Opioids are naturally found in the opium poppy plant. Some opioid medications are made from this plant while others are made by scientists in labs. Opioids have been used for hundreds of years to treat pain, cough, and diarrhea.
The most commonly used prescription opioids are oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Heroin is an opioid, but it is not a medication. Fentanyl is a powerful prescription pain reliever, but it is sometimes added to heroin by drug dealers, causing doses so strong that people are dying from overdoses.
Only 1 in 100 young adults between the ages of 12 and 17 currently misuse prescription opioids.1
Your brain is full of molecules called receptors that receive signals from other parts of the body. Opioids attach to receptors on nerve cells in the brain, spinal cord, and other organs. This allows them to block pain messages sent from the body to the brain, which is why they are prescribed for serious injuries or illnesses.
When the opioids attach to the receptors, they also cause a large amount of dopamine to be released in the pleasure centers of the brain. Dopamine is the chemical responsible for making us feel reward and motivates our actions. The dopamine release caused by the opioids sends a rush of extreme pleasure and well-being throughout the body.
57% of 12- to 17-year olds who misused prescription opioids got them from a friend or relative.1
In the short term, the release of dopamine into your body can make some people feel really relaxed and happy. But it can also cause more harmful effects, like extreme sleepiness, confusion, nausea, vomiting, and constipation. Over time, opioids can lead to insomnia, muscle pain, heart infections, pneumonia, and addiction.
Depressants: A-minus, Barbs, Candy, Downers, Phennies, Reds, Red Birds, Seeping Pills, Tooies, Tranks, Yellow Jackets, Yellows, and Zombie Pills
Stimulants: Bennies, Black Beauties, Hearts, Roses, Skippy, The Smart Drug, Speed, and Vitamin R, and Uppers
Prescription drugs are often strong medications, which is why they require a prescription from a doctor or dentist. There are three kinds of prescription drugs that are commonly misused:
Opioids—used to relieve pain, such as Vicodin®, OxyContin®, or codeine
Depressants—used to relieve anxiety or help a person sleep, such as Valium® or Xanax®
Stimulants— used for treating attention deficit hyperactivity disorder (ADHD), such as Adderall® and Ritalin®
Prescription drug misuse has become a large public health problem, because misuse can lead to addiction, and even overdose deaths.
What Makes Prescription Drugs Unsafe
Every medication has some risk for harmful effects, sometimes serious ones. Doctors and dentists consider the potential benefits and risks to each patient before prescribing medications and take into account a lot of different factors, described below. When prescription drugs are misused, they can be just as dangerous as drugs that are made illegally.
Personal information. Before prescribing a drug, health providers consider a person’s weight, how long they’ve been prescribed the medication, other medical conditions, and what other medications they are taking. Someone misusing prescription drugs may overload their system or put themselves at risk for dangerous drug interactions that can cause seizures, coma, or even death.
Form and dose. Doctors know how long it takes for a pill or capsule to dissolve in the stomach, release drugs to the blood, and reach the brain. When misused, prescription drugs are sometimes taken in larger amounts or in ways that change the way the drug works in the body and brain, putting the person at greater risk for an overdose. For example, when people who misuse OxyContin® crush and inhale the pills, a dose that normally works over the course of 12 hours hits the central nervous system all at once. This effect increases the risk for addiction and overdose.
Side effects. Prescription drugs are designed to treat a specific illness or condition, but they often affect the body in other ways, some of which can be uncomfortable, and in some cases, dangerous. These are called side effects. Side effects can be worse when prescription drugs are not taken as prescribed or are used in combination with other substances. See more on side effects below.
How Prescription Drugs are Misused
Taking someone else’s prescription medication, even if it is for a medical reason (such as to relieve pain, to stay awake, or to fall asleep).
Taking a prescription 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 your own prescription in a way that it is not meant to be taken is also misuse. This includes taking more of the medication than prescribed or changing its form—for example, breaking or crushing a pill or capsule and then snorting the powder.
Taking the prescription medication to get “high.”
Mixing it with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with specific prescription drugs.
Taking your prescription in ways other than instructed, like taking more than your prescribed dose or taking it more often
Getting and using prescription pills from a friend or family member, even if it’s for a real medical condition
Taking prescription drugs to get high
Mixing prescription opioids with alcohol or other drugs
I have an opioid prescription from my doctor; so, they can’t be that bad, can they?
