Frequently Asked Questions About the Opioids
Editor Mike HamiltonLast Update: 10 Jan. 94
Editors Note:
If anyone has any info that they would like to share with me and possibly have included in this FAQ, please send all mail to my mailbox at mdh@xxx
Contents
Opioid Info:
Natural (known as opiates):
Morphine
Codeine
Semi-Synthetic (known as opioids):
Heroin
Hydrocodone (Hycodan)
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Oxycodone (Percodan)
Synthetic (also known as opioids):
Fentanyl (Sublimaze)
Methadone (Dolophine)
Propoxyphene (Darvon)
Pentazocine (Talwin)
Opioid Addiction and Withdrawal
The FAQ will use morphine as the standard opioid and base all other opioids in relation to it.
Glossary:
opiate - narcotic analgesic derived from a natural source(opium poppy)
opioid - narcotic analgesic that is either semi or fully synthetic - also refers to entire family of both opiates and opioids
IM - intramuscular injection
SC - subcutaneous injection
Morphine
Synopsis
Morphine is naturally occurring substance in the opium poppy, Papaver somniferum. It is a potent narcotic analgesic, and its primary clinical use is in the management of moderately severe and severe pain. After heroin, morphine has the greatest dependence liability of the narcotic analgesics in common use.
Morphine is administered by several routes (injected, smoked, sniffed, or swallowed); but when injected particularly intravenously, morphine can produce intense euphoria and a general state of well-being and relaxation. Regular use can result in the rapid development of tolerance to these effects. Profound physical and psychological dependence can also rapidly develop, and withdrawal sickness upon abrupt cessation of heroin use; many of the symptoms resemble those produced by a case of moderately severe flu.
Morphine is infrequently encountered in the North American street drug culture. However, mainly because of its availability in hospitals, there have been several documented cases of morphine dependence among health professionals.
Drug Source
Morphine is isolated from crude opium, which is a resinous prep of the opium poppy, Papaver somniferum.
Trade Name
Roxinal, MS Contin, Morphine Sulfate
Street Names
"M", morph, Miss Emma
Drug Combinations
Use of morphine plus cocaine, as well as of morphine plus methamphetamine, has been reported. However, such combinations are not frequently encountered.
Medical Uses
* symptomatic relief of moderately severe to severe pain;
* relief of certain types of difficult or labored breathing;
* suppression of severe cough (rarely);
* suppression of severe diarrhea (e.g., that produced by cholera).
Physical Appearance
Morphine is legally available only in the form of its water-soluble salts. Most common are morphine sulfate and morphine hydrochloride. Both are fine white crystalline powders, bitter to the taste. Both are soluble in water and slightly soluble in alcohol.
Dosage
~~~~~~
Medical
For moderate to severe pain the optimal intramuscular dosage is considered to be 10 mg per 70 kg body weight every four hours. The typical dose range is from 5 to 20 mg every four hours, depending on the severity of the pain. The oral dose range is between 8 and 20 mg; but with oral administration morphine has substantially less analgesic potency (approximately one-tenth of the effect produced by subcutaneous injection) because it is rapidly destroyed as it passes through the liver immediately after absorption. The intravenous route is employed primarily for severe post-operative pain or in an emergency; in this case the dose range is between 4 and 10 mg, and the analgesic effect ensues almost immediately.
Nonmedical
Irregular or intermittent users (who are not substituting the drug for another narcotic analgesic) may start and continue to use doses within the therapeutic range (e.i., up to 20 mg). However, regular users who employ morphine for its subjectively pleasurable effects frequently increase the dose as tolerance develops. To take several hundred milligrams per day is common, and there are reliable reports of up to four or five grams (4000 - 5000 mg) per day.
Routes Of Administration
Morphine may be taken orally in tablet form, and can also injected subcutaneously, intramuscularly, or intravenously; the last is the route preferred by those who are dependent on morphine.
Short Term Use
~~~~~~~~~~~~~~
Low Doses (single doses of 5 - 10 mg administered by S.C or IM injection in non-tolerant users)
CNS, behavioral, subjective:
suppression the sensation of and emotional response to pain; euphoria; drowsiness, lethargy, relaxation; difficulty in concentrating; decreased physical activity in some users and increased physical activity in others; mild anxiety or fear; pupillary constriction, blurred vision, impaired night vision, suppression of cough reflex.
