When Opioid Dosages Escalate, Risks for Addiction Increase

Doctor Suspicious

Data from a recent study indicates that, as an opioid dosage is increased, the risks for adverse outcomes also increase. In layman’s terms, the more painkillers a doctor prescribes to a patient, the more likely the patient is to overdose on those painkillers and potentially to die from them.

With this information in mind, patients should consider all of their options before going on opioid painkillers.

The Study and Its Findings

A January 2020 research paper published in the journal Addiction sought to understand the potentially harmful effects of opioid dose escalation. Specifically, the researchers sought to determine whether or not increasing prescriptions of opioid pain relievers posed any real threat to patients struggling with chronic, non-cancer pain. The researchers were particularly interested not just in the duration of the prescription but mainly in the potency of the opioids prescribed.

The findings were concerning. According to the researchers, adverse outcomes were significantly higher among the patients who did receive an increase in their opioid dosage than patients who did not receive a dosage increase. The researchers concluded their report by saying, “Escalating the opioid dose for those with chronic, non‐cancer pain is associated with increased risks of substance use disorder and opioid‐related adverse outcomes.”

The study process was quite simple. The researchers examined a group of over 50,000 people to arrive at the conclusion cited above. The researchers followed 32,420 patients who stayed on the same dosage of opioid painkillers and 19,358 patients who had increased dosages. Across the study groups, the patients within the dosage escalation group experienced far more overdoses and other opioid-related adverse outcomes than patients who stayed on the same dosage throughout the study period.

The Opioid Epidemic – It Began with Overprescribing

When an opioid pain reliever dosage is increased beyond what is considered safe, this is called overprescribing. Quoting the National Institutes of Health, “Safe prescribing is a process that recommends a medicine appropriate to the patient’s condition and minimizes the risk of undue harm from it.” Overprescribing would be any prescribing action that goes beyond the above guideline and puts the patient at risk as a result.

Looking back to the period from 1995 to 2005, overprescribing was what, in many ways, caused the opioid epidemic to take off. According to the Centers for Disease Control and Prevention, the opioid epidemic came through America in three, distinct waves.

1) The first wave began in the mid-1990s with an increase in the prescribing of opioid pain relievers to the American people. Patients who had not been on painkillers were put on painkillers, and patients who were already on painkillers had their dosages increased. This increase was caused by pharmaceutical manufacturers pressuring doctors to prescribe more painkiller pills to patients. By the late-1990s, overdose deaths began to increase.

Buying heroin

2) By 2010, doctors had begun to pull back on their prescribing patterns, but millions of Americans were already addicted to opioids. This is where heroin came in. After years of record lows in heroin trafficking and use across America, heroin came back on the drug scene as a serious crisis in this country. Why? Because opioid addicts who could no longer get painkillers were looking for another way to get their fix.

3) The third wave began in 2013 when synthetic opioids such as fentanyl became popular. Shortly after, drug cartels began producing illicit synthetic opioids, mainly fentanyl. Today, most of the opioid-related drug deaths in the U.S. are caused by fentanyl.

Tens of Thousands of Americans Die from Opioid Overdoses Every Year

Though the epidemic began with pharmaceutical companies pressuring doctors to prescribe more opioid pills to patients, the opioid crisis is now a multifaceted epidemic.

The crisis includes the diversion of pharmaceutical opioid pain relievers (like OxyContin) for recreational use and misuse. The problem also includes heroin abuse, illicit fentanyl abuse, and the misuse of psychostimulants such as meth and cocaine that have opioids mixed into them.

According to the National Institute on Drug Abuse, nearly 50,000 people died from different types of opioid drugs in 2019. NIDA reports that opioid addiction is a serious national crisis that affects public health and social and economic welfare. The Centers for Disease Control and Prevention estimates that the financial burden of the opioid crisis rings to the tune of $78.5 billion each year from healthcare costs, lost productivity, addiction treatment, and criminal justice involvement.

Prescription opioids often serve as a person’s first exposure to opioids. Experts estimate that most opioid addicts begin by using opioid pain relievers. Studies show that 80% of heroin addicts misused prescription opioids before they went on to use heroin.

Given the potential danger of taking prescription opioids, especially when one’s doctor increases the dosage, it would make sense for patients to consider other safe and effective pain relief options. In fact, the Centers for Disease Control and Prevention even suggest keeping opioid pain relievers aside, used only as a last resort. Quoting their guidelines, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Opioids are not first-line or routine therapy for chronic pain.”

Patients Should Explore All of Their Options

Patient choosing options

Without giving medical advice, it would be wise for patients to explore their options when attempting to address their pain. First off, patients should make sure they are getting informed consent from their doctor. Informed consent is the simple but sometimes neglected act of a doctor fully informing their patient on the possible consequences, risks, and inherent dangers of choosing a particular medical treatment (such as opioid painkillers).

There are lots of different ways to treat pain, and patients should be informed of these options. The American Society of Anesthesiologists lists several, including:

  • Physical therapy
  • Acupuncture
  • Surgery
  • Nerve blocks
  • Radio waves
  • Electrical signals
  • Spinal cord stimulation
  • Pain pumps

There is a wealth of natural, holistic, and plant-based remedies to consider as well.

Given that opioid painkillers have been proven to have addictive properties (and that risks for addiction increase as dosages increase), patients should consider all of their options when considering how best to treat pain.

What to Do if Someone Becomes Addicted to Painkillers

If a loved one becomes addicted to opioids, whether they have a legitimate need for pain relief or not, it will be essential for them to get clean off of their drug of choice as soon as possible. That’s why parents, family members, and loved ones should know the signs of opiate addiction, what to look for, and how to respond.

The safest way to overcome an addiction to opiates is with the help of a residential drug treatment center. If you know someone who is hooked on their meds, on heroin, fentanyl, methadone, suboxone, or any other opioid substance, do everything you can to get them into a drug and alcohol treatment center as soon as possible.


Reviewed by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP, LCDC-I



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.