Opioids are extremely addictive because they activate the same receptors in our brains that react to endorphins, the “feel-good” chemical naturally produced in the brain when we do something pleasurable, like exercise or have sex. Endorphins relieve pain, reduce stress, and create feelings of euphoria that say, “That felt good, let’s do it again!” In our day-to-day life, this is a healthy process that our brains and bodies regulate quite well.

Opioids replicate this, but on a much greater scale. They create a rush of this good feeling, called a “high.” With regular use, the brain develops a tolerance, needing more and more of the drug to get the same high. At the same time, stopping use of the drug creates very unpleasant withdrawal symptoms. By this pattern of rewarding us for use, and punishing us when we stop, opioids create an enormous physical dependency that we call addiction or opioid use disorder. The hallmarks of addiction include tolerance, withdrawal, and continuing to seek and use the drug despite negative consequences, like losing one’s job, family, and health.

Opioid Abuse Destroys Users’ Health

The short-term dangers of using heroin or other opioids include reduced heartbeat and breathing (which can lead to overdose and death), reduced blood pressure, constipation, nausea, and vomiting. The long-term effects include tolerance (needing more and more to get the same high), cravings (needing the drug to feel “normal”), and withdrawal symptoms (highly unpleasant flu-like feelings when stopping use).

Users may develop additional medical problems, particularly from intravenous use (injection). These include contracting diseases like HIV/ AIDS or hepatitis B and C from sharing needles or engaging in unsafe sex while high; heart and lung problems; abscesses or blood infections; collapsed veins; poor self-care, including malnutrition, hygiene, and medical care; and risk of birth defects or stillbirth among pregnant women who abuse these drugs.

Opioids Can Be Cheap and Easy to Obtain

Many heroin users began by using prescription painkillers that were either prescribed to them or were “diverted.” Drug diversion is the term used to describe the use of prescription drugs for non-prescribed purposes—to get high. Many people who are prescribed an opioid painkiller after surgery “save” their extra pills for a future minor injury, like a sprained ankle or toothache. Sometimes young people find unused pills in their parents’ or grand- parents’ medicine cabinet and share them at a party. Sometimes drugs are stolen from a hospital or clinic and sold on the street. People addicted to painkillers may “doctor shop,” seeing multiple doctors until they find one willing to write additional prescriptions, or visit multiple pharmacies. These are all cases of drug diversion.

Increased awareness and regulation have made the most abused prescription opioids harder to divert, and thus more expensive. Heroin has quickly filled the gap for those looking for a ready substitute. Today, a single dose of heroin can cost as little as $10 in some areas, depending on purity, while prescription painkillers can sell for $80 or more per pill.

Because heroin is so addictive, readily available, and becoming less expensive, experts predict that its use will only increase without joint intervention at the community, state, and federal levels.