Respiratory:
slightly reduced respiratory rate.
Gastrointestinal:
nausea and vomiting; constipation; loss of appetite; decreased gastric motility.
Other:
slight drop in body temperature; sweating; reduced libido; prickly or tingling sensation on the skin (particularly after intravenous injection).
Duration
4 - 5 hours
Dependency Potential
high, continued use results in both psychological and physical dependency
Codeine
Drug Source
Codeine is found in opium in concentrations between %0.1 and %2. Because of the small concentration found in nature, most codeine found in medical products is synthesized from morphine via the methylation of the hydroxyl group found on the second non-aromatic ring.
Trade Name
There are no commercial name for products containing only codeine in US. Found under common name of codeine. Canada does have a codeine only syrup available under Paveral. Mainly found in combination products.
Street Name
T-three's (Tylenol #3 w/ codeine), schoolboy, cough syrup
Medical Uses
* relief of mild to moderate pain
* relief of non-productive cough
* relief of diarrhea
Drug Combinations
Sold under many name brand products, the most popular being theTylenol with Codeine series, the number on the tablet corresponds to the amount of codeine and caffeine found in the each tablet.
Tylenol #1 w/ codeine - 8 mg codeine, 15 mg caffeine
Tylenol #2 w/ codeine - 15 mg codeine, 15 mg caffeine
Tylenol #3 w/ codeine - 30 mg codeine, 30 mg caffeine
Tylenol #4 w/ codeine - 60 mg codeine, no caffeine
note: all tablets contain same amount of acetaminophen (300 mg)
Fiorinal (aspirin, caffeine, barbital, codeine)
Many other brand name product combinations.
Physical Appearance
Tylenol w/ codeine series are imprinted with number on one side and other side is Tylenol label(McNeil).
Controlled Substance Status
As a single product codeine is a schedule II controlled substance in the US. When combined with other non-controlled substance, and depending on amount per dose unit, codeine combined products range from schedule III to V.
Canada has OTC codeine products available if product has no more than 8 mg of codeine per unit dose. Some US areas may have codeine preps available OTC, but usually require release form.
As an interesting fact, a travelers handbook noted that Greece has banned codeine in that country (no idea on what it's status is now) so be careful when traveling there.
Dosage
~~~~~~
Medical
Pain relief : 30 mg - 220 mg oral or equivalent dose SC or IM
Diarrhea relief : 10 mg - 20 mg orally
Cough suppressant : 5 mg - 15 mg orally
Nonmedical
Doses can range from 30 mg up to 400 mg. LD50 for codeine is 800 mg in a average nontolerant person. At doses of > 250 mg adverse effects tend to arise, including intense itching, flushed skin, dizziness, sedation, nausea and vomiting
Routes Of Administration
Usually taken orally but can be injected IM or SC. The IV route is not recommended as reactions such as facial swelling, pulmonary edema and convulsions can occur.
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
Effects begin at 30 mg and tend to mimic those of morphine, except sedation and euphoria are less intense.
Respiratory:
same as morphine but less intense.
Gastrointestinal:
same as morphine but nausea and vomiting are less common and constipation less severe.
Other:
alleocodone is a schedule II drug, and when combined with other non-controlled drugs, is found from schedule III-IV.
Dosage
~~~~~~
Medical
as a cough suppressant 5 mg - 10 mg
for pain relief 10 mg - 30 mg
Nonmedical
doses are similar to those for pain relief
Routes Of Administration
Usually taken orally but can be inject via three routes. Unknown if hydrocodone can be sniffed or smoked. Sniffing is likely possible.
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
Has similar effects as morphine but less sedation and euphoria
Respiratory:
Less depression than morphine.
Gastrointestinal:
Less likely to cause nausea and vomiting than morphine.
Other:
Hydrocodone is a weaker opioid than morphine but still a effective opioid with similar potency to oxycodone.
Duration
3 - 4 hours
Dependency Potential
moderately low, much less potential than morphine
Hydromorphone
Drug Source
Synthetically produced from morphine.
