Drugs & Health Blog

The Connection Between Pain Medications and Heroin

Sara Bellum

Note: We published an updated version of this post in 2015. Read the updated version here.

More and more young people are using heroin these days, and sometimes they start using it because they’ve gotten addicted to prescription painkillers.

One study showed that people who abuse painkillers like OxyContin are 19 times more likely to start using heroin. The study also found that 8 out of 10 people who started using heroin abused painkillers first.

Heroin and painkillers belong to the same class of drugs: Opioids. Opioids attach to specific molecules called opioid receptors, which are found on nerve cells in the brain, spinal cord, intestines, and other organs. When painkillers or heroin attach to these receptors, they can decrease the feeling of pain. Opioids can also cause a person to feel relaxed and happy, which can lead some people to abuse the drugs.

Opioids have many negative effects. Painkillers and heroin can cause sleepiness, constipation, and, depending on the amount taken, affect a person's ability to breathe properly. In fact, taking just one large dose of painkillers or heroin could cause a person’s breathing to stop, sometimes killing them.

Why do people switch from painkillers to heroin? In an effort to cut down on painkiller abuse, changes have been made to laws and prescription drug tracking systems. Because it’s getting harder to get painkillers, people may turn to heroin because it is cheaper and easier to get.

The Danger in Abusing Painkillers or Heroin

Not everyone who abuses painkillers starts using heroin, but even painkiller abuse alone can hurt you. Opioid drugs of all kinds can be very addictive. Addiction is a disease where you feel like you need to use a drug even if that drug is hurting you and messing up your life. Addiction is caused by chemical changes in the brain after drug use.

When someone is addicted to painkillers or heroin, it is very difficult for them to stop using the drug. People trying to stop using opioids after they are addicted may have withdrawal. Some of the effects of opioid withdrawal are restlessness, muscle and bone pain, trouble sleeping, diarrhea, vomiting, cold flashes with goosebumps, and uncontrollable leg movements.

Did you know abusing painkillers was so dangerous and could lead to using heroin? Tell us in comments. 

Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.


there are more facts to this and teens need to be more aware thank you for this post.
And how many people that used pain pills weren't addicted and this happen 2

Most people using heroin started with prescription opioids. However, most people using prescription opioids do not switch to heroin. In fact, less than 4 percent of people who abuse prescription opioids switch to heroin. (You can read more about that here: http://www.drugabuse.gov/publications/research-reports/relationship-betw...)

At issue is the very large number of people being given prescription opioids. Even if a fraction switch to heroin, it represents a very large number of people. And even if they don’t switch to heroin, many die by overdosing on the pills (about 19,000 people a year).

It's an epidemic that people are living in pain because a Dr is in fear of prescribing pain meds to control that pain! It is no wonder the drug problem has gotten so bad! What do you expect? People are tired of living in agony and knowing that nobody cares! Such a sad state of affairs when I care for cancer patients writhing in pain as they take their last breath! We treat dogs better than humans! As long as the medical society ignores our cries and don't give us pain control, you'll see increases in illegal heroin and morphine sales in addition to black market vicodin and oxycontin sales. People will do what they will to survive through the pain not for a high but to work and live without pain. It is a right of life to live without pain. Don't you agree that it's time to bring our legal prescriptions back to the public??
Yes you are right! My pain management are cutting back my pain meds for no reason at all, if they lower them anymore I might have to resort to heroin to control my severe neuropathy pain! Sad!
People who live in pain suffer. I've had back surgery and a very bad car accident. I steal try to work,I maintain with painkiller pills. I use to Go to my doctor every 3 months for pain med. Now I have to go every30 Days. I don't think that is right. That's Time from my job, that's the same amount of money to pay 3 times as much.and ect.. If u are in pain the kinda pai. That will always be with you tell the end, you rely on somethin to help.
The government has no interest in anyone's rights. They are only concerned with what they are doing and their numbers and related items. Get them out of our lives and we will all be better off. In the last 100 years name ONE thing government has done by getting into our lives that has improved our lives, just one.
Healthcare. Exit.
Word !! You r so right. Government should stay out of our lives . They know nothing about pain. They should all all pain on scale of 7/10 and for 24:7 maybe then they would realize we don't want drugs , all we want is complete pain relief & our quality of life back

