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 complex 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 OUD, 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 OUD, a person must have access to opioids. Although some people get them illegally, many first use them after receiving a prescription for pain relief. If opioids are easy to get, whether through a doctor or other sources, the risk of developing OUD can go up.

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 OUD.

3. High or Frequent Doses

Taking opioids in high doses, whether for short-term or long-term pain, increases the risk of OUD. The risk is also greater for people who take higher doses or take them more frequently than prescribed.

4. Younger Age

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

5. Race and Opioid Use

According to a 2023 study in the journal Current Pain and Headache, people with a white racial background are more likely to develop OUD than individuals with other racial backgrounds.

Opioid-related deaths are higher in some minority groups. This may be partly because preventive efforts have often focused more on white populations, and because bias in pain care and opioid prescribing can affect who gets these medicines and who gets help.

6. Mental Health Conditions

People with mental health conditions such as depression, anxiety, or post-traumatic stress disorder are also at higher risk of OUD. 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 OUD 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 the environment or personal history may make someone more likely to develop OUD. These risk factors include:

• Problems with friends, family members, or coworkers
• Legal issues
• Participation in criminal activity
• 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 OUD. 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 OUD. 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 OUD are available only in research studies, but some tests can help doctors decide which opioid medications and doses are safest.

11. Ongoing 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 ongoing stress.

12. Heavy Tobacco Use

People who use a lot of tobacco have a higher risk of OUD. 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 relevant. If a doctor diagnoses OUD, they can help guide the next steps and discuss treatment options.

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Have you or a loved one been affected by opioid use disorder? What risk factors did you have? Let others know in the comments below.