Trade Name
Dilaudid
Street Name
Dillies
Medical Uses
* relief of moderate to severe pain
* relief of severe cough
Drug Combinations
most commonly used as a single product
Physical Appearance
usually bought as tablets, or injectable solution
Controlled Substance Status
Hydromorphone, like most single product opioids, is a schedule II opioid.
Dosage
~~~~~~
Medical
for pain relief 1 mg - 2 mg
Nonmedical
same as pain relief doses
Routes Of Administration
Can be administered orally, by three routes of injection, and by sniffing. Unknown if smoking is an effective route.
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
Hydrocodone has effects similar to morphine, except euphoria is similar to codeine, nausea and vomiting is quite rare, and sedation is practically non-existent
Respiratory:
Hydrocodone depresses respiration minimally.
Gastrointestinal:
Hydromorphone effects GI tract very little.
Other:
Although hydromorphone's euphoria pales with other opioids it's abuse potential comes from the fact the rush experienced from IV use is very similar to heroin's.
Hydromorphone is one of the most used opioids in the relief of pain for the terminally ill. The reasons being it's minimal side effects, and high potency.
Duration
3 - 4 hours
Dependency Potential
moderately high
Meperidine
Drug Source
Meperidine is completely synthetic and can be produced with dichlorodiethyl methylamine and benzyl cyanide.
Trade Name
Demerol
Street Name
Demmies
Medical Uses
* originally found to be useful for muscle spasms but the discovery of it's analgesic properties has resulted in it's almost exclusive use for relief of moderate to severe pain
Drug Combinations
usually found as a single product, with few combination products. Is found in combination with acetaminophen in Demerol APAP
Physical Appearance
Demerol tablets are small white tablets with the name Winthrop on one side
Controlled Substance Status
Schedule II substance in US
Dosage
~~~~~~
Medical
pain relief is achieved with approx. 50 mg - 150 mg injected or 200 mg - 300 mg oral
Nonmedical
doses similar to those used in medical settings are used in recreational use.
Routes Of Administration
orally, three injection routes, and sniffing are possible, unknown if smoking is possible
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
same as morphine but less sedation, less intense euphoria
Respiratory:
respiratory depression tends to be less common and less intense than morphine
Gastrointestinal:
nausea and vomiting are reportedly common with oral use, but less when administered via injection
Duration
3 - 4 hours
Dependency Potential
reported to be less than or equal to that of morphine
Oxycodone
Drug Source
synthesized from codeine
Trade Name
Only found as a compound product combined with aspirin or acetaminophen. [Erowid Note: This statement was true when this document was last edited, in 1994. Oxycontin and other Oxycodone-only products were made available in 1996.] Available in Canada as a single product in the form of a suppository
Street Name
Percs
Medical Uses
* relief of moderate to severe pain
Drug Combinations
Percodan is aspirin and oxycodone
Percocet is acetaminophen and oxycodone
Physical Appearance
Percodan tablets are color coded according to quantity of oxycodone in each tablet, the pink have ~2.5 mg and the orange and green having twice as much
Controlled Substance Status
Schedule II in US
Dosage
~~~~~~
Medical
10 - 20 mg oral for pain relief
5 - 15 mg injection
Nonmedical
Doses similar to those used in a medical setting are used
Routes Of Administration
Can be administered orally, three injection routes, sniffed and possibly smoked.
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
Same as morphine but milder.
