Opioid-Induced Adrenal Insufficiency: Causes, Symptoms, and What to Do

When you take opioids long-term, your body can stop making its own stress hormones — a condition called opioid-induced adrenal insufficiency, a hormonal disorder caused by chronic opioid use that suppresses the hypothalamic-pituitary-adrenal axis. It’s not an allergy or a mental health issue — it’s your adrenal glands shutting down because opioids trick your brain into thinking you don’t need cortisol anymore. Many people mistake its symptoms for depression, fatigue, or just "getting older." But if you’ve been on opioids for months or years and suddenly feel wiped out, dizzy, or nauseous after even minor stress — like a cold or a dental visit — this could be why.

This isn’t rare. Studies show up to 1 in 5 long-term opioid users develop some level of adrenal suppression. It’s more common with high doses and synthetic opioids like methadone or fentanyl, but even prescription oxycodone or hydrocodone can cause it over time. The problem? Doctors rarely test for it. Blood tests for cortisol and ACTH are needed, and most won’t order them unless you specifically mention it. And if you stop opioids suddenly without replacing cortisol, you can go into adrenal crisis — low blood pressure, vomiting, confusion, even collapse. It’s life-threatening.

What makes this worse is that people often think adrenal problems only happen with steroid withdrawal. But opioids work differently — they don’t just block pain. They hijack your brain’s stress response system. Your pituitary gland stops signaling your adrenals to make cortisol. Over weeks or months, those glands shrink and forget how to work. Even after you stop opioids, it can take months for your body to recover — if it recovers at all without help.

That’s why understanding corticosteroid withdrawal, the process of safely reducing or replacing cortisol after long-term opioid use matters. If you’re tapering off opioids, you need a plan. Sometimes, a short course of hydrocortisone can help your adrenals wake up. Other times, you need ongoing replacement. And if you’ve had surgery, an injury, or an infection while on opioids, you might need emergency steroid coverage — even if you’ve never been told you have this condition.

There’s also a strong link between opioid use disorder, a chronic condition involving compulsive opioid use despite harm and adrenal insufficiency. People with this disorder often have multiple health issues — sleep problems, chronic pain, depression — and adrenal insufficiency can make all of them worse. It’s not just about stopping drugs. It’s about fixing your body’s broken stress response.

Below, you’ll find real, practical posts that explain how this condition shows up, how it’s diagnosed, what treatments actually work, and how to talk to your doctor about it. No fluff. No guesswork. Just what you need to know if you or someone you care about is on opioids long-term and feeling off.