National Institute on Drug Abuse

National Institutes of Health
You have probably heard a lot about the “opioid overdose 

crisis” in the news lately. But what are opioids? And why 

are they such a problem? 

You might not realize this, but if you have had a sports 

injury, dental work, or surgery, it is possible your doctor 

gave you a pain reliever that was actually an opioid 

medication. While opioids can be very effective at 

treating pain, they can be very addictive and should 

only be used under a doctor’s careful watch. 

In addition to opioids given to you by a doctor, there is 

another kind of opioid you have probably heard about 

called heroin. Heroin is a very dangerous drug that is 

usually used by injecting it directly into a vein with a 

needle. The chemical makeup of heroin is the same 

as that of pain relievers and both can be very addictive 

and cause deadly opioid overdoses. In fact, 2.14 million 

people ages 12 and older had an opioid use disorder 

in 2016, including 153,000 12- to 17-year-olds.1

Our goal is to give you the facts so you can make smart 

choices and be your best self. We hope that you will use 

this booklet to share information about opioids with your 

friends, parents, teachers, and others.

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse

Letter to Teens

1 Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug 

Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2017. https://www.samhsa.gov/data/

sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed September 14, 2017.

To help you make informed choices, this booklet contains some brief 

summaries about what research is telling us. These topics represent the 

most popular questions and comments we get from teens. Share them 

with your friends to help them separate fact from myth. 
1

Letter to Teens

I. Some Things to Think About. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Opioid Overdose Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Brain Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Daily Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

II. FAQs about Opioids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What are opioids? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What are the most commonly used opioids? . . . . . . . . . . . . . . . . . . . 6

How do opioids work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

What are the health effects of opioids on the brain and body? . . . . . 8

I have an opioid prescription from my doctor; 

so, they can’t be that bad, can they? . . . . . . . . . . . . . . . . . . . . . . . . . 10

Is it safe to take my friend’s prescription opioids 

if I get hurt playing soccer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

What is heroin? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 

What is the connection between opioids and heroin? . . . . . . . . . . . 12

How many people use heroin? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

What are the effects of heroin on the brain and body? . . . . . . . . . . 13

Do opioids show up on drug tests? . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Is it safe to take opioids if you are pregnant? . . . . . . . . . . . . . . . . . . 14

Are opioids addictive? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Can opioid addiction be treated? . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Do opioids produce withdrawal symptoms when

someone tries to quit using them? . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Can you overdose on opioids? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Can you stop an opioid overdose? . . . . . . . . . . . . . . . . . . . . . . . . . . 18

What can teenagers do to protect themselves? . . . . . . . . . . . . . . . . 19

What is being done to stop the overdose crisis? . . . . . . . . . . . . . . . 20

III. Other Useful Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Contents
Opioid Overdose Deaths 

The increase in opioid overdose deaths has resulted in a 

national crisis. After marijuana, prescription drugs are the 

most commonly misused drugs in the country. Every day, 

115 Americans die from an opioid overdose.2 In 2016, the 

number of opioid overdose deaths, including prescription 

medicines and heroin, was 5 times higher than it was in 

1999.

3 This caused the government to declare a public 

health emergency. People in every community in every 

state have been affected by this crisis.

I. Some Things to

2 Centers for Disease Control and Prevention. Wide-Ranging Online Data for 

Epidemiologic Research (WONDER). Atlanta, GA: National Center for Health 

Statistics; 2017. http://wonder.cdc.gov.

3 Centers for Disease Control and Prevention. Understanding the Epidemic.

https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed June 4, 2018.

2
3

Brain Damage

Opioid misuse can cause brain damage. When opioids 

are taken as prescribed by a medical professional, they 

are relatively safe and can reduce pain effectively. However, 

opioid misuse can cause harmful medical effects like slowed 

breathing. Slowed breathing can lead to short- and long-term 

health effects, including coma, brain damage, and death.

Studies have shown that repeated opioid misuse can affect 

decision-making, behavior control, and responses to stressful 

situations. It is unknown if the damage can be reversed.

Daily Life

Opioid use can affect every area of your life. Using 

drugs, especially early in life, can lead to poor grades, 

worse performance in sports, and bad relationships with 

friends and family. Opioids also alter judgment which can 

cause you to do risky things you wouldn’t ordinarily do, like 

having unprotected sex or getting into a car crash because 

you drove while under the influence of opioids.

4–6

Addiction

Opioid misuse can cause addiction. Opioids are among the 

most addictive drugs. When addiction occurs, the body feels 

a strong need for the opioids. This is like when you are really 

hungry because you haven’t eaten in a long time. This strong 

desire, together with a loss of control over the urges to take 

the drug, is why some people continue to use opioids despite 

negative consequences.