Actually, the National Institutes of Health has a large consortium of experts who focus on pain and pain management. A lot of research is being done to find safer and more effective ways to treat pain. See https://painconsortium.nih.gov/

Yes i agree insuffrr behond excuriating pain daily i cry even scream .I hate living in pain I cant live a normal life it is so wrong that I had brain surgies I suffer pain constantly I had more operstions I had bone takennout of my brain I had deep brain surgies I had so many different operations and nothing helped my pain made a hundred times worst.I had a decompress trigimal nerve nothing I have so many different medical . Problems thst cost pain but my doctor put me on methodone that dont take awayb pain. I hate my lifebin pain its like a nightmare
I am also on methadone. It works really well for me. You need a DNA profile. My pain mgmt doc gave it too me because nothing else was working. Results showed a poor metabolized for a lot of the pain Meds.
DNA profile? That's interesting. I worry about my meds not working right due to no gallbladder and gastroparesis. Maybe I need to ask about this because they just want to cut you back even when your pain isn't going down.
Yes I do ! Not everyone is wired to be addicted . We just want to live normally without agonizing pain
As our government tightens up the supply of prescription painkillers in order to "help" the public avoid becoming addicted to these painkillers it encourages the public to switch to heroin. How does that work? Heroin is readily available and cheap due to the available supply. Then the public determines that heroin is easier to obtain and gives them a better 'high' so they switch over permanently. It is almost like our government works for the heroin dealers. I said 'almost'. This is what the War on Drugs has accomplished, a bunch of heroin addicts has been created by the US government. How disgusting. In addition, the legitimate users of the FDA approved meds for pain have a hard time getting their prescriptions filled. How much worse could it be? Get the US government OUT of the narcotics business because, as usual, they have no clue what they are doing and what damage they are causing. It is awful to watch. By the way, heroin so-called 'overdose' deaths are caused because the addicts never know what the strength of what they are buying is. When they inject it they are playing Russian Roulette. After/while you are injecting you do not know if you are going to die until you do or don't. That is how you find out. Sounds like fun. There is no agency making sure that the strength of drug (heroin) you buy from your local drug dealer is what you thought it was. If it turns out to be too strong, well, I guess you die. That is what our government has done and they keep on doing it. They are just so damn helpful. Maybe they should go help with something else, like paint or water like they did in Flint, Michigan.
I am a 79 year old woman who has never been addicted to anything. I have back and knee pain. I was getting two 5 mg hydrocodone a day until I tried marijuana to be able to get to sleep at night. For that reason my doctor canceled my hydro prescription. I think this is what drives people to heroin.
way to damn many and some of them really need these meds to live a somewhat normal life
I spent my whole life without addiction until I turned 37 and a car wreck I was introduced to pain meds I took them 4 years and finally gave in to heroin then ruined my life completely I just got help been clean two weeks now omg I'm finally free
When I was a pharmaceutical representative in 2003 I had to attend a training seminar about pain medication prescribing in which we compared heroin to prescription pain pills. We were taught that on the seventh consecutive day of taking either a pill or shooting up heroin, the human physiology is to become physically dependent to the point of having to feed the habit, to stave off the sickness, or become violently ill in going through the long withdrawal period. This was not made clear in the marketing of oxycontin. All pain pills that contain a derivative of morphine are subject to the same danger of addiction as heroin and until we educate the public and get the physicians to prescribe correctly, 5 day on with a 3 day wash, we will continue to have the addiction to pain pills and the crossover to heroin epidemic that we are swimming in today.
Are you going to be educating the heroin dealers too?
UR CRAZY IF U THINK I'M DOING THAT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!AND ITS SAD IF U DO :(
take away pain kills people will just goto what they can find and that heroin. this "drug war" is a losing battle. drugs aren't the main problem its the consequences of making them illegal.
