Opioid drugs can be naturally derived from opium in poppy plants or chemically produced. Opioids act as a pain reliever and relaxant, but can be highly addictive due to the euphoric feeling they generate. While short-term use is often harmless, regular usage may result in dependence and addiction. There are several types of opioids including prescription opioids, synthetics, and heroin. They all have a chemical structure in common, but differ in potency and methods of usage.

Prescription Opioids

Prescription opioids include any opioid drug prescribed by doctors to treat moderate to severe pain. Some common types of prescription opioids include hydrocodone, oxycodone, oxymorphone, morphine, and codeine. These pharmaceuticals are 5-8 times more potent than morphine. Most opioid overdose deaths are from these prescription painkillers, since they are legally available in nearly every community in the nation.


  • Semi-synthetic opioid drug prescribed for pain as Tylox®, Percodan®, OxyContin®. Derived from the poppy plant, has high potential for abuse.

Oxycodone Street Names

  • Hillbilly Heroin, Kicker, OC, Ox, Roxy, Perc, Oxy

How is oxycodone used?

  • Pills and tablets chewed or swallowed. Inhaling vapors by heating tablet on foil. Crushed and sniffed or dissolved in water and injected.
Identification of common prescription opioids.


  • Prescribed at Dilaudid®, it is used as a pain reliever. Hydromorphone is 2-8x more potent than morphine but shorter duration and greater sedation. Available in tablets, rectal suppositories, oral solutions, and injectable formulations.

Hydromorphone Street Names

  • D, Dillies, Dust, Footballs, Juice, Smack

How is hydromorphone used?

  • Orally or by injecting tablets dissolved in solution.


Heroin is derived from morphine but is 2-3 times more potent. It comes in the form of a white or brown powder, or a black sticky substance called black tar heroin. Unlike prescription opioids, heroin is an illegal drug that is more common in larger cities. Heroin reaches the brain very quickly as it can be injected, smoked, snorted, or mixed with water. Besides being highly addictive, it is relatively inexpensive for users to buy, making heroin a deadly drug. Often “cut” with other drugs or substances such as sugar or powdered milk. User is unaware how much actual heroin is being used, creating likelihood of overdose.

Brown (L) amd white (R) powder heroin.
Black tar heroin from dealer (L) and ready to be injected by needle (R).

Street Names

  • Big H, Black Tar, Chiva, Hell Dust, Horse, Negra, Smack, Thunder

How is it used?

  • Injected, smoked, or sniffed/snorted. High purity heroin is usually snorted or smoked.


  • Needle. Pipe. Small spoon. Straw or tube.

Synthetic Opioids

Synthetic opioids are highly potent drugs produced in laboratories that provide the same effects as naturally occurring opioids. Fentanyl is a legal synthetic often used by cancer patients, and is 100 times more potent than morphine, which makes it extremely dangerous. Carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl. Because of its powerful opioid properties, fentanyl and carfentanil is also diverted for abuse.  Both are added to heroin to increase its potency, or be disguised as highly potent heroin. Many users believe that they are purchasing heroin and actually don’t know that they are purchasing fentanyl – which often results in overdose deaths. Clandestinely-produced fentanyl is primarily manufactured in Mexico.

Fentanyl Street Names

  • Apace, China Girl, China Town, China White, Dance Fever, Goodfellas, Great Bear, He-Man, Poison and Tango & Cash

How is fentanyl used?

  • Typically injected, or inhaled like heroin.

Fentanyl Paraphernalia

  • Needle.
Lethal doses of heroin, fentanyl, and carfentanil.


  • U-4 is a highly potent synthetic opioid that looks like a white or light pink powder. A lot of times, it is often either sold in baggies or pressed into pills to look like legal painkillers. Abuse of this drug is similar to heroin, and prescription and designer opioids. Synthetics are often mixed with prescription opioids and/or heroin in the illegal drug trade. Such mixes are implicated in the recent surge of opioid overdose deaths nationally.

U-47700 Street Names

  • Pinky , Pink or U4

How is U-4 used?

  • This drug is usually snorted, swallowed or injected.

U-4 Paraphernalia

  • Needle. Straw or tube.