COVID-19 is an emerging, rapidly evolving situation.

Get the latest information from CDC ( | NIH Resources | NIDA Resources

Prescription Pain Medications (Opioids)

Also known as: Oxy, Percs, Vikes

Revised May 2019

What are prescription opioids?

A bottle with a hydrocodone label and hydrocodone tablets spilling out isolated on white background.©

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

Prescription opioids are medications that are chemically similar to endorphins – opioids that our body makes naturally to relieve pain. They are also similar to the illegal drug heroin. In nature, opioids are found in the seed pod of the opium poppy plant. Prescription opioids usually come in pill or liquid form, and are given to treat severe pain—for example, pain from dental surgery (read more about drug use and your mouth), serious sports injuries, or cancer. If you are in the hospital, they can be given through an IV (needle and tube) in your arm. Opioids are sometimes prescribed to treat pain that lasts a long time (chronic pain), but it is unclear if they are effective for long term pain. 

When opioids are taken as prescribed by a medical professional for a short time, they can be relatively safe and can reduce pain effectively. However, taking prescription opioids, puts you at risk for dependence and addiction. Dependence means you feel withdrawal symptoms when you stop taking the drug. Continued use can lead to addiction, where you continue to seek out the drug and use it despite negative consequences. These risks increase when the medications are misused. Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Opioid medications can be natural, created in labs from natural opioids, or synthetic (human-made). Common opioids and their medical uses are listed below.

Opioid Types Conditions They Treat
  • oxycodone (OxyContin®, Percodan®, Percocet®)
  • hydrocodone (Vicodin®)
  • diphenoxylate (Lomotil®)
  • morphine (Kadian®, Avinza®)
  • codeine
  • fentanyl (Duragesic®)
  • propoxyphene (Darvon®)
  • hydromorphone (Dilaudid®)
  • meperidine (Demerol®)
  • methadone
  • severe pain, often after surgery
  • some forms of long-lasting pain (severe)
  • cough and diarrhea

Fentanyl has been in the news recently. It is a powerful synthetic (human-made) opioid that is 50 to 100 times stronger than morphine, and is prescribed for extreme pain. It is extremely dangerous if misused, and is sometimes added to illicit drugs sold by drug dealers. Find out more about Fentanyl.


How Prescription Opioids Are 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 medical reason like relieving pain.
  • Taking an opioid medication in a way other than prescribed—for instance, taking more than the 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."
  • Mixing it with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with prescription pain relievers. 

What happens to your brain when you use prescription 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.

What can happen to your body when you use prescription opioids?

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.

Can you overdose or die if you use prescription opioids?

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.

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.

1 Centers for Disease Control and Prevention, Drug and Opioid-Involved Overdose Deaths -- United States, 2017-2018. Released 2019. Available at

How are prescription opioids connected to heroin use?

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

2 Compton WM, Jones, CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. England Journal of Medicine, 2016, 374:154-163.

Are prescription opioids addictive?

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.

How many teens use prescription opioids?

Misuse of prescription opioid medications among teens has dropped significantly since 2002, when it was first measured. In fact, past-year misuse of Vicodin® and OxyContin® among 12th graders is at a record low, dropping from 9.6 percent in 2002 to 1.1 percent in 2019 for Vicodin®, and from 4 percent in 2002 to 1.7 percent in 2019 for OxyContin®.

Monitoring the Future 2019: Tobacco and Nicotine: Prescription Drug Misuse Continues Decline from Peak Years: Vicodin and OxyContin

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

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2019 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Vicodin Past Year 0.90 1.10 [1.10]
OxyContin Past Year 1.20 2.00 1.70

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

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: 

  • 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:

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.

Blog Posts


See text description below

Drug and Alcohol Use in College-Age Adults in 2018

Published: September 13, 2019
The 2018 Monitoring the Future College Students and Young Adults survey shows trends in the use of marijuana, alcohol, nicotine, and synthetic drugs in college students and non-college peers.
This is an infographic. See text below for details.

Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome

Published: January 22, 2019
Use of opioids during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome or neonatal opioid withdrawal syndrome (NAS/NOWS).
See text description below

Drug and Alcohol Use in College-Age Adults in 2017

Published: September 05, 2018
The 2017 Monitoring the Future College Students and Young Adults survey shows trends in the use of marijuana, alcohol, nicotine, and synthetic drugs in college students and non-college peers.
See text description below

Fentanyl and Other Synthetic Opioids Drug Overdose Deaths

Published: May 29, 2018
This infographic summarizes a study that finds that nearly half of opioid-related overdose deaths involve fentanyl.
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.
See text description below

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.
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.
Content on this site is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. HHS Syndication Storefront: Select NIDA content is available for you to use on your own site.  Through HHS Syndication Storefront, you may promote this high-quality content on your website and it will take on the look and feel of your site.  This syndicated content will also update content in real-time, leaving you free from having to perform manual updates.