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Prescription Opiates: As Addictive as Heroin?

According to the National Survey on Drug Use and Health, more than 21.5 million Americans aged 12 and older met the criteria for substance use disorder in 2014. Of these, 1.9 million were addicted to prescription opiate pain medications and 586,000 were addicted to heroin.1 With massive increases in opiate-related overdose deaths and criminal incarceration related to drug abuse, the opiate epidemic is a serious national problem.

While many people understand that prescription opiate addiction is a chronic illness, the question remains: are prescription opiates as addictive as heroin?

Dependence, Abuse, and Addiction

Prescription opiates, like oxycodone and hydrocodone, are synthetic opioid analgesics that alter perception by targeting your brain’s opioid receptors. Because the drugs act on your brain’s feel-good chemicals, they can also produce feelings of euphoria and well-being in addition to pain relief.

If you abuse prescription opiates, you are probably chasing the ‘high’ and may need to continually up your dosage as tolerance develops and more of the drug is needed to achieve the initial effect.2,3

Tolerance fuels addiction as you continue to up your dosage and ultimately become physically dependent on the drug. Dependence occurs when the brain and body begin to need the drug in order to function normally. When you are physically dependent on opiates, you experience painful and uncomfortable withdrawal symptoms if you suddenly stop or decrease your intake of the drug. You may even find yourself continuing to use despite harmful consequences in order to avoid these withdrawal symptoms.2,3

Prescription opiates affect the brain in the same way heroin does, only the dosage is considered lower and the means of use typically safer. Prescription opiates are often given in oral form and are designed to be distributed to the body slowly. However, when drugs are abused (crushed, snorted, injected), they enter the bloodstream rapidly, producing a stronger effect and posing significantly more dangers and risks.2,3

The Link between Heroin and Prescription Opioid Abuse

Because prescription opiates act on the brain in the same way as heroin, one might argue that they are equally addictive, especially since they are the most abused prescription drugs in the United States. According to the National Survey on Drug Use and Health, nearly 3 times as many people suffer from prescription opiate addiction than heroin addiction.1 This may be because prescription opiates are legally accessible and fewer stigmas exist surrounding their use.

On the other hand, many argue that heroin is cheaper and easier to obtain because laws and policies surrounding prescription opiates have strengthened in the last few years as a result of the opiate-addiction epidemic. In a 2014 survey, 94% of people in treatment for opioid addiction reported choosing to use heroin because prescription opioids were “far more expensive and harder to obtain”.1

Prescription opiates are highly addictive and often lead many people to heroin addiction. According to the Centers for Disease Control and Prevention (CDC), 45% of people who use heroin were addicted to prescription painkillers prior to use and people who are addicted to prescription painkillers are 40 times more likely to become addicted to heroin than those who are not.4

While prescription opiate abuse may be common among heroin users, it doesn’t necessarily lead a person toward heroin. The National Survey on Drug Use and Health also reported that less than 4% of people who used prescription opiates non-medically started using heroin within the next 5 years after abusing opioid painkillers.4

Although prescription opiates may arguably be as addictive as heroin, heroin still poses more significant risks for users, including greater risk of overdose and other negative consequences (e.g., blood-borne illnesses).

Still, because many people develop tolerance to prescription opiates and need higher doses of the drug, many people choose to transition to heroin in order to save money and still achieve the high they are seeking. For this reason, it is important that all patients prescribed opioid pain medications be monitored closely for signs of addictive behavior.


  • 259 million prescriptions were written for opioids in 2012.1
  • The number of prescriptions written for opioid pain medications has increased from 76 million in 1991 to almost 207 million in 2013.2
  • In the past decade, heroin use has more than doubled in young adults between the ages of 18-25 years old.4
  • From 2000 to 2010, heroin overdoses increased by more than 50%.2
  • Approximately 23% of individuals who use heroin will develop an opioid addiction.1
  • In 2014, 18,893 overdose deaths occurred as result of prescription opiate use and 10,574 overdose deaths related to heroin occurred.1
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