Opiates / Opioids

Opiates/opioids are medications based on opium derived from the poppy plant. Technically, the correct term for naturally occurring compounds such as morphine is opiates and the synthetic compounds are referred to as opioids. The medical community generally refers to all as opiates as opioids in professional discussions.

This class includes:

  • Fentanyl (Duragesic, Actiq, Fentora, etc.)
  • Heroin (at one time a legal prescription drug)
  • Hydrocodone (Vicodin, etc.)
  • Hydromorphone (Dilaudid)
  • Methadone
  • Morphine
  • Oxycodone (OxyContin, Roxicodone, Percocet, etc.)
  • Oxymorphone (Opana and Opana ER)

What They Do

These are powerful pain relieving medications that work in the brain to decrease and block pain signals thus relieving the patient of suffering. When inappropriately prescribed and/or inappropriately taken, these are potentially highly addictive. They can cause euphoria (a powerful sense of well-being which may be accompanied by emotional highs and low) and they kill by causing "respiratory depression." This is when the opioid sedates the person and then decrease the drive to breathe resulting in brain damage and likely death. As the afflicted develops greater tolerance they try to "get the original high" and they overshoot the mark resulting in sedation. An observer may note the afflicted nodding off at inappropriate times or "zoning out" during conversations (the person is awake but frequently not able to follow simple conversations coherently or stares off into space.) Please see below for further symptoms.

Long-Acting Versus Short-Acting Classes

There are two main classes of opioid medications used for pain management, long acting and short acting. The average effective half-life of these medications is on average four to six hours but for chronic pain certain formulations have been made to allow their slow release over anywhere from 8 to 24 hours. These are available in much higher dosages indicted for chronic pain patients that may have developed tolerance.

Examples of the long-acting preparations are: 

  • Exalgo
  • Fentanyl patch (Duragesic)
  • MS-Contin
  • Opana ER
  • OxyContin

Tamper-Resistant Pills

When an addicted person wants to use these to get "high" they compromise the delivery system (e.g. crush to snort, put in solution to inject, etc.). It is for this reason that the manufacturers are now required to make tamper-resistant pills for all new opioid medications to try and decrease and hopefully eliminate their abuse. An example of how much more valuable the immediate release is to the afflicted, OxyContin 80 milligram (mg) street price prior to January, 2010, was from $50 to $80 per tablet. In January, 2010, the pill was reformulated to turn to paste when crushed, foiling attempts to crush and snort or inject. Because of this the street value has dropped to $20 to $30 per pill from $80. Immediate release Roxicodone has supplanted OxyContin as the preferred drug for addicts and a 30 mg pill of Roxicodone goes for the same price as an 80 mg OxyContin.

Signs of Opioid Addiction / Abuse

Some common signs of opioid addiction/abuse may be:

  • Extreme mood changes - happy, sad, excited, anxious, etc.
  • Sleeping a lot more or less than usual, or at different times of day or night
  • Changes in energy - unexpectedly and extremely tired or energetic
  • Weight loss or weight gain
  • Unexpected and persistent coughs or sniffles
  • Seeming unwell at certain times, and better at other times
  • Pupils of the eyes seeming smaller or larger than usual
  • Secretiveness Lying
  • Stealing
  • Financially unpredictable (large amounts of cash at times but broke at other times)
  • Changes in social groups, new and unusual friends, odd cell-phone conversations
  • Repeated unexplained outings, often with a sense of urgency

Paraphernalia

Drug paraphernalia such as unusual pipes, cigarette papers, small weighing scales, etc. "Stashes" of drugs, often in small plastic, paper or foil packages It should be made clear that the above symptoms can be seen with addiction to any substance and often addicts abuse several drugs at the same time as part of a "cocktail."

Opioid Withdrawal Symptoms

Symptoms of opioid withdrawal are similar to the symptoms of severe flu:

  • Aching limbs
  • Anxiety
  • Cold sweats, chills
  • Nausea and vomiting
  • Restlessness
  • Severe depression
  • Unbearable pain
  • Uncontrollable diarrhea