4 Dahl RE. Adolescent brain development: a period of vulnerabilities and 

opportunities. Keynote address. Ann N Y Acad Sci. 2004;1021:1-22. doi:10.1196/

annals.1308.001.

5 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime 

prevalence and age-of-onset distributions of DSM-IV disorders in the National 

Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.

doi:10.1001/archpsyc.62.6.593.

6 Thornberry TP, Krohn MD, eds. Taking Stock of Delinquency–An Overview of 

Findings. New York, NY: Springer Science & Business Media; 2006. //www.springer.

com/us/book/9780306473647. Accessed November 7, 2017.
4

II. 

"I’m addicted to pills. Just got woken up 5 hours 

into my sleep by withdrawals. Couldn’t go back to 

sleep due to the crazy hot flashes, sweating, then 

freezing, goosebumps, restlessness, the need to 

change position every few minutes after getting 

comfortable, nausea. Everything hurts."

– Comment submitted to NIDA’s 

 blog for teens
5

You may have heard people 

talking about opioids and 

not even realized it. Oxy, 

Percs, and Vikes are all 

slang terms for opioid pills.

5
What are opioids?

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.

What are the most commonly 

used opioids?

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.

6
Only 1 in 100 young 

adults between the 

ages of 12 and 17 

currently misuse 

prescription opioids.

1

1 Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey 

on Drug Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2017. https://www.

samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.

Accessed September 14, 2017.

7
8

How do opioids work?

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.

What are the health effects of 

opioids on the brain and body?

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.

57% of 12- to 17-yearolds who misused 

prescription opioids 

got them from a 

friend or relative.

1

1 Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey 

on Drug Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2017. https://www.

samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.

Accessed September 14, 2017.
9

What is prescription opioid misuse?

• 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.

10
11

Is it safe to take my friend’s prescription 

opioids if I get hurt playing soccer?

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.

Some people who get 

addicted to opioid pain 

relievers switch to heroin 

because it's cheaper and 

easier to get.
What is heroin?

Heroin is made from morphine, a natural substance taken from the 

seed pod of opium poppy plants in Southeast and Southwest Asia, 

Mexico, and Colombia. Heroin can be injected, sniffed, snorted, 

or smoked.

Common names for heroin include Big H, Horse, Hell Dust, 

and Smack.

What is the connection between opioids 

and heroin?

Heroin is a type of opioid. Prescription pain relievers and 

heroin are chemically similar and can produce similar effects.

In some communities, heroin is cheaper and easier to get than 

prescription opioids. Because of this, people who are addicted to 

prescription opioids sometimes switch to using heroin instead. Four 

out of five new heroin users report misusing prescription opioids 

before trying heroin.

8 You can overdose on both.

However, only a small fraction of people who misuse pain 

relievers switch to heroin. Less than 4 percent of people who 

had misused prescription pain medicines started using heroin 

within 5 years.

8 Preventing opioid misuse and ensuring people 

with opioid addictions get the treatment they need will also 

reduce the number of people using and addicted to heroin.

12

8 Muhuri PK, Gfroerer JC, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin

Use in the United States. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

http://archive.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf.
How many people use heroin?

Heroin use has been increasing in recent years. The number of 

people using heroin in the past year has more than doubled in the 

past 15 years, to nearly one million in 2016, including 13,000 12- to 

17-year-olds.

1

What are the effects of heroin on 

the brain and body?

Just like other opioids, heroin binds to the opioid receptors in 

the brain and body that send a rush of dopamine and extreme 

happiness through your body. Other short-term effects include dry 

mouth, nausea and vomiting, severe itching, and clouded thinking.

If the dose is too strong, it can cause you to stop breathing, 

resulting in death.

Long-term effects include insomnia, heart infections, liver and 

kidney disease, collapsed veins in people who inject heroin, 

depression, and addiction.

People who inject drugs are at an increased risk of getting HIV or 

hepatitis C. Both of these diseases are transmitted through blood 

and other bodily fluids. When people share needles or other drug 

equipment, they can come in contact with these fluids. HIV, and 

less often hepatitis C, are also spread through unprotected sex, 

which drug use makes more likely.

1 Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug 

Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2017. https://www.samhsa.gov/data/sites/

default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed September 14, 2017.

7 Johnston L, O’Malley P, Miech R, Bachman J, Schulenberg J. Monitoring the Future National Survey 

Results on Drug Use, 1975-2016: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute 

for Social Research, The University of Michigan; 2017.

