Physical and Psychological Symptoms of Opioid Dependence

Many patients who abuse opioids will not have any obvious physical symptoms. However, there are some signs to look for during the physical exam.

Look for these physical indicators of opioid dependence:

  • In long-term intravenous drug users, look for needle marks or small scabs on their arms, legs, feet, groin (or really anywhere) or along vein lines.
  • Look for irritation of the nose lining or perforated nasal septum in long-term users who take opioids intranasally.
  • Pupillary constriction suggests that a patient may be currently intoxicated.
  • Patient complaints of dry mouth, constipation, sexual dysfunction, or irregular menses are other indicators of opioid abuse.

Look for these psychosocial indicators of opioid dependence:

Many opioid dependent people go to great lengths to hide physical signs of their substance abuse. However, psychosocial indicators may also be present and more apparent. Consider the following psychosocial issues to be red flags among patients suspected of substance abuse:

  • mood swings, depression, anger, irritability
  • marital problems
  • missing school or work
  • poor performance at school or work
  • financial problems, eg: large recent debt
  • social isolation, loss of friendships
Related Resources: 
Photograph classification system for identifying skin lesions of injection drug users.
Substance Abuse and Mental Health Administration (SAMHSA)