Background Heroin and prescription painkiller use are both major public health concerns within the United States. Although the rate of prescription painkiller overdose is decreasing, the rate of heroin-related overdose is increasing. There are concerns that this increase is due to individuals progressing from nonmedical pain reliever (NMPR) use to heroin. Methods Data were obtained through a nationwide survey on drug use. The sample was representative of the United States in regard to age, gender, and race/ethnicity. Correlations between heroin and NMPR were found using both bivariate analysis and multivariable analysis after adjusting for previous drug use and demographic characteristics. Results Of the 55,160 subjects included in the analysis, 840(1.5%) reported having used heroin at least once in their life. Out of the entire sample, 4664(8.5%) reported previous NMPR use. The odds of heroin use were 3.5 times higher for those who had used NMPR than those who had not used NMPR (95% CI=2.9-4.4). Discussion These results indicate that the current increase of heroin may be due, at least in part, to individuals progressing from NMPR to heroin.