20% of 12th graders 

said they could easily get 

heroin if they wanted to.

7

13
1 Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey 

on Drug Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2017. https://www.

samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.

Accessed September 14, 2017.

9 Substance Abuse and Mental Health Services Administration. Critical Drug Testing in 

Primary Care. Rockville, MD: Substance Abuse and Mental Health Services Administration; 

2012. https://store.samhsa.gov/shin/content/SMA12-4668/SMA12-4668.pdf. Accessed 

November 7, 2017.

10 U.S. Food and Drug Administration. Drugs of Abuse Home Use Test. https://

www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/

DrugsofAbuseTests/ucm125722.htm. Accessed March 9, 201

Do opioids show up on drug tests?

Just like other drugs, opioids can show up on a drug test 

within hours of being taken. Opioids, including heroin, can 

show up on a drug test for days, and in some cases weeks, 

after being taken.

9,10 How long they stay in your system 

depends on how long a person has been taking the drug, 

the amount of drug they use, or the person’s metabolism 

(how your body handles the drug).

Is it safe to take opioids if you 

are pregnant?

Opioid use during pregnancy—even if taken as a 

doctor instructed—can lead to miscarriage or low 

birth weight. It can also cause neonatal abstinence 

syndrome, a medical condition where the baby is 

born dependent on opioids and has withdrawal 

symptoms after being born. If a pregnant woman 

tries to stop taking opioids suddenly without 

medical help, she can put the baby at risk. It is 

important for the mother to tell her doctor about 

all drugs she is taking or planning to take so that 

the baby has a greater chance of being born 

healthy. There are treatments that can help.

14
More than 65% of teens 

think that using heroin even 

once or twice can result in 

great harm. That means the 

rest — about 35% — don’t 

fully understand the risks.1 

15
I have heard about something called 

fentanyl. What is that?

Fentanyl is an opioid drug that is 50 times more 

powerful than heroin. Medically, it is used to treat 

extreme pain and for surgeries. But now it’s being 

made illegally and is sometimes mixed with other 

drugs, leading to overdose.

16
17

Are opioids addictive?

Yes. Over time, opioid use can change the brain, leading 

to addiction. Addiction means a person continues to use a 

drug despite negative consequences, and actively tries to 

get more and more of the drug. Many people get addicted 

to opioids, leading to deadly overdoses—taking enough to 

make you stop breathing.

However, many people who take prescription opioids for pain 

become dependent, not addicted. Dependence means your 

body has gotten used to the drug, and it will hurt and feel 

uncomfortable if you suddenly stop. Patients using prescription 

opioids should ask their doctors how to safely stop using them.

A person can be dependent on a drug without being addicted.

But sometimes dependence can lead to addiction, if you don’t 

make an effort to stop taking them.

Can opioid addiction be treated?

Quitting opioids can be hard, but it is possible. There are 

three FDA-approved medicines to treat opioid addiction.

Medicines like buprenorphine and methadone bind to the 

same receptors in the brain as prescription opioids to reduce 

cravings. Naltrexone is another medication that treats opioid 

addiction by preventing opioids from having an effect on the 

brain. Additionally, a medicine named lofexidine was recently 

approved to help lessen withdrawal symptoms for people who 

are trying to stop using opioids.

Counseling and therapy are also important to help people 

stop using opioids, rebuild relationships with friends and family, 

and build healthy life skills. A combination of behavioral therapy 

and medication has proven to be very effective in treating 

opioid addiction.

Doctors develop treatment plans to fit the unique needs 

of the patient.
18

Do opioids produce withdrawal 

symptoms when someone tries 

to quit using them?

Yes. The brain gets so used to the opioids that when 

someone stops taking them, they can go into withdrawal.

Withdrawal symptoms include sweating, shaking, vomiting, 

sleep problems, and diarrhea. The symptoms can be so 

severe that it can be hard for someone to stop using opioids, 

even if they want to. This is why it can take several tries to 

stop drug use.

Can you overdose on opioids?

Yes, you can. In fact, overdose deaths have almost tripled 

in the last 15 years and the majority of these deaths involve 

opioids.

11 One of the ways opioids work to relax your body 

is by slowing down your breathing. When misused, opioids 

can slow your breathing too much. This can cause you to stop 

breathing entirely and lead to an overdose. For some people, 

just one dose is enough to make them stop breathing.

Can you stop an opioid overdose?

