Purpose There is increased social discussion of the emerging issues of opioid use, health and well-being of young adults within contemporary Asian society. The purpose of this study is to contribute new knowledge of opioid-using young adults through ethnographic perspectives of the five main cultures of Pakistan. Furthermore, it tried to explore the values of opioid users. Design/methodology/approach It is a qualitative study. Semi-structured interview and observation techniques were used to gain the participants’ information, in a non-judgmental environment. Observation and life focus history interview methodology were used for data collection. The sample consisted of 18 male opioid users (approximately three from each area including: Punjab, Khyber Pakhtoon Khah, Balochistan, Sindh, Gilgit Baltistan and Azad Jammu and Kashmir). An interview script was used in interviews after written informed consent. After the detailed interview and observation of non-verbal behaviours, the researchers analysed the data by using the content analysis of qualitative method. Findings The result showed that poor relationships, conflicts over property, lack of social support and family problems increased with the use of opioids by individuals. The individual’s mental health, such as hopelessness, curiosity, mistrust and lack of interest in social activities, was the major cause of opioid addiction. Moreover, peer influences and friends may also have played contributing roles in opioids use among men. Research limitations/implications The current study added to the understanding of the relationship of different environmental, behavioural and social factors involved in developing opioid use among young individuals. The homogeneity of the sample may have weakened the generalisability of the findings of the study as all participants in the study were male. Practical implications Clinicians and allied professionals have shown a great interest in early intervention with opioid users. At the same time, there is a lack of qualitative studies exploring the lived experiences of young opioid users. That is why this study was done, to empower counsellors. Social implications Opioids, including heroin, have strong addictive tendencies. They are easily available, particularly in unplanned urban areas of Pakistan. The present study tried to understand the lived experiences and beliefs of opioid users belonging to different cultures of Pakistan. Originality/value At the same time, there is a lack of qualitative studies exploring the lived experiences of adult opioid users. Therefore, this study presented 18 interview-based facts from the opioid users belonging to different areas of Pakistan residing in capital of Pakistan. The content of these vignettes was examined in the context of an ethnographic perspective, as it has a strong connection and contribution to drug abuse.