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From: Mdh@debug.cuc.ab.ca Newsgroups: alt.drugs Subject: OPIOID FAQ (1st draft) Message-ID: <m0pQRDA-000BS4C@debug.cuc.ab.ca> 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 appriciated. 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 <mdh@debug.cuc.ab.ca> 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 (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 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