravings and prevent relapse. Self-help groups like Narcotics Anonymous provide valuable peer support and reduce the feelings of isolation that come with addiction recovery.
3. Treatment Settings: Treatment settings vary based on the severity of the addiction. Outpatient programs suit patients with stable living conditions and sufficient support systems. Outpatient intensive programs offer additional resources for patients who need more structured support. Residential programs are ideal for more severe cases where constant supervision and support are necessary for recovery.

How does Drug Detoxification Help with Opioid Withdrawal?

Drug Detoxification helps with opioid withdrawal by safely removing the opioid substances from the body, reducing withdrawal symptoms, and minimizing discomfort. Detoxification, particularly when medically assisted, alleviates symptoms such as nausea, vomiting, muscle aches, and anxiety. It provides a controlled environment where medical professionals monitor and manage severe symptoms that lead to dangerous health complications, ensuring the patient’s safety during the challenging process. Detoxification reduces withdrawal symptoms and prepares the patient for treatment.

The medications methadone and buprenorphine contribute to Drug Detoxification by easing withdrawal symptoms and supporting the transition to long-term recovery. Methadone helps reduce the intensity of withdrawal by gradually tapering off the opioid dose, allowing patients to stabilize without experiencing extreme discomfort. It is a long-term maintenance option for patients in recovery. Buprenorphine, combined with naloxone (as Suboxone), shortens the detox period, reduces withdrawal symptoms, and helps prevent misuse. Patients are better positioned for the subsequent phases of treatment after detox, including counseling and support groups, as they are physically stabilized and engage more effectively in psychological therapies. Detoxification prepares patients for long-term treatment by setting the foundation for ongoing maintenance, relapse prevention, and holistic recovery strategies.

What are the Most Effective Behavioral Therapies for Opioid Addiction Treatment?

The most effective behavioral therapies for opioid addiction are listed below.

• Cognitive Behavioral Therapy (CBT): CBT helps patients with opioid addiction identify and challenge negative thought patterns and behaviors related to drug use. It focuses on building coping skills, recognizing triggers, and managing cravings. Research shows that Cognitive Behavioral Therapy works best with other therapies and medications, helping patients develop healthier habits and stronger support systems.
• Dialectical Behavior Therapy (DBT): DBT teaches patients mindfulness techniques to regulate emotions and control cravings. The therapy encourages awareness of the present moment to prevent harmful behaviors. Borderline personality disorder is commonly treated with Dialectical Behavior Therapy, and it supports emotional regulation as part of opioid addiction treatment.
• Contingency Management (CM): CM uses a reward-based system to encourage abstinence from opioids. Patients are offered tangible incentives, such as vouchers or prizes, to maintain their drug-free status and achieve their treatment goals by utilizing Contingency Management.
• 12-Step Programs: Programs like Narcotics Anonymous (NA) and SMART Recovery provide peer-led support for patients recovering from opioid addiction. These programs offer a structured framework for maintaining sobriety and building a sense of community. Recovery through 12-step programs is maintained through social connection and peer accountability.

How Long does It Take to Recover from Opioid Addiction?

Opioid addiction takes several months to years to recover from, depending on the severity of the addiction, the type of opioid used, and the treatment approach. Recovery begins with managing withdrawal symptoms, which last from a few days to two weeks.

Withdrawal symptoms begin within 6 to 24 hours after the last opioid use. Early symptoms include anxiety, insomnia, muscle aches, tremors, diarrhea, and intense cravings. Symptoms peak within 1 to 3 days, causing fatigue, irritability, nausea, vomiting, and stomach pain. Most physical symptoms improve within 4 to 7 days, but withdrawal from short-acting opioids lasts up to 10 days, while long-acting opioids require 14 days or more for symptoms to subside.

Long-term recovery involves Medication-Assisted Treatment (MAT) using medications like methadone, buprenorphine, or naltrexone. These medications help reduce cravings, prevent relapse, and stabilize brain chemistry over time. Treatment plans combine MAT with behavioral therapies to address psychological and emotional challenges.

Sustained recovery requires continuous care, including counseling, peer support, lifestyle changes, and relapse prevention strategies. Full recovery from opioid addiction extends beyond detox and withdrawal, requiring months or years of consistent treatment, depending on the patient’s progress and commitment to long-term sobriety.

Is There an Opioid and Opiate Addiction Rehab Program?

Yes, there are opioid and opiate addiction rehab programs that support recovery through medical care, therapy, and long-term planning.

Medical detox is the first stage of rehab programs. The process helps manage withdrawal symptoms in a safe, supervised environment. Medications like buprenorphine and methadone reduce cravings and ease discomfort during detox.

