How Does Prescription Drug Abuse Lead to Heroin Addiction?

Last Updated on October 4, 2023

prescription drugs at a pharmacy

The rise in prescription drug abuse has created an unexpected trend, a rise in the use of the opioid drug heroin. According to the National Institute on Drug Abuse (NIDA), 1 in 15 people who abuse prescription pain relievers will try heroin within ten years.1

In general, many people transition from opioid painkillers to heroin because heroin is cheaper and easier to get. However, it’s not always that simple and there are many other factors that play a role in this behavior.

Before we can understand the connection between prescription drug abuse and heroin addiction, we must first understand what opioids are, how they affect the body, as well as the factors that predict the transition from prescription drugs to heroin.

So, let’s jump right in.

What Types of Prescription Drugs Are Most Commonly Abused?

The most recent data available in 2021 from the National Survey on Drug Use and Health states that:2

  • 558,000 Americans had a prescription stimulant use disorder
  • 681,000 Americans had a prescription tranquilizer or sedative use disorder
  • 1.4 million Americans had a prescription pain reliever use disorder

Certain types of prescription drugs are more commonly abused than others due to the way they affect the brain and body. Some side effects, such as relaxation or mild euphoria may produce a psychological reward, which reinforces the behavior and can lead to dependence and addiction. According to the National Institute on Drug Abuse, opioids, central nervous system (CNS) depressants, and stimulants are some of the most commonly abused types of prescription drugs.3

Commonly abused prescription opioid drugs include:

Commonly abused prescription CNS depressants include:

Commonly abused prescription stimulants include:

How Does Prescription Drug Abuse Typically Start?

Misusing prescription drugs always begins as a choice to take the medication, but the abuse that follows isn’t always intentional. People often assume that prescription opioids are safer than illegal drugs like heroin just because they are medically prescribed. However, they can produce many of the same effects if they are taken incorrectly and may be just as dangerous.

In many instances, prescription opioid abuse begins unintentionally. The following scenarios are examples of how this might happen in your life.

  • You may start taking prescription opioids after surgery to help with the recovery. After a week or two of using them, you might have already developed a tolerance and may experience withdrawal symptoms when you run out. This might motivate you to see your doctor to get more or to find another way to get the medication (such as buying it online without a prescription or through a friend who knows someone).
  • Your doctor may have given you sleeping pills for short-term treatment of insomnia. Maybe you started taking larger doses without talking to your doctor first because you felt like the dose he prescribed wasn’t working anymore. You may not have even noticed you were addicted until after you ran out and started experiencing withdrawal symptoms.
  • You were out walking with a friend and you slipped on some ice, fell, and hurt your back. She offers you some painkillers that she had leftover from a dental procedure and you took them. You liked the way they made you feel so you exaggerated your symptoms to get some from your own doctor. When that prescription ran out, you started feeling sick (withdrawal symptoms) and bought some pain meds from a local dealer because you couldn’t get any more from your doctor.

Over time, taking powerful and addictive prescription medications can cause certain brain changes that make it difficult to maintain self-control and make good decisions. People also often experience strong cravings for these prescription drugs, which makes them even more difficult to resist.

What Are Opioids?

Opioids are a class of drugs that are naturally found in the opium poppy plant. They are prescribed by doctors (painkillers/narcotics) to manage pain. They are also abused illegally (heroin).4

In addition to controlling pain, prescription opioid medications can also make people feel relaxed, happy, and they can also produce a mild euphoric high. These side effects are very addictive, which is why people get hooked on opioids so quickly.

How Do Opioids Affect the Body?

According to the National Institute on Drug Abuse, opioids bind to and activate opioid receptors in cells that are located across various parts of the body and brain. When opioids attach to those receptors, they block pain signals and release large amounts of dopamine throughout the body. This reinforces the drug-taking behavior because it makes the person feel good.

Aside from the pleasurable side effects opioids produce (relaxation, euphoria, happy feelings), they also have many negative physical side effects on the body. Opioids can cause:

  • Dizziness
  • Slowed breathing
  • Nausea
  • Constipation
  • Confusion
  • Coma
  • Brain damage

Misusing prescription opioids can increase the likelihood that these physical side effects will be severe.

