Opioids
DESCRIPTION
Opioids are a class of medication that takes its name from the opium poppy, where opioids originally come from. One of the main functions of opioids is to relieve pain and they have been the mainstay of analgesia for thousands of years. An opioid is a synthetic chemical that works by binding to the opioid receptors in the central nervous system (brain and spinal cord). Our bodies produce their own natural opioids, called endorphins. Opioids reduce the nerve transmission to the brain and reduce feelings of pain and affect those brain areas controlling emotion. They are used to treat moderate to severe pain.
Know Your Body & Mind — ‘Set’
Know Your Environment — ‘Setting’
Know Your Drug — Practice Harm Reduction
ADMINISTRATION
Most commonly swallowed but can also be shelved (rectal), snorted or injected (IV or IM liquids).
DURATION OF EFFECTS
Duration and Half Life is dependent on the type of opioid and differentiate between onset, peak and total durations. Research the specific pharmaceutical you are taking.
*Opioids vary in the duration of their effects. 15 minutes – 36 hours, e.g. pethidine is much shorter acting than oxycodone. Fentanyl can last for up to 72 hours.
Even though the apparent effects of the drug may have worn off, Opioids can stay active for a long period of time (up to a couple of days) dependent on what type. Do your research.
DRUG TESTS
Roadside Police: Roadside saliva tests do not look for opioids but other substances can be detected that might have been cut into opioids. It is illegal to drive under the influence of any illicit drugs, including opioids and any driver may be subject to a roadside behavioural impairment test. Wait at least 24 hours before driving.
Workplace: OHS law gives employers rights to test employees for drug use. This should be contained in workplace policy, it should be reasonable, and a risk assessment should be done to determine whether testing of employees is appropriate. Be mindful of issues around opioid substitute treatment (OST) medications and the workplace.
Urine: Up to 3 days Hair: Up to 90 days Blood: Up to 3 days Saliva: Up to 3 days.
EFFECTS
Effects vary from person to person. Check out our table below that has listed the potential physical, psychological and emotional effects.
There are multiple forms of opioids used to treat pain. These include:
Codeine – ie. Panadeine, Nurofen Plus, Mersyndol, Dolased, Panafen Plus
Dihydrocodeine- ie. Paramol
Tramadol
Oxycodone- ie. Endone, Percocet
Morphine sulfate- ie. MS Contin
Methadone- ie.Biodone, Physeptone
Buprenorphine- ie. Suboxone, Subutex
Hydromorphone- ie. Dilaudid
Fentanyl- ie. Durogesic (transdermal patches), Actiq (lozenges/lollipops), Sublimaze (intravenous injection).
SAFER DOSING
Taking drugs is never without risk. In an unregulated market it’s impossible to know the purity or dose of any drug. ‘Dose’ depends on the form a drug is in (liquid, powder, pill, crystal) and how you have it (snort, eat, inject).
- Opioid doses differ between types. You can find a lot of useful information online around doses for different types of Opioids. (see > http://drugs.tripsit.me/)
- A single pill generally contains a dose within the effective therapeutic range.
- If unsure what the strength of the tablet is, or to test for possible hypersensitivity to opioids, it is safer to take a small test dose, half a pill or smaller to test the effects.
- ‘Maximum safe dose’ is person-specific and dependent on current opioid exposure, as well as on whether the person takes opioids regularly and has a tolerance or is dependent on them.
DRUG CHECKING
Lab-quality testing has been trialled in Australia and is not available as a health service yet but DIY reagents like produce a reaction with opioids. See photos of testing results here > verbinding.110110
The pharmaceutical market is regulated and because of this the pills are made to a very high standard.
When sourcing from a dealer you could encounter counterfeit pills that contain unknown substances at unknown doses with unknown side effects. Counterfeit pills are very common. Approach any opioid sourced from a dealer with caution.
Physical effects
COMMON
- Slowed breathing
- Decreased heart rate
- Decreased blood pressure
- Warm sensations in extremities
- Lethargy
- Drowsiness
& Sedation - Constipation
- Decreased saliva production resulting in oral health issues
(long term use) - Itchiness
LESS COMMON
- Irregular menstruation
- Hypoxia (oxygen deprivation)
- Unconsciousness
- Nausea/Vomiting
- Respiratory depression/ failure
- Muscle spasms
- DEATH
RARE
- Risk of Coma
- Brain damage due to respiratory depression
- Bluish fingers, toes, lips
Emotional effects
COMMON
- Euphoria
- Feeling of wellbeing
- Contentment
- Relief of anxiety
LESS COMMON
- Moodiness
- Depression
Psychological effects
COMMON
- Decreased Sexual Desire
- Confusion
- Pain Relief
LESS COMMON
- Paranoia
- Sensitivity to light
- Constant stress or anxiety about getting the next hit to avoid feeling sick
RARE
- Insomnia
SAFER USING
- Use around friends/people you trust and in a safe environment – somewhere you feel comfortable
- Wait at least 30mins after eating before taking.