Yes, if you act quickly. If you think a friend or family member 

has overdosed on opioids, call 911 so they can receive immediate 

medical attention. When paramedics arrive, they will likely give 

the person naloxone. Naloxone works to quickly block the effects 

of opioids. It is available as an injectable solution, an auto-injector, 

and a nasal spray.

Some states require a doctor to prescribe naloxone, but other 

states allow pharmacies to sell naloxone without a personal 

prescription. This lets friends and family members use it to 

save someone who is overdosing. But naloxone doesn't take 

the place of medical care, and after using it, the person who 

overdosed should immediately get medical help.

11 Rudd RA. Increases in drug and opioid-involved overdose deaths — United States, 2010–2015.

MMWR Morb Mortal Wkly Rep. 2016;65. doi:10.15585/mmwr.mm655051e1
19

What can teenagers do to 

protect themselves? 

Take charge of your own health. The best thing teenagers can do 

is to turn away from peer pressure to use opioids “for fun” and to 

only take opioids as prescribed by your doctor. Even then, opioids 

should be taken for as short a time as possible. If your doctor or 

dentist prescribes opioids for a painful condition, ask them how 

quickly you can stop taking them or if there are other medications 

to use instead.
Ongoing Research to Find Solutions

Researchers funded by the National Institutes of Health are exploring 

better ways to prevent and treat opioid misuse. They are looking 

at how opioids work on brain pathways, trying to figure out how to 

develop safer medicines. Ideally, they can develop a pain reliever 

as strong as an opioid that does not have the risk of addiction.

Researchers are also trying to find other ways to treat pain, like 

exercise techniques, massage therapy, and methods to stimulate 

key brain pathways without taking a medicine.

Scientists have also developed better ways to deliver medicines to 

the body. For example, there is now a device that sprays a medicine 

into the nose to block an overdose. New injection products and 

body implants can now be inserted into someone’s arm to deliver 

medication more slowly to treat opioid addiction for months, 

instead of having to take a pill daily or every other day.

Follow NIDA’s Teen Web site to learn more about new scientific 

discoveries, teens.drugabuse.gov.

20

What is being done to stop the 

overdose crisis?

Opioid misuse has become a nationwide public health crisis. Luckily, 

federal, state, and local governments, advocacy organizations, and 

health professionals are working together to tackle the crisis from 

every angle. A holistic public health approach is being undertaken to:

• Improve access to treatment and recovery services

• Promote the use of overdose-reversing drugs

• Strengthen our understanding of the crisis through better 

public health monitoring

• Develop safe, effective medications strategies for pain management

• Improve medications to treat people who are addicted to opioids

• Advance better pain management practices
Here are some helpful places to go for 

more information:

The National Institute on Drug Abuse (NIDA)

The NIDA website, drugabuse.gov, has information on a variety of 

drugs and related topics. NIDA’s teen site, teens.drugabuse.gov, has 

free downloads, entertaining and informative videos and games, and a 

blog for teens, where you can leave us a comment or two. Get the scoop 

on how different drugs affect the brain and body, and read real stories 

from teens who have struggled with drug use and addiction.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA)

The NIAAA website, niaaa.nih.gov, contains the latest research, news, 

and other resources related to alcohol. NIAAA even has a site especially 

for young teens called “the cool spot,” thecoolspot.gov, with quizzes 

and other interactive resources that give you information on alcohol 

and resisting peer pressure.

The National Institute of Mental Health (NIMH)

To learn more about mental health conditions like depression or 

schizophrenia, visit the NIMH website, nimh.nih.gov, and read the 

Director’s Blog on various topics, including suicide prevention, bipolar 

and borderline personality disorders, coping with traumatic events, 

and more.

Centers for Disease Control and Prevention (CDC)

CDC’s Rx Awareness campaign uses real stories of the consequences 

of prescription opioids to educate the public about the harms associated 

with misuse. Visit cdc.gov/rxawareness to learn more about the campaign 

and how to get involved. 

Substance Abuse and Mental Health Services Administration (SAMHSA)

You can find treatment programs through findtreatment.samhsa.gov

provided by the SAMHSA. Also, you can call the SAMHSA Treatment 

Referral hotline at 1-800-662-HELP. Treatment can help you, a friend, 

or someone you love get back to the person you or they once were.

III. Other Useful

21
U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

NIH Pub. No. 18-DA-8054

Printed July 2018

This publication is available for your use and may be reproduced in its entirety

without permission from NIDA. Citation of the source is appreciated, using the 

following language: Source: National Institute on Drug Abuse; National Institutes

of Health; U.S. Department of Health and Human Services.

To order this, or other NIDA publications, please visit https://drugpubs.drugabuse.gov.