Key Takeaways
- Prescription opioid painkillers and heroin affect the same opioid receptors in the brain, which helps explain why some people with opioid use disorder may transition from prescription medications to heroin.
- Not everyone who takes prescription opioids develops an addiction or begins using heroin. Physical dependence and addiction are also not the same thing, although opioid misuse can increase the risk of developing opioid use disorder.
- Opioid use disorder is treatable. Evidence-based treatment may include medications such as buprenorphine, methadone, or naltrexone along with behavioral therapy, counseling, and ongoing recovery support.
Prescription painkillers and heroin are both opioids, and they affect many of the same receptors in the brain. Some people who develop opioid use disorder after using prescription painkillers later turn to heroin or other illicit opioids when prescription medications become difficult or expensive to obtain. However, this progression does not happen to everyone who takes prescription opioid medication.
The opioid epidemic in the United States has claimed countless lives and torn apart families and communities. Although the factors surrounding the epidemic are complex, understanding the connection between prescription painkillers and heroin can help people recognize the risks of opioid addiction and understand when treatment may be needed.
The Rise of Prescription Painkillers
In the 1990s and early 2000s, prescription opioid use expanded significantly in the United States, while the risks associated with long-term opioid use and addiction were often underestimated.
Opioids such as oxycodone, hydrocodone, codeine, and morphine can be effective medications for treating certain types of pain. However, they can also produce tolerance and physical dependence, particularly with prolonged use.
Some people may begin taking opioid medication for a legitimate medical reason and later find themselves taking larger amounts, taking the medication more frequently, or struggling to stop.
As tolerance develops, a person may need a higher dose to experience the same effects. Physical dependence can also develop, meaning stopping or reducing opioid use may produce uncomfortable withdrawal symptoms.
However, physical dependence on prescription opioids does not automatically mean someone has an addiction.
Prescription Opioid Dependence vs. Opioid Use Disorder
Understanding the difference between physical dependence and addiction is important when discussing prescription painkillers.
Physical dependence occurs when the body adapts to the presence of an opioid. If the medication is suddenly stopped or significantly reduced, withdrawal symptoms may occur. A person can develop physical dependence while taking an opioid as prescribed.
Opioid use disorder (OUD) involves a problematic pattern of opioid use that causes significant impairment or distress. A person may struggle to control their opioid use, experience strong cravings, continue using despite harmful consequences, or spend significant amounts of time obtaining, using, or recovering from opioids.
Tolerance and withdrawal can occur with opioid use disorder, but they are not by themselves proof that someone has an addiction.
Recognizing the signs of painkiller addiction early can help someone seek appropriate care before opioid use causes further harm.
Why Do Some People Transition From Prescription Painkillers to Heroin?
Some people with opioid use disorder eventually transition from prescription painkillers to heroin or other illicit opioids, but this is not an inevitable progression.
Several factors can contribute to this transition.
A person who has developed opioid dependence or opioid use disorder may experience strong cravings and painful withdrawal symptoms when opioids are unavailable. If prescription medications become difficult to obtain or too expensive, someone may seek another source of opioids.
Heroin has historically been one such alternative because it can produce effects similar to prescription opioids and may be cheaper or easier to obtain through illicit markets.
Other factors may include increasing tolerance, loss of access to prescription opioids, opioid cravings, and progression of an existing opioid use disorder.
Importantly, most people who receive prescription opioids do not inevitably progress to heroin use. Prescription opioids have legitimate medical uses, and taking them under the direction of a healthcare professional is different from misusing them.
Prescription Painkillers vs. Heroin
Although prescription opioid painkillers and heroin have important differences, both belong to the opioid drug class and affect opioid receptors in the brain.
| Prescription Opioid Painkillers | Heroin | |
| Drug class | Opioid | Opioid |
| Medical use | Used to treat certain types of pain | No accepted medical use in the U.S. |
| Legal status | Legal when appropriately prescribed and used | Illegal in the U.S. |
| Examples | Oxycodone, hydrocodone, morphine, codeine | Heroin |
| Can it cause physical dependence? | Yes | Yes |
| Can it lead to opioid use disorder? | Yes | Yes |
| Overdose risk | Yes | Yes |
The fact that these substances affect similar systems in the brain helps explain why someone who has developed an opioid use disorder involving prescription painkillers may experience cravings for or respond to another opioid such as heroin.
The Vicious Cycle of Opioid Addiction
Once opioid use disorder develops, breaking the cycle can become extremely difficult without appropriate support.
Heroin is a highly addictive opioid that can produce physical dependence and powerful cravings. Over time, someone may begin using opioids not simply to experience euphoria but to avoid withdrawal and feel physically normal.
Withdrawal can include symptoms such as muscle aches, nausea, vomiting, diarrhea, sweating, restlessness, anxiety, insomnia, and intense opioid cravings.
The fear of experiencing these symptoms can become another reason someone continues using.
At the same time, continued opioid use can affect relationships, employment, finances, physical health, and mental health. A person may recognize the damage their opioid use is causing while still finding it extremely difficult to stop.
That is one reason opioid addiction should not simply be viewed as a failure of willpower. Opioid use disorder is a medical condition for which effective treatments are available.
Where Fentanyl Fits Into the Connection
The modern opioid crisis has become even more complicated because of illicitly manufactured fentanyl.