You are exactly right. Most people know this. It is intuitive and accurate. Why doesn't our useless government know this? In the last 100 years name one thing and I mean ONE thing that the government has ever done by mixing into people's lives that benefited people. Just name one thing. I am laughing because you will not even be able to come up with one damn thing. It is disgusting. This War on this and that. Nothing they do benefits anyone but them. It gives them high paying jobs and big pensions and free medical. Gives us headaches. Best thing that ever could happen for us is to fire them all or give them work that does not involve us. I pray for it daily. I ask God to take the government out of my life. I hope he hears that, so far he hasn't.
Not strong enough with regards to "one large large dose of pain killers or Heroin could cause a person to stop breathing, somtimes killing them. The ignorance regarding all the factors is killing more and more young people. Half-Life of any medication needs to br publicized. Body size, weight and age as well as gender. Metabolism if each is individual is completely different and unique. I received a call, wrong number, from a 18 year old female who's friend died from an "accidental" overdose of Clonazepam and heroine, age 19, by the hand of her 24 year old boyfriend. He didn't call for help. I spent a long time talking and explaining why this "accident" ended her life. EVERYTHING I explained to her, I would ask, "Have you ever been told or were aware of this?" Her answer was always "no" By the time I finished explaining Half-Life, body type, and metabolism, she stopped crying. Education on physiology of the human body, metabolism and the build up of drugs, even in a weekend of abuse for a 100 pound young girl, will potentially kill you. As it did to her friend. RUSSIAN ROULETTE is the game they're playing. Because it's all about fun to the uneducated young who live for fun in the moment. Ignorance because no one is Teaching them. One time. One weekend. They haven't any idea how much their body has remaining in it's system from the last time. They feel fine. "CUMULATIVE" and Half-Life need to be yelled from every high school. Daughter/sister to Anesthesiologists'. Ever Vigilant, my dad would say about his medical field. Constantly and endless recording and even observation of the color of his patients fingernails.
your doctor will consider your health history, age, physical condition, life stressors and other factors to determine which medications may be right for you. Some medications may be prescribed only during the detoxification period, when your body is adjusting to the absence of heroin.
I was addicted to oxycotin and as my need for them got greater I could not keep up with the demand my body needed to function. I got so tired tired tired of witwithdrawal. Bad enough when your supplier were your own parents, it was there monthly medication. Their doctor had no problem writing 300+ for oxy/dros/dilaudid each meds for each of them. So we became full blown addicts right along with other people who would get pills from them as well. So one month after I had taken my last oxy and your body not ok but it jolts when you hear ive no more. I think you get sick faster than anything. Well i remember being hours in my withdrawal my mother said I can help you out but dont ask no questions. I had no problem with not asking, I just want the pain to go away. She took my arm tied it up and because I trusted my mother I didnt know she was about to introduce me to herion.
My God, how could she do her own child like that???
It really is a struggle I started out taking oxys and opanas then I started I.V.ing them. But the pills got sparse and expensive when I could find them, and believe it or not the needle is more addictive than the pills. If you've never shot up you wouldn't understand (also if you've never shot up don't ever try it) but when shooting up pills you end up with a lot of fillers and b.s. in your veins, which is no good. But then there was heroin, easy to find, if you get good stuff its not as bad for your veins as the pills, and it is a lot more potent. I used to crave the pills but that was nothing compared to how ungodly sick I got when I couldn't get heroin. Not to mention all the friends that I've watched fight it for years, many of which now have hep c, many have lengthy prison sentences for what they did while desperate to get high, and sadly many of my friends died fighting this addiction. Its no joke trust me I made my mistake and im still struggling to get away from it. I hope at least one person will read this and decide never to go near heroin or people who are doing it, because you'll end up just like them if you're around them long enough. Herion addiction is a terrible life long struggle that has taken many of my friends lives, and if you go down that road chances are you'll never find your way back
Wow good thing you made the right choice on the end
Will you email me please? I get this may be weird but I can't comment

Hi W, we can't email you (sharing contact information is against our blog commenting policies), but if you want to talk with someone, you can try one of the resources here: http://teens.drugabuse.gov/blog/post/lifeline-where-to-get-help-when-you...

