| NIDA for Teens

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

What are prescription opioids?

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.

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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.

**Opioids**
Opioid Types	Conditions They Treat
oxycodone hydrocodone diphenoxylate morphine codeine fentanyl propoxyphene hydromorphone meperidine methadone	severe pain, often after surgery some forms of long-lasting pain (severe) cough and diarrhea

Fentanyl 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 misuse 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 misuse 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 misuse 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.

Overdose deaths involving prescription opioids rose sharply from about 3,400 in 1999 to more than 17,000 in 2017. While overdose deaths linked to prescription opioids have been declining steadily since 2017, more than 14,000 people died from an overdose of prescription pain medication in 2019. 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.

¹ Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at https://wonder.cdc.gov/.

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

²Compton 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 misuse prescription opioids?

The chart below shows the percentage of teens who say they 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; 2020 (in percent)*
Drug	Time Period	8th Graders	10th Graders	12th Graders
Vicodin	Past Year	0.5	0.9	1.2
OxyContin	Past Year	0.9	[1.0]	2.4

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

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:

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.

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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.