Not all opioids are created equal, but all carry risk. The biggest difference between prescription and illicit opioids lies in how they’re made, regulated, and consumed.
Prescription Opioids
These are legal drugs prescribed by medical professionals to treat moderate to severe pain. They are regulated for safety, dosage, and purity. Common examples include:
- Oxycodone (OxyContin, Percocet)
- Hydrocodone (Vicodin)
- Morphine
- Codeine
- Fentanyl (when prescribed)
Risks: Even when used as directed, prescription opioids can be addictive. A 2021 report from the CDC noted that people who take prescription opioids for longer than five days have a significantly higher risk of developing dependence.
Illicit Opioids
These are unregulated opioids often produced illegally. They may be chemically similar to prescription drugs but carry higher risks due to unknown potency and contamination. Common examples include:
- Heroin
- Illegally manufactured fentanyl
- Street pills that mimic oxycodone or hydrocodone but contain fentanyl
Risks: Illicit opioids are a major driver of overdose deaths. Fentanyl, for example, is up to 100 times more potent than morphine. Because it is often mixed into other drugs without the user's knowledge, it dramatically increases the risk of accidental overdose.
A 2024 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that synthetic opioids like illicit fentanyl were involved in more than 70 percent of opioid-related deaths in the United States.