Thanks for the info
dank memes
I'm addicted to pills. Just got woken up 5 hours into my sleep by withdrawals. Couldn't go back due to the crazy hot flashes, sweating, then freezing, goosebumps, restlessness, the need to change position every few minutes after getting comfortable, nausea, everything hurts, negative thoughts, I get crazy nightmares also when I withdrawal. So I decided to do some internet surfing. Anyhow, this is only an hour or two into the withdrawals. I popped 2 pills just now and I'm waiting for them to subdue. It's not enough to get high, I just want these symptoms to calm down.
I'm so sad for you. I hope you over come this addiction. I am praying for you Lena.
How can we get you the help you need to kick your habit?
I take morphine and the dr writes me out a prescription for 60: 60mg extended release and 120: 10mg extended release and also 4 bottles of morphine solution per month at 10mg/5ml concentration. (600mg in each bottle). (I had a 75ug fentanyl patch before the morphine) I wouldn't say I'm full blown addicted but I would say 100% that I am dependant on the medicines. I take them for chronic pain and it scares me the thought of not having them for pain and also the withdrawals that will happen if I do stop taking them. I'm prescribed 80mg slow release twice a day and upto 80mg of oral solution a day. It is true tolerance to strong opioids builds fast and the way it says "a big dose can kill" if someone with no tolerance tried a fentanyl patch it even warns them on the box that it's only for people with opioid tolerance. I will also say do not start using painkillers unless you really need them! I remember when they first gave me codeine, then dihydrocodeine, then tramadol then after a few years on that it was onto the fentanyl patch then finally now where I'm on morphine. I live in the uk and here it's harder to get opioids but they still prescribe them. If I could rewind the clock and start from fresh I wouldn't take them. The side effects are horrific the nausea and constipation are the worst. Some days when the pain is bad I will take 200-250mg of extended release tablets in the morning then take my usual 80mg at night. Before I started opioid therapy I used to see heroin addicts as junkies and smack heads but now I am dependant on an opioid I can definitely see how there is a bigger picture and how 80% of heroin addicts start out on painkillers. I have always said to my self as soon as I start to feel the pendulum is swinging from dependance to addiction is when I tell the dr straight away. I live in England and here the problem of teenagers getting prescribed painkillers and turning to heroin isn't as bad as we don't have to pay stupid prices for our prescribed medicines. All we have to pay is £8.05 per item so for them 3 items it is £8.05 x 3. Also I am age 22 and take the morphine (along with other non opioids like Lyrica and amitriptyline.) for back pain, hip pains, knee pain and they don't know what it is. This website has a lot more info than the UK website talk2frank has.
I don't understand? Was there physical pain first and no relief and the heroin helps like Advil? I thought heroin was taken to disappear from reality. Zone out. What does it mean to get high? And when a pain killer makes someone sleepy, is that getting high, too?

When we talk about "getting high," we mean a rush of relaxed and happy feelings that come from drugs' effects on the brain. Sometimes that includes feeling sleepy, and sometimes not. Opioids and Advil work in different ways. Heroin and opioid pain relievers both attach to molecules in the body called opioid receptors. That blocks pain messages being sent to the brain, and typically makes users feel high and zoned out. (Advil, on the other hand, works by reducing swelling.) Some people abuse prescription opioid drugs -- that means taking them to feel high, not because a doctor prescribed them for pain -- and get addicted. If they can't get more prescription opioids, they sometimes start using heroin, because it affects the same part of the brain as prescription opioids. Unfortunately, both heroin and prescription opioids can be very dangerous and even deadly if abused. You can read more about how different drugs work here: http://teens.drugabuse.gov/drug-facts

