Prescription Opioids and Heroin Research Report
Heroin use is driven by its low cost and high availability

One main factor that contributes to the popularity of a drug is availability. One key to prevention is reducing exposure. While efforts to reduce the availability of prescription opioid analgesics have begun to show success, the supply of heroin has been increasing (see Increased drug availability is associated with increased use and overdose). Prescription opioids and heroin have similar chemical properties and physiological impacts; when administered by the same method (i.e., ingested or injected), there is no real difference for the user.

It is not clear whether the increased availability of heroin is causing the upsurge in use or if the increased accessibility of heroin has been caused by increased demand. A number of studies have suggested that people transitioning from abuse of prescription opioids to heroin cite that heroin is cheaper, more available, and provides a better high.  Notably, the street price of heroin has been much lower in recent years than in past decades.1 In addition to these market forces, some have reported that the transition from opioid pills to heroin was eased by sniffing or smoking heroin before transitioning to injection.2 In a recent survey of people in treatment for opioid addiction, almost all—94 percent—said they chose to use heroin because prescription opioids were "far more expensive and harder to obtain."3


  1. Unick G, Rosenblum D, Mars S, Ciccarone D. The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008. Addiction. 2014;109(11):1889-1898.
  2. Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. "Every 'never' I ever said came true": transitions from opioid pills to heroin injecting. Int J Drug Policy. 2014;25(2)257-266.
  3. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.