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

When you take opioids long-term, your body can stop making its own cortisol—a hormone your adrenal glands need to handle stress, regulate blood pressure, and keep energy levels stable. This is called opioid-induced adrenal insufficiency, a condition where prolonged opioid use suppresses the hypothalamic-pituitary-adrenal axis, leading to low cortisol production. It’s not an allergy or overdose. It’s a silent shutdown of your body’s natural stress response. And it often goes unnoticed until you get sick, injured, or try to stop the opioids—and then you crash.

This isn’t rare. Studies show up to 20% of people on long-term opioid therapy develop this issue, especially those taking high doses for months or years. The problem? Symptoms like tiredness, dizziness, nausea, and low blood pressure look like depression, aging, or just "feeling off." Many doctors don’t test for it because they’re focused on pain control, not hormone levels. But if you’ve been on opioids for over three months and suddenly feel worse when you cut back—or even just during a cold or flu—you could be dealing with adrenal insufficiency. It’s not in your head. It’s in your adrenal glands.

adrenal insufficiency, a condition where the adrenal glands don’t produce enough steroid hormones, especially cortisol from opioids is different from Addison’s disease. It’s usually reversible, but only if caught early. Stopping opioids cold turkey can trigger a life-threatening adrenal crisis—low blood pressure, vomiting, confusion, even coma. That’s why tapering slowly under medical supervision matters. If your doctor doesn’t mention adrenal testing, ask for a morning cortisol level or an ACTH stimulation test. It’s a simple blood draw that can save your life.

People who take opioids for chronic pain, cancer, or after surgery are most at risk. But even those on low doses for years can develop this. It’s not about being "addicted." It’s about biology. Your body adapts. And when it does, your adrenal glands forget how to work on their own. That’s why some patients feel fine on opioids—but fall apart when they’re switched to a different painkiller or try to quit. The fix isn’t more pain meds. It’s often a short course of corticosteroids to help your adrenals wake back up.

And here’s the thing: this condition doesn’t show up on drug tests. No one checks for it unless you speak up. If you’ve been on opioids for a while and feel like you’re always running on empty, it’s not just stress or laziness. It might be your body’s cortisol levels hitting rock bottom. The good news? Once identified, this is manageable. You don’t have to live with constant fatigue. You don’t have to risk an adrenal crisis. You just need to know what to look for—and who to ask.

In the posts below, you’ll find real-world guidance on how opioid side effects like this one connect to broader medication risks—from drug interactions and withdrawal patterns to how your body adapts over time. You’ll see how slow up-titration, Type A vs Type B reactions, and medication adherence all tie into what’s happening inside your system when opioids change your hormone balance. These aren’t isolated issues. They’re part of the same story: how long-term drug use reshapes your biology, and how to protect yourself.