Respiratory:
Less respiratory depression than morphine
Gastrointestinal:
Less constipating than morphine
Duration
3 - 4 hours
Dependency Potential
Moderate
Fentanyl
Drug Source
Synthetically produced
Trade Name
Sublimaze
Street Name
China white
Medical Uses
Mainly relief of moderate to severe pain and as a surgical anesthetic
Drug Combinations
none
Physical Appearance
Found as a injectable solution, and a transdermal patch
Controlled Substance Status
Schedule II in US
Dosage
~~~~~~
Medical
50 ug - 200 ug
Nonmedical
same range as medical use
Routes Of Administration
can be administered via three injection routes, sniffed and smoked
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
euphoria is less than morphine
Respiratory:
same as morphine but has potential to cause respiratory muscles
to go into spasm and result in respiratory arrest
Gastrointestinal:
less constipating that morphine
Duration
1 - 2 hours
Dependency Potential
moderately high
Methadone
Drug Source
synthetically produced
Trade Name
Dolophine
Street Name
Dollies
Medical Uses
occasionally used for pain relief, but main use is in opioid withdrawal treatment as a substitute drug
Drug Combinations
none
Physical Appearance
found as a fruity solution for oral use, in wafers, and tablets also found as a injectable solution
Controlled Substance Status
Schedule II in US
Dosage
~~~~~~
Medical
3 - 5 mg provides same pain relief as 10 mg morphine
Nonmedical
rarely used non-medically, but doses used are approx. same
as medical doses
Routes Of Administration
can be injected via three routes, taken orally, unknown if
methadone can be smoked, can be sniffed
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
Oral use provides little euphoria and tends to block opioid receptors in brain, so commonly used as a maintenance drug during rehab.
Respiratory:
Produces little depression in contrast to morphine
Gastrointestinal:
produces constipation of less intensity than morphine
Other:
Developed by Nazi Germany during WWII as Germany was unable to acquire adequate supplies of morphine.
Duration
first dose last approx. 8 hours and subsequent doses last 18 - 24 hours.
Dependency Potential
oral use provides little euphoria so little abuse potential in that form. When injected, methadone give very similar effects to morphine so has similar addiction potential.
Propoxyphene
Drug Source
Synthetically produced with similar structure to that of methadone
Trade Name
Darvon, Darvon N
Street Name
none
Medical Uses
for relief of mild pain
Drug Combinations
Darvon compound is aspirin and propoxyphene
Physical Appearance
Darvon N as pink oval pills
Controlled Substance Status
Schedule III in US
Dosage
~~~~~~
Medical
range from 50 mg - 150 mg of hydrochloride
Nonmedical
similar to medical dose ranges.
Routes Of Administration
can be taken orally, three possible injection routes, no info on possible intranasal or smoked administration
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
oral use provides very little euphoria, mild sedation; at larger doses sedation becomes quite prominent and symptoms such as staggering and slurred speech become apparent.
Respiratory:
little respiratory depression in medical dose range
Gastrointestinal:
little effect on GI tract
Other:
IV use is reported to give rush similar to heroin; poor analgesic with standard dose providing less pain relief than standard aspirin dose
Duration
3 - 4 hours
Dependency Potential
low
Pentazocine
Drug Source
synthetically produced
Trade Name
Talwin
Street Name
yellow footballs
Medical Uses
for relief of moderate to moderately severe pain
Drug Combinations
Talwin NX - pentazocine and nalaxone (opioid antagonist)
Physical Appearance
usually found in orange-yellow tablets
Controlled Substance Status
Schedule III
Dosage
~~~~~~
Medical
50 mg - 100 mg for pain relief
Nonmedical
similar to medical dosage
Routes Of Administration
can be taken orally, three injection routes, and sniffed
possibly smoked
Short Term Use
~~~~~~~~~~~~~~
CNS, Behavioral, Subjective:
poor opioid, very little euphoria, mainly just sedates and clouds mind, little recreational use
Respiratory:
less depression than morphine
Gastrointestinal:
very little constipation or nausea, vomiting occurs
Other:
as a opioid agonist/antagonist has potential to cause psychotic effects such as hallucinations, severe confusion
Duration
3 - 4 hours
Dependency Potential
moderate potential, similar to hydrocodone
Opioid Dependence And Withdrawal
Opioids have specific withdrawal and dependence characteristics common to all opioids, varying according to the specific drug. All opioids cause both physical and psychological dependence with prolonged use. Depending on the opioid in question withdrawal can become evident after continued use in as little time as 2 weeks or as long as 2 months.
Withdrawal is commonly overstated by media and tends to be similar to bad case of flu. This is due to the fact that most opioid users don't tend to be able to acquire enough drug to result in severe withdrawal. It must be noted that physical symptoms may be similar to flu, psychological symptoms can be quite painful. Depression, mood swings, hypersensitivity to pain are some common symptoms. Opioid withdrawal DOES NOT endanger life as does alcohol and other depressant withdrawal.