Why Do People Transition to Heroin After Abusing Prescription Opioids?

Heroin is both cheaper and easier to get than prescription opioid medications, making it an ideal transition for individuals who are addicted to opioids.

Prescription drugs are expensive costing between $5 to $50 per pill depending on the type. Comparatively, heroin can cost as little as $10 per balloon and can be easier to buy.

Newsweek reports that there has been a shift in the demography of those who are using heroin. “Heroin addicts these days are more likely than ever before to be rich, white and suburban . . . that shift is likely attributable to the unanswerable demand for one of medicine’s greatest—and most controversial—discoveries: prescription opioids.”5

As restrictions have been passed to make prescription opioids more difficult to obtain, many who are already addicted are turning to heroin. Rafel Lemaitre of the White House Office of National Drug Control Policy says, “It’s hard to talk about the heroin problem without talking about the prescription drug problem.”6

Prescription drug abuse in and of itself is an alarming trend and researchers are now pursuing alternative drugs with less addictive qualities, such as meloxicam, in an effort to reduce abuse, addiction, and overdose-related deaths. However, as those who are addicted to prescription drugs seek a cheaper and more accessible high through heroin, it is becoming an increasingly dangerous situation and risks exposing young people with little to no knowledge of dangerous drugs to a precarious future of addiction and possibly death.

What Factors Predict Heroin Addiction Following Prescription Drug Abuse?

Not all people who use opioid medications will become addicted and transition to heroin, but some do. One study examined the transition to heroin use among people who were misusing prescription opioids to better understand the different factors that predict such behavior.

According to the study, these were the top factors that predicted the initiation of heroin use:7

  • Using prescription opioid drugs in ways other than prescribed: The study found that individuals who snorted or sniffed prescription opioids instead of taking them orally as prescribed, were more likely to develop an addiction to heroin. This behavior indicates an intensifying relationship with the drug and its high.
  • Using prescription opioid drugs frequently: The rate at which individuals used prescription opioids was a telltale predictor of heroin use. The study found that those who used the prescription more often were more likely to transition to heroin.
  • Developing a physical dependence to prescription opioids: Not everyone who takes opioid painkillers will develop a physical dependence on them. However, according to the study, those that did were more likely to transition to heroin use later.
  • Using prescription opioids to get high: Many people misuse prescription opioids to self-treat for pain. Instead, the study found that individuals who misused prescription opioids with the intent of getting high were much more likely to transition to using heroin.
  • Abusing prescription opioids at an early age: According to the study, the individuals who started misusing prescription painkillers at a younger age (teens or early 20s) were more likely to initiate heroin use.

Another report by the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed “that people aged 12 to 49 who had used prescription pain relievers non medically were 19 times more likely to have initiated heroin use recently than others in that age group. The report also showed that four out of five recent heroin initiates (79.5 percent) had previously used prescription pain relievers nonmedically.”8

As prescription drug abuse increases, the number of people who will attempt and become addicted to heroin is expected to dramatically rise in the near future.

How Do I Know If Someone Is Addicted to Prescription Opioids?

If you’re concerned about a loved one, it’s important to know that just because he or she is taking a prescribed opioid painkiller, does not mean he or she will get addicted. However, if you’ve noticed behavioral changes or your intuition is telling you that something’s wrong, you should pay close attention.

You may need to ask yourself about your loved one’s personal risk of addiction. Although anyone can become addicted to prescription opioids, regardless of ethnic background, age, or social status, the risks increase with certain factors.

According to the Mayo Clinic, some of the most common risk factors for prescription opioid addiction include:9

  • Young age (teens or early 20s)
  • Stressful living situation, such as poverty or unemployment
  • Family history of drug abuse
  • History of criminal behavior
  • Regular contact with high-risk people or high-risk situations where drug abuse is common
  • Severe depression or anxiety
  • Thrill-seeking or risk-taking behaviors
  • Heavy tobacco use

If your loved one is addicted to his or her prescription opioids, he or she may still hold down a normal job and maintain a generally stable life. However, if left untreated, the opioid addiction will only get worse, which will cause major life problems down the road.

