Objective: This study examined the means of obtainment, indication, and prescriber of an index opioid in self-reporting heroin users.Design: Cross-sectional, observational study.Setting: A survey was submitted by participants in the United States with current or past heroin use.Participants: Three hundred twenty-three participants greater than 18 years of age completed the survey.Main outcome measure: Participants were surveyed regarding prescription opioid use prior to heroin initiation and specifically how they were obtained. Surveys were comprehensive in nature, divulging information including which opioid(s) was/were used, how they were obtained, by which prescriber (if prescribed), and if there was a diagnosis for chronic pain.Results: Roughly 47 percent of participants reported using prescription opioids prior to heroin. The most commonly used prescription opioid prior to heroin initiation was oxycodone (92.5 percent). The most common acquisition of opioids was through the prescribing of a physician, which occurred in roughly 63 percent of cases. These prescriptions were obtained most often from primary care physicians and emergency departments. Only 34 percent of participants reported being diagnosed with a chronic pain condition prior to using heroin.Conclusions: This study further supports the role that prescription opioids play in the transition to heroin use. It suggests that oxycodone is the most common prescription opioid used prior to heroin initiation. Additionally, it reports descriptive information as to how and where prescription opioids are obtained.