Prescription Pain Medications (Opioids)

When opioids enter the brain, they attach to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain and body, especially areas involved in feelings of pain and pleasure, as well as a part of the brain that regulates breathing.

Opioids affect the brain's "reward circuit," causing euphoria (the “high”) and flooding the brain with the chemical messenger dopamine. Surges of dopamine in the reward circuit encourage you to continue pleasurable but unhealthy behaviors like taking drugs, leading you to repeat the behavior again and again. Repeated surges from drug-taking can lead to addiction.

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

Short-Term Effects

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

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

Mixing prescription opioid medications with alcohol can cause a dangerous slowing of the heart rate and breathing. This can lead to a coma or death.

Long-Term Effects

People who use prescription opioid medicines for a long period of time increase their risk of addiction and overdose.

Yes, you can overdose and die from prescription opioid misuse. In fact, taking just one large dose could cause the body to stop breathing.

Deaths from overdoses of prescription drugs increased from the early 1990s to 2017, largely due to the increase in misuse of prescription opioid pain relievers. Between 2017 and 2018 (the latest year for which data is available), these overdoses decreased by 13.5 percent.  However, nearly 15,000 people died from an overdose of a prescription pain medication in 2018. The risk of overdose and death increases if you combine opioids with alcohol or other medications that also slow breathing, such as benzodiazepines (e.g. Xanax^®). Among all age groups, males are more likely to overdose from prescription pain medicines than females are.¹ 

Learn more about drug overdoses in youth.

Signs of Overdose

Signs of a possible prescription opioid overdose are:

• slow breathing
• blue lips and fingernails
• cold damp skin
• shaking
• vomiting or gurgling noise
• looking like you have passed out---or with a nodding head going in and out of consciousness

People who are showing symptoms of overdose need urgent medical help (call 911 immediately). A drug called naloxone can be given to reverse the effects of an opioid overdose and prevent death—but only if it's given in time.

Naloxone is available as an easy-to-use nasal spray called Nasal Narcan^® or autoinjector with the brand name Ezvio^®. It's often carried by emergency first responders, including police officers and emergency medical services. In some states, doctors can now prescribe naloxone in advance to people who use prescription opioids or to their family members, so that if an overdose happens, naloxone can be given right away without waiting for emergency personnel (who may not arrive in time).

Read more about how naloxone saves lives.

Prescription opioids are closely related to heroin chemically, and their effects can be very similar, especially when misused. Nearly 80 percent of people addicted to heroin started first with prescription opioids.  Heroin can be cheaper to get, so about 4% of people who misuse prescription pain medications switch to heroin. This adds up to hundreds of thousands of heroin users,  because millions of people are misusing prescription opioids.²

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. They often continue to take the drug simply to avoid painful withdrawal symptoms.

Opioid withdrawal can cause:

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

Doctors, dentists and other health care providers who prescribe opioids know how to weigh the risks of opioid dependence and addiction against the benefits of the medication.  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. Learn more about dentists and prescription opioid medications.

These symptoms can be extremely uncomfortable and are the reason many people find it difficult to stop using opioids. There are medicines being developed to help with the withdrawal process. The FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

The chart below shows the percentage of teens who say they misuse prescription opioid pain medicines.

Explore teen substance use trends over time, by grade and substance with an interactive chart featuring Monitoring the Future data from 2016 to present. 

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

• Call the 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 want to help a friend, you can:

• Share resources from this site, including this page.
• Point your friend to NIDA's Step by Step Guide for Teens and Young Adults.
• Encourage your friend to speak with a trusted adult.

If a friend is using drugs, you might have to step away from the friendship for a while. It is important to protect your own mental health and not put yourself in situations where drugs are being used.

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

NIDA Resources:

Check out the newly revised Opioids & Other Prescription Drugs Event Toolkit

• Opioid Facts for Teens
• Mind Matters: The Brain's Response to Opioids
• Commonly Abused Prescription Drugs Chart
• Drug Use and Your Mouth
• DrugFacts: Prescription and Over-the-Counter Medications
• DrugFacts: High School and Youth Trends

Other Government Resources:

• Opioids and Adolescents [Office of Adolescent Health]
• Pick Your Poison. Intoxicating Pleasures & Medical Prescriptions: Opium [National Library of Medicine]
• Prescription Pain Medications: What You Need to Know [Scholastic, Inc.]
• Slang Terms and Code Words: A Reference for Law Enforcement Personnel (PDF, 1MB) [Drug Enforcement Agency]

Educator Resources:   

• Monitoring the Future 
• National Survey on Drug Use and Health [Substance Abuse and Mental Health Services Administration]
• United States Adolescent Substance Abuse Facts (National and State Data) [Office of Adolescent Health]
• Youth Risk Behavior Surveillance System [Centers for Disease Control and Prevention]