All opioids carry risks of dependence and overdose

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What are opioids?

Opioids are a family of drugs that have a ‘depressant’ effect, meaning that they slow down your central nervous system, which can affect your breathing. When taking opioids, most people feel sleepy and relaxed, and they often also feel really good.

Opioids are mainly available as medications. As there is a risk of dependency, overdose and other harms when using opioids, access to these drugs is tightly controlled in most places. Generally, you will need a prescription from a doctor to obtain opioids, though in some places, people can access weaker opioids without a prescription.

Medications that contain opioids are sometimes ‘diverted’, which means that they are given away or sold to people who haven’t been prescribed them. For example, oxycodone is a strong opioid that’s often used to treat pain – it’s sold under brand names like ‘OxyContin®’, ‘Endone®’ and ‘Percocet®’. But when it’s diverted for non-medical use, it may be known by a street name instead. The street names used for different drugs will depend on where you live.

In most countries, having opioid medications that weren’t prescribed for you is illegal.

Other types of opioid are made and sold illegally. For example, opioids like heroin and fentanyl are available as medications but they are also made illegally and sold for non-medical use.

All opioids, no matter how they are made or obtained, carry risks of dependence and overdose.

The following are common types of opioids. A few brand names are also listed, though these will vary based on where you live:

  • Buprenorphine (Buprenex, Suboxone, Cizdol, Probuphine)
  • Codeine (Empacod, Mersyndol, Pinex, Tylenol)
  • Fentanyl (Actiq, Duragesic, Fentora, Lazanda)
  • Heroin
  • Hydromorphone (Dilaudid, Dicodid, Hydromorph, Palladone, Laudicon, Lorcet, Sophidone).
  • Methadone (Amidone, Biodone, Dolophine, Metadon, Physeptone, Symoron)
  • Morphine (Dolcontin, Duramorph, Infumorph, Maracex, Otamorph, Statex)
  • Opium
  • Oxycodone (Endocet, OxyContin, OxyNorm, Percodan, Percocet, Roxipirin, Tylox).
  • Pethidine (Aldolan, AstraZeneca, Clopedin, Cluyer, Demerol, Meperidine)
  • Tapentadol (Nucynta, Palexia, Yantil, Tapenta, Tapal).
  • Tramadol (Conzip, Invodol, Larapram, Maxitram, Ryzolt, Tilodol, Tramulief, Zytram).

Opioid medications are sold under different brand names. You can find out if your medicine contains opioids by asking your doctor, asking the pharmacist or checking the ingredients on the packet.

Opioids can come in different forms, including:

  • Tablets
  • Capsules
  • Suppositories (inserted into the rectum)
  • Soluble tablets and films
  • Powders
  • Syrups
  • Cough medicines
  • Liquids for injection
  • Skin patches

Opioid medications come in different doses or strengths and your doctor will tell you how often you should take your medicine. It is important that you follow your doctor’s directions when you take opioid medications.

Opioids that are made illegally can have varying and unpredictable strengths. If you are using an illegal opioid, it’s always advisable to use a small amount first to test its strength.

Opioids work mainly by ‘binding’ or sticking to ‘receptors’ in our central nervous system (brain and spine). When we take opioids, messages that travel between our brain and the rest of our body are slowed down.

At the same time, our brain releases dopamine. This is why, when we take opioids, we have strong feelings of relaxation and generally feel really good. Any pain that we may have had gets better or goes away.

Opioids don’t just slow down pain messages. They also slow down other messages like those telling our body to keep breathing.

This is why opioids can be very dangerous. If a person takes too much of an opioid or takes it with another ‘depressant’ like alcohol, or with sedatives like benzodiazepines, their breathing can become dangerously slow or stop altogether.

Some people may become dependent on opioids. Dependence happens when a person’s body adjusts to functioning with opioids in it and finds it hard to work properly without them. For some people, becoming physically dependent on opioids can take just a few days. It will depend on their history, the type of opioid and the dose they take.

Some people use opioids recreationally, meaning that they take opioids to feel relaxed or to experience pleasure, even without any medical need for them. Recreational use may involve opioid medications or illegal opioids like heroin.

Medications that contain opioids are usually prescribed to treat moderate to severe pain. They work best treating short-term (‘acute’) pain. Opioids are also prescribed to treat long-term (‘chronic’) pain, although it’s not clear that they work well for this type of problem.

Opioids are also used to reduce pain and suffering for people who are nearing death.

In some countries, the opioid codeine is used in cough medicines.

The way in which an opioid is taken depends on what it’s being used for.

In medical settings, opioids may be given to people by mouth, through injections and in various other ways.

Opioid medications for use at home often come as tablets and are swallowed. However, some opioid medications come as patches that go on the skin, syrups to swallow, or tablets and films that dissolve under the tongue.

Illegal opioids like heroin come in different forms, which determines how they are used. Some types of heroin, like brown or ‘tar’ heroin, need to be smoked or dissolved and injected. White heroin, which comes as a fine powder, can be injected or smoked but can also be snorted (inhaled through the nose).

The main things opioids do is reduce pain and produce a pleasant, relaxed feeling – even euphoria. But there may be other effects, including:

  • sedation and sleepiness
  • dizziness
  • dry mouth
  • nausea
  • vomiting
  • constipation
  • slowed breathing and heartbeat

Using opioids for a long time can lead to more unpleasant side effects, like:

  • hormone problems (including testosterone)
  • sleep problems (including sleep apnoea)
  • increased sensitivity to pain (‘opioid-induced hyperalgesia’)
  • problems with the immune system
  • ongoing constipation
  • tolerance (needing a higher dose for the same effect)
  • changes in mood

Opioids can:

  • depress a person’s respiratory system (slow down their breathing)
  • lead to dependence
  • lead to withdrawal symptoms when someone who has an opioid dependence stops taking them suddenly. Withdrawal is characterised by symptoms like body aches, sweating, shaking, lethargy and vomiting

Using opioids carries the risk of developing dependence and Opioid Use Disorder. This section defines a few key terms that are important for understanding how opioids affect our bodies, and how dependence develops.

Tolerance occurs when a person uses an opioid again and again. Over time, their body adjusts and the person needs a higher dose of the opioid for it to have the same effect.

Tolerance can lead to people taking increasing amounts of medication to achieve the same effect, which may increase their risk of overdose.

Dependence can happen when a person uses an opioid again and again over longer periods of time and their body gets used to the opioid so that it needs the drug to work normally.

Withdrawal occurs when someone who has a physical dependence on opioids stops taking them or suddenly decreases the amount they’re taking. Their body has become accustomed to functioning with opioids and struggles to work properly without them. Withdrawal often involves unpleasant flu-like symptoms such as nausea, dizziness, vomiting, shaking and body aches.

Opioid Use Disorder or OUD is a medical condition that is diagnosed by a doctor. It is often diagnosed when a person’s opioid use is causing harms or having a negative impact on important areas of their life (work, friends, family etc.).

While OUD can only be diagnosed by a doctor, friends and family members may recognise changes in behaviour or mood as signs that a person is suffering harm because of their opioid use.