Many young adults who abuse prescription opioids are not prepared to deal with an overdose, a new study finds. They tend to think prescription medications are less dangerous than heroin, the researchers say.

“What we found is that when it comes to how to handle an overdose, prescription opioid users who weren’t using drugs for official medical reasons were less savvy than, say, more traditional heroin-using populations,” study author David Frank of the CUNY Graduate Center in New York City told HealthDay. “In fact, they tend to have a pretty severe lack of knowledge and a lot of confusion about it, despite the fact that most have experienced overdoses within their drug-using network.”

Young people who abuse opioids think of themselves as being very different from people who use heroin, Frank said. He conducted in-depth interviews with 46 young adult New Yorkers, ages 18 to 32, who abused prescription painkillers. Almost three-quarters of the participants were white, and half had at least some college education.

The participants tended to see prescription painkillers as relatively harmless medication that was less addictive than heroin, and less likely to cause an overdose. Yet almost all the study participants said they knew someone who had overdosed on painkillers, or had overdosed themselves. The majority did not know about overdose prevention or response options, including the opioid overdose antidote naloxone.

In most cases, participants said when faced with an overdose, they used potentially ineffective methods such as slapping the person or placing them in a cold shower to revive them. Among those who had heard of naloxone, many thought it was expensive or difficult to obtain. In New York state, naloxone is distributed freely, along with training, at most official harm reduction or needle-exchange programs, the researchers noted. Many participants said these programs place too much emphasis on heroin use.

The study appears in the International Journal of Drug Policy.