i have been taking prescription drug for 15years i tryed advil 8m I.B for a year did not help it just missed with my insides really bad so i started pain pill it help my pain then i got cancer and it went up when i was getting treat i saw kids in there to so sometimes pain pills are a good thing and the pain i have will never go away so i do understand what u are saying but there are people who ake only what they need
The article said, "In an effort to cut down on painkiller abuse, changes have been made to laws and prescription drug tracking systems. Because it’s getting harder to get painkillers, people may turn to heroin." It's quite interesting that the Taliban had almost completely eradicated the poppy fields in Afghanistan until the U.S. invaded - they are now back up to almost 100%. The government has begun a smear campaign and is cracking down hard on legitamate doctors and on patients who need pain medication. The TV is full of commercials about the "dangers of prescription opiods". Facebook is flooded with ignorant memes about the pharmaceutical companies that make legal pain meds and the pharmacies that sell them. Is it a coincidence that you can go online and see pics of U.S. soldiers gaurding the poppy fields at a time that the streets are flooded with heroin? Is this why it's hard to legally get pain meds? he streets are flooded with heroin.
Don't take them!!!!!!!!!!!!! Heal Naturally!!!!!!!! They are fake,and they make you a fake person!!!
As a chronic pain suffer myself I as well as most in my "pain community" try to go natural, use physical therapy, OTC's, anything before having to rely on prescription pain meds. Even then we try an try not to take them as to not become Dependant on them, as living with all our ailments and the problems that arise due to them is enough of a problem! Inevetibly they become a daily part of life. :-( Now with the war on prescription pain meds being what it is were being stripped of what little relief we do get if any! This is just so we can do most things folks take for granted...bathing, cooking, cleaning, etc... Most of us have already had to stop working and miss out on so many events in life its sad. There was a natural pain killer that did work well called Kratom, but as of Sept. The govt made it illegal. Coincidentally they've also come up with this new "wonder drug" that's under testing that promises to not have the same addiction problems as the opiods...which is making me think they've now found and are patening Kratom hence making it illegal to us. Smh! So I'm glad u don't face these daily issues and can heal naturally but for a lot of us...do we not deserve any quality of life?
Thank you for putting it so eloquently. I had to stop teaching due to pain. I was taking 18 advil a day, seeing chiropractor 2 to 3x a week. Finally taking hydrocodone allowed me to work 4 more years. Then I physically collapsed from pain. After 2 surgeries I could no longer work at all. My pain meds simply allow me to do my chores, go out to eat once a week. Now due to federal guidelines my pain doctor says he is going to stop my meds. I'm allergic to other meds, stomach, liver is ruined from nsaids. I'm so stressed worrying about what to do I'm barely functioning. No one in the medical community seems to care about older women in pain.
I never knew pain killers could lead to h and actually I don't think it ever would either .... Maybe doing pain killers makes you more likley but I believe it's for a diff reason... Most people who take meds don't know the price of H or how much it cost per point . Ppl don't just know that stuff .. How do they learn ?? How do they take their first hit ?? Do they just go out on face book and start looking for it ? NO THEY DONT!!!! Someone you know/trust enough to hear them out explains to you the pros and most don't explain the cons or atleast they just say ..."ITS JUST LIkE MEDS Just a little bit worse " they take a hit the girl you like takes a hit . And your like man I'm out of meds and they are becoming an issue in my life . Why not try this just one time it's not like I know where to get it anyways . Boom . Excuse after excuse bc your "friend triggered that addiction thinking process where you can literally fool yourself.. And after taking that first hit its like I've already done it okay .. And then you start feeling bad for not paying for it or your friend starts getting stingy with it .. So you have to buy some for yourself and your like ah just this one time i never really got a good hit "lies" then you have to trust that so called "friend" to not lie about to price . Which 9/10 times he is going to lie to get him some or put cash in his pocket . And then you are an addict
