Common signs of opioid use in a teen include tiny pupils, nodding off, and constipation. You may also see secretive behavior, mood swings, missing cash, or pills running low at home. Slow breathing or being hard to wake can signal an overdose. Call 911 and give naloxone if you have it.
Any one sign can have another cause, so look for a pattern. If the pattern points to opioids, have a doctor see him. When needed, opioid addiction treatment for adolescents can help a teen stop safely.
What Teen Opioid Misuse Looks Like
Opioid use in teens often starts with pills. It helps to know how these drugs work and how many teens use them.
How Opioids Work in the Body
Opioids are drugs that ease pain. Some, like morphine and codeine, come from the opium poppy plant. Others, such as oxycodone and fentanyl, are partly or fully made in a lab.
Opioids work by locking onto opioid receptors on nerve cells in the brain, spinal cord, and gut. This blocks pain signals and can bring a strong sense of calm. They can also slow the nervous system, so a high dose can slow or stop breathing. Opioids affect the part of the brain that drives reward. Repeated use can lead to opioid dependence. That risk is real even with prescribed opioids taken for pain relief after surgery or for chronic pain.
How Common Is Teen Opioid Misuse?
Misuse means taking a medicine without a prescription, in a bigger dose, or to get high. In the 2025 National Survey on Drug Use and Health, 1.6 percent of teens ages 12 to 17 said they had misused prescription opioids in the past year [1]. That is about 402,000 young people.
SAMHSA runs the survey. Its behavioral health statistics team does the work. SAMHSA is short for the Substance Abuse and Mental Health Services Administration. The count covers misuse of prescription opioids, not every form of opioid use. Heroin and illicitly made fentanyl are measured separately.
Utah teens report misuse too. In the 2025 SHARP survey, 1.1 percent of Utah 12th graders said they had ever misused prescription narcotics [2]. SHARP stands for Student Health and Risk Prevention, and the Utah Department of Health and Human Services runs it.
Some parents first hear about opioids through old slang for OxyContin. A separate post on what “hillbilly heroin” means covers that nickname, where it came from, and what it means for parents.
The Opioids and Look-Alikes Teens Run Into
Teens today can come across opioid drugs in several forms. Some are real prescription medications. Others only look real but hold something much stronger.
Prescription Painkillers Such as Percocet
Many families keep prescription painkillers at home. A teen may first try pills left over from a sports injury, a pulled tooth, or a relative’s surgery. It is against the law to share or sell even one.
Percocet is one kind of these pills. It mixes oxycodone with acetaminophen, the drug in Tylenol. So if he takes too much, it can also hurt his liver. This type of opioid and other opioid medications are controlled substances. Teens often call the tablets by a short name, and they are widely known as percs.
Fentanyl and Other Illicit Opioids
Fentanyl is a synthetic opioid. It is much stronger than morphine, and much of it is made in secret labs and sold on the street. In 2024, the Centers for Disease Control and Prevention (CDC) found synthetic opioids such as fentanyl in 47,735 of the 79,384 overdose deaths [3].
The opioid epidemic began here with pills from doctors. Now it is driven by street drugs like fentanyl. Heroin and street fentanyl are illegal opioids, and as with other illegal drugs, no one checks what is in them or how strong they are.
Heroin is still rare among teens, but its use went up in 2025. The National Institute on Drug Abuse reported that 0.9 percent of 12th graders used heroin in the past year, up from 0.2 percent in 2024 [4].
Counterfeit Pills
Some street fentanyl is pressed into fake pills that look like real prescription drugs. A common target is the blue oxycodone 30 mg tablet.
A real M30 pill is a prescription medicine, but many blue pills sold under that name are fakes. Many fakes hold fentanyl instead of oxycodone.
You cannot tell a real pill from a fake one by looking at it, since fakes can copy the color, shape, and stamped letters. Fake oxycodone is not the only one. Fakes of anxiety and ADHD pills are sold too, and some hold designer drugs such as nitazenes.
The CDC counted 3,810 drug overdose deaths among people ages 15 to 24 in 2024 [3]. The death rate for that age group fell 37 percent from 2023. Our full guide to how counterfeit pills are made and sold explains why a single pill can kill and what parents can do.
Codeine Cough Syrup, or Lean
Codeine is a weaker opioid. It is found in some prescription cough syrups that doctors give to adults.
Some teens mix codeine and promethazine syrup with soda and call it lean, purple drank, or sizzurp. With alcohol or other drugs, this mix can slow his breathing to a deadly level.
Cough syrup bottles that are not his can be a clue. So can cups he keeps out of sight or a sweet medicine smell in his room. A separate post explains what codeine syrup and lean are and the signs parents tend to notice at home or in the car.
Tianeptine, Sold as Gas Station Heroin
The Food and Drug Administration (FDA) has not approved tianeptine for any medical use in the United States. It is sold online and at some gas stations as pills, liquids, and powders.
