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Prescription Opioids and Heroin

Heroin use is rare in prescription drug users

While prescription opioid abuse is a growing risk factor for starting heroin use, only a small fraction of people who abuse pain relievers switch to heroin use. According to general population data from the National Survey on Drug Use and Health, less than 4 percent of people who had abused prescription opioids started using heroin within 5 years (Muhuri et al., 2013). This suggests that prescription opioid abuse is just one factor in the pathway to heroin.  Furthermore, analyses suggest that those who transition to heroin use tend to be frequent users of multiple substances (polydrug users) (Jones, et al., 2015). Additional analyses are needed to better characterize the population that abuses prescription opioids who transition to heroin use, including demographic criteria, what other drugs they use, and whether or not they are injection drug users.


  • Jones CM, Logan J, Gladden RM, Bohm MK. Vital signs: demographic and substance use trends among heroin users – United States, 2002-2013. Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA: Centers for Disease Control and Prevention; 2015.
  • Muhuri PK, Gfroerer JC, Davies MC; Substance Abuse and Mental Health Services Administration. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review. http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf. Published August 2013. Accessed October 8, 2015.

This page was last updated January 2018

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NIDA. (2018, January 17). Prescription Opioids and Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin

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