People that have legitimate pain problems are now being policed like common criminals because of these regulations. Don't you understand, if you take pain relief away from people that need it, you won't stop the people that take it anyway they can get it (illegally). It's just like saying to murderers: it's illegal to have a certain weapon (maybe a gun). Do you think that they will stop and say: I was going to kill someone with a gun today but I just found out that's illegal, oh wait, murder is illegal. Criminals will find a way to do what they want to do, just like people looking for a high are going to do whatever they want to make that happen. Why punish law abiding citizens for the behavior of murderers, and why punish people that legitimately need pain medicine for their very real pain. The proof is in the pudding: heroin abuse has increased because people who were using medicine to treat their pain have now been forced to find new ways because their doctors are scared to death to lose their licenses. The people that were fictitiously getting prescription pain pills are either: (a.)Still getting them somehow or (b.)now turned to street drugs. Either way, the war on drugs is an outrageous failure and a travesty for the well being of pain sufferers everywhere.
Finally someone that approached this topic with a coherent and logical thought process... Frankly, it's my personal belief that everyone has the right to use whatever drug/medicine/poison they want; it's their body, if they want to take pills to such a degree that dying is a real possibility for them it's not my or anyone else's business so long as they aren't endangering anyone else in the process. And by the way people, a majority of these comments aren't actual users of Rx pain medications/heroin. They are staged posts on what you are told is a public forum, I basically do the same thing for a living, it's just targeted marketing and you can easily determine their key demographic based on the "comments" posted. I'm not saying I think kids should go out and do all the drugs they can get their hands on by any standard. I just want people to stop trying to make correlations with drugs that don't exist. Intoxication has always existed with humanity, and no matter how much you try to regulate the pharmaceutical companies, monitor the doctors, make it harder for honest patients, or even police the illegal users, there will always be a market for intoxicants. If people could just make their peace with a reality where this will always exist it will stop being an epidemic/crisis/scourge. Then arrangements can be made to have these substances used in such a way as to minimize the potential for harm. And as for teens who are thinking about trying it, maybe parents should just give them factual data so they can decide on their own, and make sure they are doing better jobs as parents. Or if that seems too difficult a task; don't have children. Clearly if you can not convince your own child that they shouldn't do drugs because it's probably in their best interests, your genes might not be the ones to be passing onto the next generation.
I must have taken at least 5000 pills after an accident. You name it - I took it, OxyContin, dilaudin, morphine, tramadol, fentenyl.. Even got many pills off the street because the prescriptions just weren't enough. I was in constant pain. Crawling around on all fours looking for body peace. The pain destroyed me, physically, mentally and spiritually. It took every inch of my being to keep going. I would maybe get 20 mins of sleep at a time. Totally maybe 2 hours a day. I had to sleep/sit in a zero gravity lawn chair for a year. So, whomever said 'heal naturally' is out of their effing minds. I had two small children. One with special needs. And I wouldn't let them into my room most times because it would have broke their hearts to see their mother like that. The pain was so great I couldn't sometimes make it to the bathroom - it was so humiliating. The point I am making is these painkillers are so needed. I wouldn't be here today without them. Was I going down the path of addiction. Probably. But I was taking them for pain management ONLY. So after this long journey of popping pills that when the pain subsided slightly I stopped taking prescription meds. Not even a withdrawal symptom. Nothing. I cut down on them slowly towards the end. Even though the pain subsided slightly it was still there constantly. But My tolerance for the meds started to decrease as my tolerance for the pain started to increase. So my advice to people wanting to stop is take it slowly. Instead of your 20mg dose of oxy take a 15mg dose. Bite them where you have a little left over. Once I popped my last prescription pill. With a renewal waiting for me at the pharmacy. I said enough. And never looked back. Do I miss them? Absolutely! And trust me on this - I love taking pills and have addictive personality. But in the end it's mind over matter. You can do it! Baby steps. Never tell yourself you will never take another again. That will be your demise. Ps. I'm 100% healed. Busted my back and shattered my leg/ankle. I got titaium galore and had 6 surgeries. I know what pain is and why these pills are needed. Just take them for what they are prescribed and you will be ok.

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