Sellers often make false claims about mood. The FDA warns that tianeptine can cause agitation, changes in blood pressure, slowed breathing, coma, and death [5].
Teens who take tianeptine every day can become dependent on it. They can go through withdrawal when they stop. The chapter on gas station heroin covers these products and what parents should know.
Signs of Opioid Use in a Teenage Boy
Signs of opioid use fall into three groups: changes in his body, changes in how he acts, and things that turn up at home. No single sign proves drug use, and many also fit illness, poor sleep, or low mood.
Physical Signs
Physical symptoms often show up during or soon after use. Watch for:
- Very small, pinpoint pupils, even in dim light
- Heavy drowsiness or nodding off in the middle of a talk
- Slow or shallow breathing, which can signal an overdose
- Unsteady walking or slurred speech
- Slowed thinking or trouble focusing
- Scratching his skin a lot, upset stomach, or constipation
- Changes in sleep, such as sleeping at odd hours
With repeated use, he may need more to feel the same effect. Between doses, opioid withdrawal symptoms such as sweating, a runny nose, yawning, and muscle aches can look like the flu. Needle marks may suggest injection, but their absence does not rule out opioid use.
Behavioral and Emotional Signs
Behavior often changes before you see anything physical. A teen who uses opioids may hide his phone, his friends, or where he goes. He may lie more, lock doors, or get angry at simple questions.
Mood swings are common. He may seem very calm on a dose, then cranky or anxious as it wears off. Many teens let go of things they once handled, such as sports, chores, or a part-time job, and drop old friends.
Money problems are another clue. Cash may go missing from wallets, or he may sell games, clothes, or other things he owns for no clear reason.
What You Might Find at Home
Clues at home are often the clearest. Check whether prescription medications in the house are running out faster than they should. Count the pills in any opioid bottle, even old ones from a past surgery.
Other finds can include loose pills, small blue tablets, burned foil, empty cough syrup bottles, or packages ordered online. These clues can point to other drugs too, and our post on signs of drug use in teens can help you sort out what you see.
Opioid Overdose: Signs and What to Do
An opioid overdose can kill, so treat it as an emergency. Look for:
- Pinpoint pupils
- Falling asleep, or not waking up when you shake him or call his name
- Slow, shallow, or stopped breathing
- Choking or gurgling sounds
- A limp body
- Pale, blue, or gray skin, mainly on the lips and nails
Call 911 and give naloxone if you have it. If normal breathing has not returned after 2 to 3 minutes, give another dose with a new device. Follow the dispatcher’s instructions for rescue breathing or CPR. If he is breathing normally but unconscious, lay him on his side. Stay until help arrives, even if he wakes up. [6]
Naloxone, sold as Narcan, can reverse an opioid overdose. It will not harm someone who has not taken opioids.
The American Academy of Pediatrics (AAP) states, “There are no age limits on who can carry and administer naloxone” [7].
In Utah, pharmacists can hand out naloxone without a prescription. The nose spray is also sold over the counter. Keep it at home, since it can prevent an overdose death.
Accidental overdose is a real danger with fake pills. A teen may not know he is taking fentanyl. Mixing opioids with alcohol, sleep aids, or pills like Xanax also raises his overdose risk.
The Opioid Withdrawal Timeline
Opioid withdrawal occurs when a body used to opioids stops getting them. MedlinePlus says symptoms usually start within 12 hours of the last dose of heroin [8]. With methadone, they start within 30 hours.
Early and Later Withdrawal Symptoms
Withdrawal can be mild or severe, and it often feels like a bad flu. Early symptoms include:
- Anxiety and agitation
- Muscle aches, sweating, and chills
- A runny nose, watery eyes, and yawning
- Trouble sleeping
Later on, he may have:
- Stomach and muscle cramps
- Diarrhea, nausea, and vomiting
- Goosebumps and large pupils
Pills like oxycodone tend to follow the faster heroin pattern. With these short-acting drugs, the worst of it tends to pass in several days. Withdrawal from methadone and other long-acting opioids tends to last longer.
Some people have sleep disturbances, low mood, worry, and cravings for weeks or months. Doctors sometimes call this post-acute withdrawal syndrome (PAWS).
Why Opioid Detox Needs Medical Supervision
Opioid withdrawal hurts, but it is not usually deadly. Still, vomiting and diarrhea can cause dehydration. Strong cravings also often lead a teen back to use.
A major danger comes after withdrawal, since it lowers tolerance. A dose he once took can now stop his breathing. Returning to opioid use after detox raises overdose risk.
So a teen who has just gone through withdrawal is at increased risk.
A teen needs a clinician’s plan for opioid withdrawal. Depending on his symptoms, health, and home support, care may take place at home with medical guidance or in a treatment setting. Do not try to manage it alone.
Medicine can ease withdrawal and cravings. Buprenorphine or methadone may be used when suitable for the teen. These medicines can also support ongoing treatment. Detox alone does not treat opioid use disorder.
