Opioid use disorder (OUD) happens when someone can’t stop taking opioid medications, even if they want to. They might know the medication is harming them or making life harder, but they can’t quit using it. This condition is complicated and often starts when a person takes too much of a prescribed pain medication. In a 2021 survey, about 7 percent of U.S. adults who’d used prescription opioids in the past year met the criteria for prescription drug use disorder.

If you’re concerned about opioid use disorder — for yourself or someone you know — it’s important to understand the risk factors. Not everyone has all of them, but most people with OUD have at least one.

1. Access to Opioids

To develop opioid use disorder, a person must have access to opioids. While some people get them illegally, many start using them through a prescription for pain relief. If opioids are easy to get — whether through a doctor or other sources — it can increase the risk of developing OUD.

2. Long-Term Opioid Use

How long someone takes opioid medications also affects their risk. Most people who take the prescription drug for a day or two won’t develop a problem. However, using opioids for five days or more increases the chances of continuing to take them. That’s why people who are prescribed opioids over a longer period are more likely to develop opioid use disorder.

3. High or Frequent Doses

Taking opioids in high doses, whether for short-term or long-term pain, increases the risk of opioid use disorder. The risk is also greater for people who take higher doses or take doses closer together than prescribed.

4. Younger Age

Anyone can develop opioid use disorder, but younger people are at higher risk. Teens and young adults in their 20s may be especially vulnerable.

5. Race and Opioid Use

White people are more likely to develop opioid use disorder than people of other races, according to a 2023 study in the journal Current Pain & Headache. Doctors are more likely to prescribe strong painkillers to white people, so they often have easier access to opioids.

However, research also shows that opioid-related deaths are more common in some minority groups, possibly because preventive interventions have focused more on white populations. Racial stereotyping in pain treatment and prescribing practices may also play a role.

6. Mental Health Conditions

People with mental health conditions such as depression, anxiety, or post-traumatic stress disorder are also at higher risk of opioid use disorder. Researchers aren’t sure if these mental conditions directly increase the risk, but they do know that people with mental health diagnoses are more likely to be prescribed pain medication.

7. Neurodivergence

“Neurodivergence” refers to natural differences in how people think, learn, and behave. Neurodivergent conditions, such as autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD), may increase the risk of OUD. Some people with neurodivergence may misuse substances to help manage their symptoms.

A small study from Germany showed that ADHD was more common among people being treated for opioid use disorder than in the general population. ADHD-related impulsivity may play a role, but the link between opioid misuse and autism is less clear. More research is needed to understand these connections.

8. Environmental or Social Risk Factors

Many factors related to environment or personal history may make someone more likely to develop opioid use disorder. These risk factors include:

• Problems with friends or family members or at work
• Legal issues
• Participation in crimes
• Poor performance at school
• Sexual or physical abuse
• Risky or thrill-seeking behavior

Researchers don’t yet know exactly why these factors make OUD more likely.

9. Family History

Growing up around drug misuse can make someone more likely to develop opioid use disorder. If substance use is common in a family, it may seem normal or acceptable. Family-related trauma can also increase the risk of mental health conditions, which may lead to substance use.

10. Genetics

A person’s genes may contribute to the risk of opioid use disorder. Some genetic traits are linked to opioid misuse, and research suggests that about half of a person’s risk is inherited. Scientists are still working to identify which genes are involved. Right now, genetic tests for opioid addiction are available only in research studies, but some tests can help doctors decide which opioid medications and doses are safest.

11. Chronic Stress

Living with significant levels of stress can raise OUD risk. Stress may come from work, money problems, or difficulty paying for basic needs like food, housing, or healthcare. However, many different situations can contribute to chronic (ongoing) stress.

12. Heavy Tobacco Use

People who use a lot of tobacco have a higher risk of opioid use disorder. This may be because nicotine and opioids affect the brain in similar ways, making each substance feel more rewarding. They can also lessen withdrawal symptoms from one another, which may increase the likelihood of continued use.

Talk to a Doctor

If you’re worried about your opioid use or someone else’s, talk to a healthcare provider. Share your concerns, any symptoms you’ve noticed, and risk factors that may be important. If a doctor determines that opioid use disorder is present, they can help you find the best treatment options and start the path to recovery.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and other mental illnesses, and their loved ones. On MyDepressionTeam, more than 150,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression and other mental health conditions.

Have you or a loved one dealt with opioid use disorder? What risk factors did you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.