Signs of opioid addiction and what families can do
Opioid addiction is dependence on heroin, methadone, fentanyl or opioid painkillers. The key signs are pinpoint pupils, drowsiness and "nodding off", withdrawal with a runny nose, body aches and insomnia whenever use stops, and money or belongings going missing. Because of the overdose risk it is the most life-threatening addiction, so families need to act now rather than wait for "rock bottom".
Warning signs of opioid addiction
- Pupils shrunk to pinpoints, even in a dim room
- Drowsiness, nodding off mid-conversation, slow and slurred speech
- Withdrawal episodes: runny nose, watery eyes, yawning, goosebumps, muscle and joint pain, diarrhoea, insomnia, irritability
- Long sleeves in hot weather, needle marks and bruises, syringes, burnt spoons or foil around the house
- Missing money, valuables or medication from the home medicine cabinet; new debts
- Painkillers running out faster than prescribed, prescriptions from several different doctors
- Constipation, loss of appetite and weight, pale skin, neglect of appearance
- Lying, unexplained disappearances, a new circle of friends, trouble at work or school
What the family should do
What to do
- Learn the signs of an overdose and keep the emergency number at hand — 101 in Israel.
- Talk at a calm moment, without shouting: stick to concrete facts — what you have seen and what you are afraid of.
- Get a consultation for yourselves without waiting for their agreement — the family can start changing things first.
- If they are on methadone or another substitution therapy, stay in touch with the treatment programme and do not interfere with prescriptions.
- Find out in advance where medically supervised detox is available, so no time is lost once they say "yes".
- Protect the children: needles, pills and drugs in the home are dangerous for them too.
What not to do
- Do not give money "for medicine" or "to pay off a debt" — with opioid addiction it almost always ends up buying the drug.
- Do not attempt a locked-room "home detox": opioid withdrawal is hard and should happen under medical supervision.
- Do not stop methadone or substitution therapy on your own or push them to quit "cold turkey" without a doctor.
- Do not assume the danger is over after detox, hospital or prison: tolerance drops, and their old dose can kill.
- Do not cover for them with their employer, the police or relatives — that only buys the illness more time.
How opioid addiction is treated
Treatment starts with medically supervised detox, where withdrawal symptoms are managed by doctors; it usually takes 5 to 14 days. At IsraRehab, detox is carried out by licensed staff under a medical director who is a psychiatrist. But detox is not treatment. It is preparation for treatment: the body is clear, yet everything that led to heroin or pills is still there.
Next comes an inpatient programme of 30 to 90 days or longer. Under the Full Return Method it rests on three layers of therapy: CBT to recognise triggers and handle cravings, existential work on what a sober life is for, and the 12-step programme, which gives a community that stays after discharge. At the same time the body is rebuilt — sleep, nutrition, exercise — because opioids disrupt the brain's reward system for a long time.
If someone is on methadone or another substitution therapy, decisions about tapering and moving to a drug-free programme are made only by a doctor — gradually and under supervision. My part of the work is motivation, treatment strategy and preparing the family, not medical prescriptions.
The most dangerous period is the first months after discharge: tolerance is already lower, and a relapse on the "usual" dose can end in an overdose. That is why aftercare lasts at least 12 months and the family learns to spot early warning signs. If your loved one refuses treatment, I start with a crisis intervention — a prepared conversation that ends with them agreeing to treatment.
Crisis intervention →
A prepared family conversation after which the person agrees to get treatment.
Treatment at IsraRehab ↗
If detox or inpatient care is needed, treatment takes place at the licensed IsraRehab centre under medical supervision.
When to call emergency services immediately
- Signs of an overdose: the person cannot be woken and does not respond to voice or pain, breathing is slow, gurgling or has stopped, pupils are pinpoint, lips and fingertips turn blue. Call 101 in Israel or your local emergency number at once, follow the dispatcher's instructions and do not leave them alone.
- Naloxone is an emergency antidote for opioid overdose, given by paramedics and, where available, by trained people on the spot. Even if the person comes round, they still need an ambulance: naloxone can wear off before the opioid does.
- Using again after a break — after detox, hospital, prison or a clean period — sharply raises the risk of overdose.
- Opioids combined with alcohol, sleeping pills or sedatives — a dangerous mix that suppresses breathing.
- Talk of suicide, goodbye messages or a deliberate overdose — get emergency help without delay.
Frequently asked questions
What are the signs of opioid addiction?
Pinpoint pupils, drowsiness and nodding off, slow speech, needle marks, syringes or burnt spoons at home, and missing money or belongings. When use stops there is withdrawal: runny nose, yawning, muscle aches, diarrhoea, insomnia. The sooner the family acknowledges the problem, the better the chance of acting before an overdose.
Opioid overdose: what to do?
Call 101 in Israel or your local emergency number immediately and follow the dispatcher's instructions. Check breathing; if the person is breathing but unconscious, roll them onto their side so they do not choke. If naloxone is available and you know how to use it, use it — but call the ambulance regardless. Do not waste time on cold showers and do not give any other substances.
How do you come off methadone?
Only under medical supervision. Methadone must not be stopped abruptly: a doctor reduces the dose gradually according to an individual plan. After that, a full rehabilitation programme and aftercare are needed — otherwise the risk of going back to heroin or other opioids is high.
Why is relapse after rehab or prison so dangerous?
During a period without use, tolerance to opioids falls. The person takes their old dose, but the body is no longer prepared for it — many overdoses happen this way. That is why the first months after discharge need close attention and support.
What if they refuse treatment?
Start with yourselves: a family consultation, no more money or covering up, and clear boundaries. If nothing changes, we prepare a crisis intervention — a structured conversation after which the person agrees to start treatment. The first consultation is free.
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