How Adolescent Opioid Use Disorder Is Treated
Opioid use disorder is a health problem. A person with it keeps using opioids even when it causes harm. Doctors check for it with the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Its checklist looks at cravings, loss of control, and trouble at home or school. Opioid use disorder symptoms can range from mild to severe, and the plan for each teen depends on where he falls.
Medication for Opioid Use Disorder
MOUD stands for medications for opioid use disorder. It means using medicine to treat opioid addiction. Medication-assisted treatment is an older, broader term for medicine combined with counseling. One MOUD option is buprenorphine.
Buprenorphine eases cravings and withdrawal and is often mixed with naloxone. Naltrexone blocks the high from opioids and comes as a monthly shot.
For opioid use disorder, methadone is usually provided through a federally certified opioid treatment program. Naltrexone can help prevent a return to use after an opioid-free period. The right medicine depends on the teen’s age, health, and past use.
The AAP calls medicines like buprenorphine proven ways to cut cravings, prevent overdose, and support recovery. It notes that medicine helps teens stay in treatment. It also says a teen should not have to go to therapy to get medicine.
This medicine can be hard to get. The AAP reports that only 1 in 8 treatment facilities offer buprenorphine for teens [7]. Before you pick a place, ask about its opioid use disorder treatment.
Levels of Care and Family Involvement
A good treatment plan fits the level of care to how serious the problem is. Treatment options include outpatient counseling, programs that meet a few days a week, and day programs. Detox in a hospital or clinic is one more choice.
In residential treatment, the teen lives at the program during care, which adds structure and daily support. Some programs that offer residential treatment for teens prescribe medicine on site. Others work with an outside doctor.
Family therapy helps parents and teens rebuild trust and set clear rules at home. Many teens with substance use disorders also have depression, anxiety, or trauma. Care for those mental disorders belongs in the same plan.
Frequently Asked Questions
What Are the First Signs of Opioid Use in a Teen?
Early signs often include tiny pupils, heavy drowsiness, nodding off, and constipation. You may also see secret behavior, mood swings, new friends, lost cash, or pills going missing at home. If you see a pattern of these changes, call his doctor and talk with your teenager about drugs.
How Long Does Opioid Withdrawal Last?
With short-acting opioids, symptoms often start within a day and ease over several days. Methadone and other long-acting opioids can cause longer withdrawal. Fentanyl withdrawal can vary, and poor sleep or cravings may last for weeks.
Is Opioid Use Disorder a Mental Illness?
Opioid use disorder is a mental health condition. The DSM, the manual doctors use to diagnose mental health conditions, lists it as a substance use disorder. It changes how the brain works, but it can be treated with medicine, talk therapy, and steady help over time.
Can a Parent Give Naloxone to a Teenager?
A parent can give naloxone to a teen who shows signs of an opioid overdose. The AAP says there is no age limit on who can carry or give it. Spray it in his nose, call 911, and stay with him, since he will still need medical care after it works.
If you see signs of opioid use in your son, a calm talk with his doctor is a good first step. For long-term support, learn more about prescription drug addiction treatment for teens. Call our confidential admissions team to get guidance for your son’s next steps.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you think someone is overdosing, call 911. For a mental health crisis, call or text 988. For treatment referrals, call the SAMHSA National Helpline at 1-800-662-4357.
Sources
- Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2025 National Survey on Drug Use and Health (2026). https://www.samhsa.gov/data/sites/default/files/reports/rpt57150/2025-nsduh-annual-national-html/2025-nsduh-annual-national.htm
- Utah Department of Health and Human Services. 2025 Student Health and Risk Prevention (SHARP) Survey: State of Utah Results (2025). https://dsamh-training.utah.gov/_documents/SHARPreports/2025/State_of_Utah_Profile_Report.pdf
- Centers for Disease Control and Prevention, National Center for Health Statistics. Drug Overdose Deaths in the United States, 2023 to 2024, NCHS Data Brief No. 549 (January 29, 2026). https://www.cdc.gov/nchs/products/databriefs/db549.htm
- National Institutes of Health, National Institute on Drug Abuse. Reported Use of Most Drugs Remains Low Among U.S. Teens, 2025 Monitoring the Future Survey (December 17, 2025). https://www.nih.gov/news-events/news-releases/reported-use-most-drugs-remains-low-among-us-teens
- U.S. Food and Drug Administration. Tianeptine. https://www.fda.gov/consumers/health-fraud-scams/tianeptine
- Centers for Disease Control and Prevention, NIOSH. Responding to a Suspected Opioid Overdose (2019). https://www.cdc.gov/niosh/publications/numbered/2019-127.html
- American Academy of Pediatrics. Adolescent Opioid Use: Frequently Asked Questions (updated August 26, 2025). https://www.aap.org/en/patient-care/substance-use-and-prevention/opioid-use-in-adolescents-screening-treatment-and-support/
- MedlinePlus, U.S. National Library of Medicine. Opiate and Opioid Withdrawal (reviewed May 15, 2026). https://medlineplus.gov/ency/article/000949.htm