Inpatient rehab provides 24-hour care in a residential setting. Treatment includes individual counseling, medication management, group therapy, and yoga or art therapy activities. Inpatient rehab is recommended for severe addiction or patients with mental health disorders.

Outpatient rehabilitation programs allow patients to live at home while attending scheduled treatment sessions. Programs include Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and standard outpatient care. Outpatient rehabilitation programs work best for patients with mild addictions or patients with strong family or community support.

Aftercare planning prevents relapse by providing continued access to counseling, peer support groups like Narcotics Anonymous, and sober living environments. Aftercare ensures that patients have ongoing tools and resources for long-term recovery.

Can Opioid Addiction Be Prevented?

Yes, opioid addiction can be prevented through a multifaceted approach involving education, healthcare interventions, and community support. Safe prescribing practices reduce the risk of addiction. For instance, limiting the duration and dosage of opioid prescriptions lowers the chances of long-term use. Prescription drug monitoring programs track controlled substances and prevent misuse. Education initiatives that inform healthcare providers and patients about the risks of opioids and available alternative pain management options help reduce unnecessary exposure to these drugs. Campaigns like the CDC’s Rx Awareness play a significant role in raising public awareness of the dangers of opioid misuse.

Community-based harm reduction programs contribute to preventing opioid addiction. Initiatives such as syringe exchange programs, safe injection sites, and the distribution of fentanyl testing strips help reduce the spread of diseases and prevent overdose deaths. The distribution of naloxone enables quick reversal of overdoses, saving countless lives. Early intervention through substance use disorder screening and Medication-Assisted Treatment (MAT) prevents opioid addiction from developing further. The stigma surrounding opioid use disorder and addressing socio-economic factors that contribute to addiction remain significant challenges that must be tackled for long-term success in prevention.

What Mental Health Disorders are Commonly Linked to Opioid Use Disorder?

Mental health disorders that are commonly linked to opioid use disorders are listed below.

• Depression and Anxiety Disorders: Depression and Anxiety Disorders are mental health conditions commonly linked to Opioid Use Disorder (OUD). Depression is a mood disorder marked by persistent sadness, hopelessness, and a lack of interest in activities once enjoyed. Anxiety disorders, including generalized anxiety and panic disorder, involve excessive worry or fear that disrupts daily life. Patients with Depression and Anxiety Disorders turn to opioids for self-medication, which worsens their symptoms and increases the likelihood of developing OUD. Opioid use exacerbates depression and anxiety symptoms, creating a vicious cycle.
• Post-Traumatic Stress Disorder (PTSD): Post-Traumatic Stress Disorder (PTSD) is a mental health condition that develops after exposure to traumatic events, causing symptoms like flashbacks, severe anxiety, and uncontrollable thoughts about the trauma. Patients with PTSD use opioids to cope with these overwhelming emotions, increasing the risk of OUD. The emotional dysregulation and heightened stress associated with Post-Traumatic Stress Disorder (PTSD) make it challenging to manage opioid use, leading to dependence.
• Bipolar Disorder: Bipolar Disorder is characterized by extreme mood swings, including periods of mania or hypomania and deep depression. Patients with bipolar disorder are more prone to developing substance use disorders, including OUD, due to impulsivity and attempts to self-medicate during mood swings. Opioids provide temporary relief, increasing the risk of addiction.
• Schizophrenia: Schizophrenia is a chronic disorder characterized by disruptions in thought processes, perceptions, emotional responses, and social interactions. Patients diagnosed with schizophrenia face a higher risk for substance use disorders, including opioid addiction. The increased risk results from attempts to self-medicate symptoms or from environmental and social factors, such as isolation or limited access to mental health care.

Does Trauma Contribute to Opioid Addiction?

Yes, trauma contributes to opioid addiction. Studies show that patients with Opioid Use Disorder (OUD) have a higher prevalence of childhood and interpersonal trauma, with 80.5% of treatment-seeking opioid-dependent reporting histories of abuse or neglect. Trauma increases the risk of chronic pain conditions, which leads to opioid use and misuse. Emotional stress and affective dysregulation, common outcomes of trauma, drive users to self-medicate with opioids. Conditions such as depression, PTSD, and anxiety mediate the connection between trauma and opioid misuse. Early life trauma is linked to more severe OUD independent of other mental health conditions, emphasizing the role of stress pathways in the development of addiction. The cumulative impact of multiple traumatic events or early exposure to trauma heightens the risk of opioid misuse, with gender differences playing a role, as women with OUD are more likely to report childhood sexual abuse.