Fentanyl is a synthetic opioid that is significantly more potent than heroin and morphine. Pharmaceutical fentanyl has legitimate medical uses, but illicitly manufactured fentanyl is now commonly involved in the illegal drug supply.
According to the National Institute on Drug Abuse, illicitly manufactured fentanyl can be mixed into drugs such as heroin or pressed into counterfeit pills made to resemble legitimate prescription medications.
This creates an especially dangerous situation because someone may consume fentanyl without knowing that it is present or how much they are taking.
As a result, the connection between prescription painkillers and heroin can no longer be understood without acknowledging the role fentanyl plays in today’s illicit opioid supply.
Addressing the Connection Between Painkillers and Heroin
Breaking the connection between prescription opioid misuse and illicit opioid use requires addressing the problem at several stages.
- Education: People who receive opioid medications should understand their benefits as well as the risks associated with prescription opioids, including physical dependence, misuse, and overdose.
- Responsible prescribing: Healthcare professionals can monitor opioid use and help patients evaluate appropriate pain-management options.
- Early recognition: Recognizing changes in opioid use, cravings, withdrawal symptoms, or other signs of opioid use disorder can allow treatment to begin earlier.
- Overdose prevention: Naloxone can temporarily reverse an opioid overdose and can be an important harm-reduction tool for people at risk of opioid overdose.
- Access to treatment: People with opioid use disorder should have access to evidence-based treatment, including medications for opioid use disorder when appropriate.
- Reducing stigma: Shame can discourage people from discussing their opioid use or seeking treatment. Treating addiction as a health condition can make it easier for people and families to ask for help.
Treating Heroin and Opioid Addiction
The treatment of heroin addiction should be tailored to the individual’s medical needs, substance use history, mental health, support system, and other circumstances.
There is no single treatment approach that works for everyone.
Medications for Opioid Use Disorder
Medications used to treat opioid use disorder include buprenorphine, methadone, and naltrexone.
Buprenorphine and methadone can reduce opioid withdrawal symptoms and cravings, while naltrexone blocks the effects of opioids after a person has completed an appropriate opioid-free period.
These medications can be combined with counseling and other recovery services as part of an individualized treatment plan.
Counseling and Behavioral Therapy
Behavioral therapies can help people recognize patterns associated with opioid use and develop healthier ways of responding to stress, cravings, and triggers.
Approaches may include cognitive behavioral therapy, motivational interviewing, contingency management, and other behavioral therapies used in addiction treatment.
Mental Health and Integrated Care
Addiction does not always occur in isolation. Depression, anxiety, trauma, and other co-occurring mental health conditions may occur alongside opioid use disorder.
Addressing both substance use and mental health needs can therefore be an important part of treatment.
Ongoing Recovery Support
Recovery continues after formal treatment ends.
Peer support, family involvement, counseling, relapse prevention planning, and continued aftercare can help people build stability and maintain the changes they have made during treatment.
“I’ve seen people start with pain medication and end up somewhere they never thought they’d be. At some point, it stops being about getting high and becomes about not feeling sick and just making it through the day. That’s how quietly opioids can take over someone’s life.”
Help for Opioid or Heroin Addiction
The connection between painkillers and heroin is one part of a much larger and more complicated opioid epidemic. Prescription opioids can provide legitimate pain relief, but opioid misuse and opioid use disorder can have serious consequences.
A transition from prescription painkillers to heroin is not inevitable, and developing opioid use disorder does not mean recovery is out of reach.
At Midwest Recovery Centers, we provide individualized addiction treatment designed to address both substance use and the circumstances surrounding it. If prescription painkiller use has progressed into heroin or other opioid use, our team can help you understand your treatment options and begin working toward recovery.
Contact Midwest Recovery Centers to learn more about our opioid addiction treatment programs.
Frequently Asked Questions
Can prescription painkillers lead to heroin use?
Some people who develop opioid use disorder involving prescription painkillers may eventually transition to heroin or other illicit opioids. Factors such as opioid cravings, physical dependence, reduced access to prescription medications, cost, and availability can contribute to this transition. However, using prescription opioid medication does not mean someone will eventually use heroin.
Why do some people switch from prescription opioids to heroin?
Someone with opioid use disorder may turn to heroin when prescription opioids become difficult or expensive to obtain or when cravings and withdrawal become difficult to manage. Heroin affects many of the same opioid receptors as prescription opioids, which can make it a substitute for some people with an existing opioid use disorder.
Are prescription painkillers and heroin the same type of drug?
Yes. Heroin and prescription opioid painkillers such as oxycodone, hydrocodone, codeine, and morphine are all opioids. However, prescription opioids have legitimate medical uses when appropriately prescribed, while heroin is an illegal opioid in the United States.
Does everyone who becomes dependent on prescription opioids use heroin?
No. Physical dependence on prescription opioids does not mean someone will use heroin or develop opioid use disorder. Physical dependence can occur when opioids are taken as prescribed because the body adapts to the medication. Anyone concerned about dependence or opioid use should speak with a healthcare professional before abruptly stopping prescribed opioids.
How is opioid addiction treated?
Opioid use disorder can be treated with evidence-based approaches that may include medications such as buprenorphine, methadone, or naltrexone, behavioral therapy, counseling, treatment for co-occurring mental health conditions, peer support, and continued recovery care. Treatment should be individualized according to each person’s needs.
Reviewed and Assessed by
Taylor Brown, B.A.Com., CRADC
Tim Coleman, M. of Ed.