- Carry naloxone. Depending on your state you can either buy naloxone over the counter in a pharmacy with/without a prescription. QuIHN’s NSP service also do free naloxone training and then you receive a free take home one with you.
SWALLOWING
- Use as per recommended on packaging if available.
SNORTING
- Crush the pill into a fine powder.
- Snort small amounts of water before and after to avoid damaging the protective lining in your nose
- Use your own clean straw/spoon for snorting to prevent the risk of infection or blood borne virus transmission ‘BBV’ (e.g. hepatitis C, HIV) via microscopic amounts of blood
- Do not use money – it is covered in bacteria.
- Repeated snorting can damage the membranes of the nose leading to blood noses and possible permanent damage to the septum. Switch nostrils regularly and give your nose a break
INJECTING
- Many opioids are now tamper proof and do not mix up well. This can result in dangerous outcomes if injecting. Many also now contain naloxone and people need to be mindful of this to avoid withdrawal effects.
- Avoid Blood Borne Viruses by using new & sterile syringes & equipment.
- Use sterile water to mix up.
- Wash your hands thoroughly before and after, you can also use an alcohol swab to clean your fingertips.
- Alcohol wipes can reduce the risk of skin infections if they are used correctly. For maximum effect, swab once, in one direction on the injection site, and leave to dry naturally.
- Dispose of syringes & equipment responsibly in a yellow disposal bin, all NSPs have bins available.
LONG TERM EFFECTS
Physical dependence. Withdrawal symptoms can begin within hours of last use. This includes:
- sneezing
- excessive yawning
- coughing
- sweating
- chills
- restless legs
- irritability
- moodiness
- insomnia
- severe muscle & bone pain
- diarrhea
- increased urinating
- dehydration
- anxiety
- nausea
- vomiting
- cramps
- involuntary spasms
- sensitive genitals (females)
SAFER HANDLING
Carrying opioids without a prescription and paraphernalia (e.g. injecting/snorting/plugging equipment) puts you at risk of criminal charges including trafficking, even if you don’t deal. Know your local laws e.g. the Drugs Misuse Act 1986 (Qld), the Drugs Poisons and Controlled Substance Act 1981 (Vic).
Drug combinations
Possible outcomes. What works for one person may not work for another. We recommend you proceed with caution.
Unsafe combinations
- Alcohol: Can cause nausea and vomiting at low doses and higher doses can cause respiratory/breathing failure.
- Other depressants e.g. other opioids, GHB, Heroin & benzodiazepine i.e.valium: The central nervous system and/or respiratory-depressant effects may be additively or synergistically present. The substances potentiate each other strongly and unpredictably, very rapidly leading to unconsciousness. While unconscious, vomit aspiration is a risk if not placed in the recovery position. Blackouts and memory loss likely.
- Ketamine, DXM, MXE, Nitrous Oxide: Can cause respiratory/breathing failure.
Cautionary combinations
- Stimulants (Amphetamines and Cocaine): can cause heart strain.
- MAOIs – Monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.
- SSRIs (anti-depressants) – There have been very infrequent reports of a risk of serotonin syndrome with this combination, though this should not be a practical concern.
Low risk effects
- Cannabis: Is low risk and can sometimes have synergy.
- Psychedelics (LSD, Mushrooms, DMT, Mescaline): Low risk with no synergy.
Check out the TripSit drug combinations chart here for info on other combinations.
Call 000 if experiencing adverse effects, feel unwell or concerned in any way
Disclaimer
This educational resource has been developed collaboratively by healthcare workers and people who use drugs for their peers and the wider community. The role of Hi-Ground is to provide practical, evidence-based, unbiased information to assist you to make educated choices and to promote harm reduction, community care, and wellbeing.
In an unregulated market it’s impossible to know the purity or dose of any substance. Taking drugs from an unregulated market carries its own risk, and you can educate yourself and practice harm reduction to reduce this risk.
Knowledge is power.
This resource is produced by DanceWize & Hi-Ground