Prescription Pain Medications (Opioids)

What are prescription opioids?

Three viles of prescription drugs

Also known as: Oxy, Percs, Happy Pills, Hillbilly Heroin, OC, or Vikes

Prescription opioids are medications that are chemically similar to endorphins – opioids that our body makes naturally to relieve pain – and also similar to the illegal drug heroin.  In nature, opioids are found in the seed pod of the opium poppy plant. Opioid medications can be natural (made from the plant), semi-synthetic (modified in a lab from the plant), and fully synthetic (completely man made). 

Prescription opioids usually come in pill form and are given to treat severe pain—for example, pain from surgery or serious injury or pain that results from chronic health conditions like cancer. Opioids are also commonly prescribed to treat other kinds of pain that lasts a long time (chronic pain), but there is little evidence showing they are effective for chronic pain, and some research suggests that they can even make pain worse.

For most people, when opioids are taken as prescribed by a medical professional for a short time, they are relatively safe and can reduce pain effectively. However, dependence (feeling withdrawal symptoms when not taking the drug) and addiction are still potential risks when taking prescription opioids.  These risks increase when these medications are misused.  Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Common opioids and their medical uses are listed below.

Opioids
Opioid Types Conditions They Treat
  • oxycodone (OxyContin, Percodan, Percocet)
  • hydrocodone (Vicodin, Lortab, Lorcet)
  • diphenoxylate (Lomotil)
  • morphine (Kadian, Avinza, MS Contin)
  • codeine
  • fentanyl (Duragesic)
  • propoxyphene (Darvon)
  • hydromorphone (Dilaudid)
  • meperidine (Demerol)
  • methadone
  • severe pain, often after surgery
  • acute (severe) pain
  • some forms of chronic pain (severe)
  • cough and diarrhea

Fentanyl has been in the news recently.  It is a powerful opioid prescribed for extreme pain that is 50 to 100 times more potent than morphine. It is extremely dangerous if misused. Find out more about fentanyl.

Types of opioids:

Type of Opioid

How Are They Derived

Examples

Natural opioids (sometimes called opiates)

 nitrogen-containing base chemical compounds,  called alkaloids, that occur in plants such as the  opium poppy

 morphine, codeine, thebaine

Semi-synthetic/manmad opioids

 created in labs from natural opioids

 hydromorphone, hydrocodone, and oxycodone (the  prescription drug OxyContin), heroin (which is made  from morphine)

Fully synthetic/manmad opioids

 completely manmade

 fentanyl, pethidine, levorphanol, methadone, tramadol,  dextropropoxyphene

How are prescription opioids misused?

 People misuse prescription opioid medications by taking them in a way that is not intended, such as:

  • taking someone else’s prescription, even if it is for a legitimate medical purpose like relieving pain.
  • taking an opioid medication in a way other than prescribed—for instance, taking more than your prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug.
  • taking the opioid prescription to get high.

Sometimes people misusing opioids combine them with alcohol or other drugs, which is particularly dangerous. Misusing opioids increases risk for both addiction and overdose.

How do prescription opioids affect the brain?

Opioids attach to specific proteins, called opioid receptors, on nerve cells in the brain, spinal cord, gut, and other organs. When these drugs attach to their receptors, they block pain messages sent from the body through the spinal cord to the brain. They can also reduce or stop other essential functions like breathing when they attach to opioid receptors in a brain area that controls respiration.

Opioid receptors are also located in the brain’s reward center, where they cause a large release of the neurotransmitter dopamine. This causes a strong feeling of relaxation and euphoria (extreme good feelings). Repeated surges of dopamine in the reward center from drug-taking can lead to addiction.

Learn more about how the brain works and what happens when a person abuses drugs. And, check out how the brain responds to natural rewards and to drugs.

What are the other effects of prescription opioids?

In addition to pain relief and euphoria, other effects of opioids include:

  • sleepiness
  • confusion
  • nausea (feeling sick to the stomach)
  • constipation
  • slowed or stopped breathing.

These medications are not safe to use with alcohol or other medications that also slow breathing, such as depressants, because their combined effects can increase the likelihood of a fatal overdose.

Does misusing prescription opioids lead to heroin use?

Prescription opioids are chemically closely related to heroin, and their effects, especially when misused, can be very similar. Because heroin may be cheaper to get, people who have become addicted to prescription pain medications sometimes switch to using heroin.. Nearly 80 percent of people addicted to heroin started first with prescription opioids.  However, the transition to heroin use from prescription opioids is still rare; only about 4 percent of people who misuse prescription opioids use heroin.

