FAQ-Opioid

From: Mdh@debug.cuc.ab.ca
Newsgroups: alt.drugs
Subject: OPIOID FAQ (1st draft)
Message-ID:
Date: 30 Jan 94 04:33:35 GMT

Ok this is the first draft of the opioid FAQ I put together. It is by no means complete and any contribution would be appreciated. Please send all info to my mail box at mdh@debug.cuc.ab.ca. Most of the information is there and any missing or incorrect info is in the FAQ just let me know.

Here it is....

OPIOID  FREQUENTLY  ASKED  QUESTIONS  FILE

Editor: Mike Hamilton
Last Update: 10 Jan. 94
Newsgroup : alt.drugs

Article Separation
** 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. (Kinda like class inheritance in C++).

A little glossary to start the FAQ:

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 (i.e, 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 the Tylenol 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 : 30mg - 220mg oral or equivalent dose SC or IM

Diarrhea relief : 10mg - 20mg orally

Cough suppressant : 5mg - 15mg orally

Nonmedical
Doses can range from 30mg up to 400mg. LD50 for codeine is 800mg in a average nontolerant person.
At doses of > 250mg 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 30mg 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 5mg - 10mg
for pain relief 10mg - 30mg

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 1mg - 2mg

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. 50mg - 150mg injected or 200mg - 300mg 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 ~2.5mg and the orange and green having twice as much

Controlled Substance Status
Schedule II in US

Dosage

Medical
10 - 20mg oral for pain relief
5 - 15mg 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
50ug - 200ug

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 - 5mg provides same pain relief as 10mg 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 50mg - 150mg 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
50mg - 100mg 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.

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

End of FAQ

---

Written by: Slake.

---

HOME

Opium
Glossary
Opium War
Opium FAQ
Codeine FAQ
Opium Images
Opium Timeline
Meet The Family
Opioid Receptors
Just For Chemists
Offshore Pharmacies
The Afghan Connection
The Pleasure and the Pain
Heroin: A Drug Fit For Heroes?
Google Narcotics Anonymous Directory
Confessions of an English Opium-Eater
Vicodin: 'some of them actually think they deserve it'