Prescription Pain Medications (Opioids)

What is prescription opioid misuse?

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 made by people). 

Prescription opioids usually come in pill form and are given to treat severe pain—for example, pain from dental surgery, serious sports injuries, or cancer. Opioids are also commonly prescribed to treat other kinds of pain that lasts a long time (chronic pain), but it is unclear if they are effective for long term pain. 

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 and addiction are still potential risks when taking prescription opioids. Dependence means you feel withdrawal symptoms when not taking the drug. Continued use can can lead to addiction, where you continue to use despite negative consequences. 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, and is sometimes added to illicit drugs sold by drug dealers. 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/man-made opioids

 created in labs from natural opioids

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

Fully synthetic/man-made opioids

 completely man-made

 fentanyl, pethidine, levorphanol, methadone, tramadol,  dextropropoxyphene

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 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.
  • Mixing them 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?

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.

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 misuses drugs. And, check out how the brain responds to natural rewards and to drugs.

What happens to your body when you use 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

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 have been increasing since the early 1990s, largely due to the increase in misuse of prescription opioid pain relievers. Nearly 23,000 people died from an overdose of a prescription pain medication in 2015, with alarming increases among young people ages 15 to 24.Learn more about drug overdoses in youth.

The risk of overdose and death increase if you combine opioids with alcohol or other medications that also slow breathing, such as Benzodiazepines (e.g. Xanax).

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

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 is given in time.

Naloxone is available as an easy-to-use nasal spray or autoinjector. It is 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 in the event of an overdose, it 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, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Available at http://wonder.cdc.gov.

What about prescription opioids and 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. Even so, because millions of people are using prescription opioids, this adds up to hundreds of thousands of heroin users.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.

Opioid withdrawal can cause:

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

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. 

How many teens use prescription opioids?

Below is a chart showing the 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; 2016 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Vicodin Past Year 0.80 1.70 [2.90]
OxyContin Past Year 0.90 2.10 3.40

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

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

Learn more about prescription drug misuse among young adults

What should I do if someone I know needs help?

If you see or hear about someone misusing steroids, talk to a coach, teather, or other trusted adult. 

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.
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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.
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Teens Mix Prescription Opioids with Other Substances

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