Brain Fog After Opioid Use: What’s Normal?

Have you felt forgetful, unfocused, or like your mind isn’t as sharp as it used to be? Many people in recovery from opioid use disorder (OUD) go through something called brain fog. It can make it hard to think clearly, remember things, or get through everyday tasks.

It helps to know what’s normal during OUD recovery — and what might mean you need extra support. When you understand why these changes are happening, you can take steps to feel better. And if something doesn’t seem right, you’ll know when it’s time to reach out to your OUD specialist for help. Recovery is about healing your whole self, including your mind.

What Is Brain Fog?

“Brain fog” is a term that encompasses many related cognitive (thinking-related) experiences — such as memory, focus, and understanding — around how you think, feel, and understand the world around you.

You don’t have to have all of these symptoms to be experiencing brain fog. What’s important is that you know what might happen and keep track of your experiences.

Brain Fog and Opioid Use Disorder

There are several reasons why OUD may lead to brain fog. These reasons relate to how OUD can affect brain function and structure.

Structural Brain Changes From OUD

People living with opioid use disorder may experience changes in brain volume associated with opioid use. This means that some areas of the brain may become smaller and take up less overall space. Brain volume may change during recovery, but research is still ongoing. Some researchers suggest these changes may resemble a type of brain injury that could require specific treatment.

There are also structural changes in the brain that may occur with OUD. These include changes to the gray and white matter in the brain, which may be linked to cognitive changes and difficulty with executive function (a set of cognitive functions that help people navigate daily life).

Chemical Brain Changes From OUD

Opioid use also affects brain chemistry. Over time, it causes the brain to make less dopamine, an important brain chemical that helps regulate motivation, reward, and focus. Not having enough dopamine can contribute to symptoms such as brain fog. OUD also may cause the brain to make more adrenaline.

When people stop using opioids, dopamine levels may drop quickly, and adrenaline levels may remain high. It takes time for these brain chemicals to stabilize again without the influence of opioids. Stabilization involves changes in how much of each chemical the body produces and how sensitive brain receptors (the parts of brain cells that respond to chemicals) are to them. It’s possible to experience brain fog until that stabilization happens.

The Effects of Brain Changes From OUD

Opioid use disorder has been shown to cause problems with your working memory. Working memory is your ability to hold information in your brain and use it to complete tasks, such as deciding what to pay attention to or making choices. These effects can persist even if you are treated with an approach called medications for opioid use disorder (MOUD), also called pharmacotherapy or medication-assisted treatment. Opioids may also affect your episodic memory. This is your ability to remember personal experiences or events from the past.

Opioids have also been found to affect decision-making, visual memory, and executive functioning.

These changes can be long-lasting. While some people may find that their brains recover over time, others may find that they continue to struggle with cognitive and memory issues for a long time, at least several years into recovery. This may happen even if you abstain from opioid use or undergo MOUD treatment.

People with long-term opioid use may be more likely to experience cognitive problems and have them be longer-lasting, but more research is needed to say this for sure. People who have used more opioids may also have more problems with brain fog.

MOUD and Brain Fog

Some treatments used in MOUD may contribute to brain fog. For example, common side effects of methadone are drowsiness and dizziness, which may contribute to brain fog. Buprenorphine, another MOUD treatment, can also cause these side effects, especially if too much is taken. Buprenorphine can also interfere with sleep, which can contribute to symptoms of brain fog.

Treating Brain Fog With Opioid Use Disorder

There’s no single treatment for brain fog that comes from opioid use disorder. Treatment options will depend on what’s causing your brain fog. Something called cognitive retraining may help. This is like physical therapy for your mind. You’ll get certain tasks, practice them regularly, and hopefully see improvement in your brain fog.

Cognitive retraining is still a relatively new area of research. One study found that cognitive retraining helped improve the working and episodic memory of people recovering from OUD. People who did the retraining were also less likely to use or misuse substances compared to people who didn’t get working memory training. If you’re interested in this kind of treatment, reach out to your healthcare provider to see if it’s an option for you.

Other Causes of Brain Fog

Opioid use disorder isn’t the only thing that can cause brain fog. It can also be connected to:

• Not getting enough sleep
• Changes to hormones
• Stress
• Mental health diagnoses, like depression or anxiety
• Poor nutrition
• Diabetes
• Autoimmune diagnoses
• Long hospital stays
• Some chemotherapy treatments

You may find that your brain fog gets worse when you don’t sleep well, when a mental health problem shows up, or when you’re under stress. In those situations, you may be able to think better when you take care of those issues.

When Brain Fog Means Something More

Sometimes, brain fog may be worse than what’s expected after a diagnosis of OUD. If you think this is true for you or your loved one, it’s important to get medical advice from a qualified healthcare professional right away.

If your brain fog started after you began a new medication, started feeling depressed or anxious, stopped sleeping well, experienced significant stress, or received a neurodivergent or autoimmune diagnosis, talk to your doctor. They may be able to help you address it by identifying and treating the underlying cause.

If you think that brain fog is connected to your MOUD treatment, it may be possible to switch to another one that might not have that side effect. Your healthcare provider can help you get access to medications that will both help with OUD and have side effects you can live with.

If you feel like brain fog is putting you or your loved one at a higher risk of relapsing, your doctor can be helpful there, too. They can help you get the support you need to manage brain fog without turning to opioids.

Finally, if your brain fog gets worse, it’s time to see a medical professional. They can help figure out what’s going on or what changed so you can get the help you need.

Managing Brain Fog

There are a few strategies you can try to manage brain fog and its effects. These may help some people more than others, but it may be worth trying strategies such as the following, which may improve mental clarity:

• Take proper care of yourself, including getting the nutrition and the sleep you need.
• Write down information you want or need to remember so you can access it even if you forget it.
• Get regular exercise or physical activity.
• Talk to a therapist.
• Give your brain regular breaks, especially when you’re performing difficult tasks.
• Make efforts to manage your stress levels.

Your healthcare provider can give you specific instructions about what they think will help you the most. Follow their advice to help your brain feel its best and raise your sense of well-being with OUD.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

How have you experienced brain fog connected to opioid use or recovery? Let others know in the comments below.