Can you become addicted to prescription opioids?

Yes, prescription opioids can be addictive.  People who misuse prescription opioids are at greater risk of becoming addicted to opioids than people who take them as prescribed by a doctor, but patients taking opioids as prescribed for a period of several weeks or more may develop a dependence to the drug, in which they feel unpleasant withdrawal symptoms when not taking it.

Opioid withdrawal can cause:

  • restlessness
  • muscle and bone pain
  • sleep problems
  • diarrhea
  • vomiting (throwing up)
  • cold flashes with goosebumps (“cold turkey”)
  • involuntary leg movements

Dependence is not the same as addiction, but in some cases it can contribute to developing an addiction.

Carefully following the doctor’s instructions for taking a medication can make it less likely that someone will develop dependence or addiction, because the medication is prescribed in amounts and forms that are considered appropriate for that person.

Doctors should always weigh the risks of opioid dependence and addiction against the benefits of the medication, and patients should communicate any issues or concerns to their doctor as soon as they arise. The earlier a problem is identified, the better the chances are for long term recovery. 

Can you die if you misuse prescription opioids?

Yes. In fact, taking just 1 large dose could cause the body to stop breathing. In 2014, opioid medications resulted in 19,000 deaths in the United States. If you compare it to 2001, when 5,500 people died from an overdose of opioid pain relievers, you can see how dramatically deaths have increased in the last decade. Among young people, males are much more likely to overdose from opioid abuse than are females.1 In 2014, among young people ages 15 – 24, males accounted for three out of every four deaths from an overdose of pain relievers.

The risk for overdose and death are increased when opioids are combined with alcohol or other drugs, especially depressants such as Benzodiazepinexs (e.g. Xanax).

Signs of Overdose

Signs of a possible heroin overdose are:

  • slow breathing
  • blue lips and fingernails
  • cold damp skin
  • shaking
  • vomiting or gurgling noise

People who are showing symptoms of overdose need immediate medical help—call 911. A drug called naloxone can be used to reverse the effects of an opioid overdose and prevent death if it is given in time.  Naloxone is an opioid antagonist, which means that it binds to the opioid receptors and blocks their effects.

Naloxone, which is available as a nasal spray or in an easy-to-use autoinjector, is often carried by emergency first responders, including police officers and emergency medical services.  In some states, doctors can now prescribe naloxone to people who use heroin or to their family members, so that in the event of an overdose, it can be given immediately without waiting for emergency personnel (who may not arrive in time). Read more about how Naloxone Saves Lives.

1 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Available at http://wonder.cdc.gov.

How many teens misuse prescription opioids?

NIDA’s Monitoring the Future study collects data on teen abuse of two types of prescription opioids—Vicodin and OxyContin:

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2015 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Vicodin Past Year 0.90 2.50 4.40
OxyContin Past Year 0.80 2.60 3.70

* Data in brackets indicate statistically significant change from the previous year.

For the most recent statistics on teen drug abuse, see results from NIDA’s Monitoring the Future study.

Learn more about prescription drug abuse in our infographics.

What should I do if someone I know needs help?

If you, or a friend, are in crisis and need to speak with someone now, please call:

  • National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by).

If you need information on treatment and where you can find it, you can call:

For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.

Blog Posts

Chat Day Transcripts

Infographics

Infographic - see text below for description

Abuse of Prescription (Rx) Drugs Affects Young Adults Most

Published: February 08, 2016
More young adults use prescription drugs nonmedically than any other age group.
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Substance Use in Women and Men

Published: January 08, 2016
This infographic shows differences in substance use trends between women and men for marijuana use disorder, abuse of prescription pain medicines, treatment admissions for sleeping aid misuse, and nicotine cessation.
See text description below

Monitoring the Future 2015 Survey Results

Published: December 16, 2015
NIH’s 2015 Monitoring the Future survey shows long term decline in illicit drug use, prescription opioid abuse, cigarette and alcohol use among the nation’s youth.
This is an infographic. See text below for details.

Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome

Published: September 01, 2015
Use of opiates during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome (NAS). One baby per hour is born suffering from opiate withdrawal in the U.S.
Infographic - see text below for description

Teens Mix Prescription Opioids with Other Substances

Published: April 08, 2013
Teens who abuse Rx opioids often combine them with marijuana or alcohol.
See text description below.

Prescription Drug Abuse: Young People at Risk

Published: June 07, 2012
The RX Risk: Roughly 1 in 9 youth abused prescription drugs in the past year.