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The epidemic of substance abuse in the U.S. is a growing problem. The increase of people addicted to prescription painkillers, combined with the ongoing problems of illicit drug and alcohol abuse, is resulting in staggering statistics. Substance abuse costs $700 billion each year between crime, job productivity losses and health care, according to the National Institute on Drug Abuse.1

People take drugs voluntarily at first. Unfortunately, once continued use rewires the brain, using drugs can result in abuse, addiction, major health problems and even death. Legal drugs like prescription painkillers can be just as dangerous as illegal drugs. This article reviews the top three most addictive drugs.


About 23 percent of people who try heroin, an opiate, develop an addiction to the drug.2 When heroin reaches the brain, it’s converted into morphine, which binds to opioid receptors. These receptors are found in many areas of the brain and body, especially in the pain and pleasure centers.

When people take heroin, they feel an initial rush of euphoria and warmth. As the body builds a tolerance to the drug, more of it is needed to gain the same effects. Another result is dependence, where continuing to use heroin to avoid withdrawal symptoms is necessary. Combined with the desire to feel euphoric and numb, these factors make heroin one of the most addictive drugs.

Prescription Painkillers

Drugs like oxycodone, hydrocodone and fentanyl are opioids, a term used for synthetic or partially synthetic opiates. This makes the way these drugs affect the body and their detrimental consequences similar to those of heroin.

Prescription opioids, which are manufactured legally and prescribed by doctors, can have effects similar to heroin when not taken as prescribed. When taken in larger doses or more frequently than doctors advise, painkillers are dangerous and can be fatal.

Prescription drugs like Vicodin and Oxycontin are currently among the most commonly abused drugs in the U.S. Research shows that misuse of these drugs is a gateway to heroin addiction for many.2


Cocaine is a powerfully addictive stimulant drug that is typically snorted, injected or smoked in the form of crack.3 It’s an illegal street drug that is often taken in a binge pattern. Bingeing is when cocaine is used repeatedly within a short time, at increasingly higher doses, to stay high.

When individuals take cocaine, dopamine is released, giving users feelings of pleasure. The drug stops the brain from recycling dopamine, as it does in response to natural pleasurable stimuli. The unchecked flood of dopamine causes cocaine’s high.

Continued use of cocaine may cause long-term changes in the brain’s reward systems, leading to addiction. As the brain adapts to the high levels of dopamine brought on by cocaine, people take stronger and more frequent doses to achieve the same high and alleviate initial withdrawal. This is how cocaine is one of the most addictive drugs.

Crossing the Line

Drug abuse and addiction can be thought of as instances that are part of a larger sequence. Any use of an illicit drug or misusing medication is drug abuse, but the instance when drug abuse becomes drug addiction is different for each person. This is why recreational drug use is dangerous; the next instance may be crossing the line into addiction.

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  1. https://www.drugabuse.gov/related-topics/trends-statistics
  2. https://www.drugabuse.gov/publications/drugfacts/heroin
  3. https://www.drugabuse.gov/publications/drugfacts/cocaine
Crossing the Line: The Most Addictive Drugs
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