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Frequently Asked Questions About the Opioids

Editor Mike Hamilton
Last 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@debug.cuc.ab.ca

Contents


Glossary on terms used in FAQ

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. 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.