Common signs of opioid addiction include:

  • Getting the same prescription from multiple doctors (also called doctor shopping)
  • Making poor decisions, including ones that put your loved one and others in harm’s way
  • Borrowing prescription drugs from other people
  • Frequently “losing” prescriptions and needing replacements
  • Taking opioid drugs even when not experiencing any pain
  • Regularly taking prescription opioids more frequently than prescribed or to get high
  • Extreme mood swings

It’s not uncommon for loved ones of people who are addicted to opioids to feel extremely worried about their drug use, experience anxiety over it, and make excuses for their behavior. Although it may be tempting to ignore the issue completely and pretend it’s not a problem, your loved one is much more likely to recover if you address the issue directly.

If you believe your loved one is addicted to his or her prescription opioids, you should talk to their doctor right away and encourage the person to seek help.

What to Ask Your Doctor Before Taking Opioids

When you get a new prescription (especially an opioid painkiller), you should ask your doctor several questions to ensure that the prescription is right for you. If you are worried about the potential risk of addiction, this step is especially important.

According to the FDA, these are some of the most important questions you should ask your doctor before taking prescription opioids:10

  • Why do I need this medication?
  • Are there any non-opioid options that could help me?
  • How long should I take this prescription medication?
  • How can I reduce the risk of potential side effects?
  • What should I do if I have a history of addiction?
  • Are there any possible interactions with the other medications I am taking?
  • What should I do with any opioid medication that is leftover?

If you feel uncomfortable taking opioids, it’s best to ask these questions instead of blindly taking a prescription. You can also always get a second opinion from a different doctor if you feel like you need it.

What Is the Best Treatment for Heroin Addiction and Opioid Use Disorder?

Opioid use disorder is a chronic relapsing disease that requires ongoing treatment to overcome. Health experts and doctors recommend a combination of behavioral therapy and medication for the best treatment results.

Nova Recovery Center’s opioid rehab in Austin Texas provides comprehensive and individualized care for opioid addiction. After completing an opioid outpatient detox program, clients can enroll in a residential opioid rehab program or an outpatient opioid rehab program (IOP) to receive ongoing care.

These programs are comprised of evidence-based treatment methods like cognitive behavioral therapy, contingency management, rational emotive behavioral therapy, individual therapy, and family therapy. All of which are proven to be effective for substance use disorders.

In addition, our opioid addiction treatment program uses a 12-Step-based program that uses treatment modalities like individual and group counseling, 12-Step facilitation therapy, educational lectures, and certified peer recovery support to support long-lasting recovery. Our board-certified doctors will also prescribe medications, if necessary, to help individuals cope with withdrawal symptoms, mood disorders, and other conditions that have contributed to their addiction.

After drug rehab in Austin, our treatment team will provide personalized recommendations for ongoing care, such as an Austin sober living program and/or IOP. Research shows the longer an individual stays in treatment, the more likely they are to sustain long-term sobriety. This is our hope and goal for every single client we work with.

If you or a loved one is struggling with prescription opioid addiction or heroin addiction, our experienced and caring team of treatment professionals is here to help. Take hold of life-saving treatment today by contacting us today.


  1. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse
  2. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
  3. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-classes-prescription-drugs-are-commonly-misused
  4. https://www.hopkinsmedicine.org/opioids/what-are-opioids.html
  5. https://www.newsweek.com/prescription-drugs-have-pushed-heroin-suburbs-252625
  6. https://www.nbcnews.com/news/world/painkiller-use-breeds-new-face-heroin-addiction-flna836713
  7. https://pubmed.ncbi.nlm.nih.gov/26785634/
  8. https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm
  9. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-tell-if-a-loved-one-is-abusing-opioids/art-20386038
  10. https://www.fda.gov/consumers/consumer-updates/what-ask-your-doctor-taking-opioids

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