Resource CenterIs Someone You Know Using Opioids? What to Look For

Is Someone You Know Using Opioids? What to Look For

Two people sitting with their hands clasped together as part of a difficult but supportive conversation.

By Peg Rosen

If you’re worried someone you care about is using opioids, there are some signs you can look for. If they’re using needles to inject opioids, signs of skin damage, such as small holes, scabs, and bruises on their arms, called track marks, can be an obvious sign of their habit. But opioids come in many other forms, including pills, snortable powders, nasal sprays, and lozenges, all of which are easier to conceal and make it harder for others to notice.

Still, there are red flags that suggest someone may be using opioids. Some can be mistaken for symptoms of depression or other mood disorders, so you’ll want to look out for several signs. If possible, bring in a trusted adult who can help you figure out what’s going on and how to handle the situation.

Here are things to watch for and what you can do if you think a friend or family member is using opioids.

Behavior and Appearance

Changes in their personality or attitude. You may think they just aren’t themselves. Someone who’s usually full of energy may not be up to do much of anything anymore. People often start lying or get angry to cover up their habit. Some also become aggressive or even abusive.

Avoiding friends and family. A person may be absent for long stretches or stay holed up in their room at home or in their dorm. They may also have a totally new friend group and may not introduce you to them.

Loss of interest in things they used to care about. They may ditch sports, art classes, volunteer gigs, or other social activities they usually enjoy.

Secretiveness. Because opioids carry so much stigma, people tend to hide the fact that they are using. They may not tell you where they are going or who they are spending time with. They may not want you in their room or near their phone.

Erratic moods. Intense highs and lows are a big sign of opioid use, because opioids initially deliver a euphoric rush that can make someone feel super happy. But as the high begins to fade, users can crash to devastating lows, especially if they are physically dependent and feeling symptoms of withdrawal.

Anxiousness and jitteriness. During the early stages of physical dependence on opioids, people who are using can become irritable as the drugs begin to leave their system and they go into withdrawal. Over time — and as the brain adjusts to opioids — they may begin to seem anxious and on edge when they haven’t taken enough to meet their dependence.

Not doing well at school or work. Grades may tank. They may miss days on the job. And if school faculty or employers call them on it, they may minimize it or get irritable in response.

Stealing. A person who is physically dependent on opioids can go to great lengths to get drugs. They may steal from work or stores. Eventually, they may take from the people closest to them. It doesn’t happen because they’ve turned into a bad person. It happens because they have lost control of their drug use.

Changes in appearance. Someone who is using opioids may:

Go days without bathing, brushing their hair, or changing their clothes.
Look pale and tired, as if they haven’t slept in days.
Always wear long sleeves, even in very hot weather, to hide track marks on their arms and hands. Track marks may also appear on the soles of feet, on legs, or between toes.
Have needle holes, which often look like red dots to start, get darker over time, and eventually scab over.
Have bruised veins, which are dark purplish or even black. If someone is injecting in one area frequently, the tracks can look like one large bruise.

Change in eating habits. Many people who use opioids drop in weight because they experience nausea or lose interest in anything but finding more opioids. On the flip side, opioids can lead to weight gain in some cases because they make people less active and can trigger cravings for high-sugar, high-carb foods.

Physical Symptoms of Opioid Use and Addiction

Constricted pupils. Small, pinpoint pupils are a classic sign that someone is high on opioids. If they are experiencing withdrawal, their pupils may appear very large.

Slow, shallow breathing. Opioids are considered depressants, which means they slow down the central nervous system, which slows breathing. Most fatal overdoses from opioids occur because breathing slows to a point that not enough oxygen gets to the brain and a person suffocates. If you are concerned about someone’s breathing, call 911 immediately. If available, also give them naloxone or Narcan, a medication that can quickly reverse an overdose.

Learn about how to get and use naloxone.

Lack of responsiveness. If someone is high, they may seem zoned out, unable to hear you, or uninterested in what you are saying. If they pass out or become unresponsive, call 911 and give them naloxone immediately.

Drowsiness. They may nod off frequently, even mid-conversation. People using opioids may also sleep much of the day.

Clumsiness and lack of coordination. When someone is high, their movements may seem jerky and unsteady. They may bump into things and trip.

Itchy, flushed skin. Opioids can cause an allergic reaction in the skin. People who are using opioids may scratch a lot and appear flushed and red, especially on their face, arms, and upper chest.

They seem like they have the flu. When someone is going through withdrawal from opioids, they can become physically ill. They may wrap themselves in sweaters or blankets to combat chills and body aches. Vomiting, nausea, diarrhea, and night sweats are also common.

Other Clues of Opioid Use or Addiction

Many people who become addicted to opioids eventually turn to injecting drugs with needles, no matter what form they had used before. Besides track marks on their body, you may find the following clues in their car, pockets, bedroom, bathroom, and trash:

Empty resealable plastic bags with powder or powdery residue inside.
Scorched pieces of aluminum foil used to heat and melt powders and crushed pills.
Missing or scorched spoons, also used to heat and melt powders and crushed pills.
Empty gel capsules, used to hold powdered opioids.
Shoes with missing shoelaces. Shoelaces are commonly used as tourniquets, which make veins easier to find and ease injection. You may also notice belts notched to holes far smaller than waist-size or knotted neckties.

What to Do If You Think Someone Is Using Opioids

Don’t wait to act if you notice signs like these. The longer someone uses opioids, the deeper their addiction may become and the greater their chances of an overdose. It may be an uncomfortable conversation, but it’s critical that someone talks to them and offers support and resources.

You may consider talking with your loved one to offer support and resources. Remember to:

Start simple. You may choose to ask your loved one a question about their experience or start with, “I’ve been noticing [this behavior or symptom]. Can we talk about it?”
Listen carefully and don’t judge them.
Tell them you are here to help them and share resources like the ones below.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) Help Line: 800-662-HELP (4357)
- SAMHSA’s treatment locator
- The American Society of Addiction Medicine’s physician finder
- The 988 Suicide and Crisis Lifeline: Call or text 988

How to Support Your Loved One and Yourself

For additional advice on talking to a loved one about opioid use, including words or phrases you may want to use, check out this guide from the Wisconsin Department of Health Services.

If you still don’t know what to do or if the person you’re concerned about shuts you down, reach out for support. A mental health professional who specializes in substance misuse and addiction can help you manage the situation.

You can be another source of support for your friend or family member by getting naloxone or Narcan and learning how to use it. You may be able to find in-person Narcan training at a local community health center or hospital by using the National Harm Reduction Coalition’s resource finder. You could also take a course online through the Centers for Disease Control and Prevention or the American Red Cross.

Just as it’s important to take steps to protect and help your friend or family member, it’s also important to take care of yourself during this hard time. You may talk to a mental health professional or other supportive friends and family or attend a Narcotics Anonymous family meeting or Al-Anon meeting, where individuals meet to talk about how they’ve been affected by a loved one’s addiction. (You can still go to Al-Anon even if your loved one is using something other than alcohol.)

You can’t help your friend or family member struggling with addiction if you don’t look out for your own well-being too. Take some time to practice self-care and prioritize your needs.