Prescription opioids are used to treat severe pain. People who have major surgeries including dental work, serious sports injuries, or cancer are sometimes prescribed these pills to manage their pain. When taken as prescribed, opioids are relatively safe and can reduce pain in the short term. But if a person misuses the drug and doesn’t take them as prescribed, opioids can have dangerous consequences.
In the brain, neurotransmitters such as dopamine send messages by attaching to receptors on nearby cells. The actions of these neurotransmitters and receptors cause the effects from prescription drugs. Each class of prescription drugs works a bit differently in the brain and can cause actions similar to some illegal drugs:
Prescription opioid pain medications bind to molecules on cells known as opioid receptors—the same receptors that respond to heroin. These receptors are found on nerve cells in many areas of the brain and body, especially in brain areas involved in the perception of pain and pleasure.
Prescription drugs can help with medical problems when used as directed. However, whether they are used properly or misused, there can be side effects:
Using opioids like oxycodone and codeine can cause you to feel sleepy, sick to your stomach, and constipated. At higher doses, opioids can make it hard to breathe properly and can cause overdose and death.
Using stimulants like Adderall or Ritalin can make you feel paranoid (feeling like someone is going to harm you even though they aren’t). It also can cause your body temperature to get dangerously high and make your heart beat too fast. This is especially likely if stimulants are taken in large doses or in ways other than swallowing a pill.
Using depressants like barbiturates can cause slurred speech, shallow breathing, sleepiness, disorientation, and lack of coordination. People who misuse depressants regularly and then stop suddenly may experience seizures. At higher doses depressants can also cause overdose and death, especially when combined with alcohol.
In addition, misusing over-the-counter drugs that contain DXM (an ingredient in cold and cough medicines) can also produce very dangerous effects. Read more about misuse of cough and cold medications.
Misusing any type of drug that causes changes in your mood, perceptions, and behavior can affect judgment and willingness to take risks—putting you at greater risk for HIV and other sexually transmitted diseases (STDs).
Yes, more than half of the drug overdose deaths in the United States each year are caused by prescription drug misuse. Deaths from overdoses of prescription drugs have been increasing since the early 1990s, largely due to increases in misuse of prescription opioid pain relievers. In 2017, more than 33,800 people died from an overdose of prescription drugs. The good news is that among young people ages 15 to 25, deaths from prescription drug misuse declined slightly in 2017.1 Learn more about drug overdoses in youth.
Mixing different types of prescription drugs can be particularly dangerous. For example, benzodiazepines interact with opioids (pain relievers) and increase the risk of overdose. Also, combining opioids with alcohol can make breathing problems worse and can lead to death.
1 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released 2018. Available at http://wonder.cdc.gov.
Yes, prescription drugs that effect the brain, including opioid pain relievers, stimulants, and depressants, can cause physical dependence that could lead to addiction. Medications that affect the brain can change the way it works—especially when they are taken over a period of time or with increasing doses. They can change the reward system, making it harder for a person to feel good without the drug and possibly leading to intense cravings, which also make it hard to stop using.
This dependence on the drug happens because the brain and body adapt to having drugs in the system for a while. A person may need larger doses of the drug to get the same initial effects. This is known as “tolerance.” When drug use is stopped, uncomfortable withdrawal symptoms can occur. When people continue to use the drug despite a range of negative consequences, it is considered an addiction. When a person is addicted to a drug, finding and using that drug can begin to feel like the most important thing—more important than family, friends, school, sports, or health.
Carefully following the doctor’s or dentist’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. However, dependence and addiction are still potential risks when taking certain types of prescription drugs. These risks should be carefully weighed against the benefits of the medication and patients should communicate any issues or concerns to their doctor right away.
Other kinds of medications that do not act in the brain, such as antibiotics used to treat infections, or drugs to help with heartburn, are not addictive.
While past year use of any prescription drug among 12th graders has steadily and slowly dropped since 2015, prescription and over-the-counter drugs are the most commonly misused substances by Americans age 14 and older, after marijuana and alcohol.
Below is a chart showing the percentage of teens who misuse prescription drugs.
Swipe left or right to scroll.
Monitoring the Future Study: Trends in Prevalence of Any Prescription Drug for 12th Graders; 2015 – 2018 (in percent)
Encourage your friend to speak with a trusted adult.
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.
Taking someone else’s prescription medicine, even if you are in real pain, can be dangerous. Before prescribing opioids, doctors consider a lot of different factors, including the patient’s weight, other medical conditions, and potential interactions with other medications they might be taking. Without talking to a doctor, you won’t know how the opioids will affect you or what dose you should take. You should never share prescription opioids and only use them when prescribed to you by a doctor.