The Truth about Opioids

In 2007, according to the National Survey on Drug Use and Health (NSDUH), 12.5 million persons aged 12 and older in the U.S. used prescription drug medications for a nonmedical purpose. The majority of teens who use Darvon do so in conjunction with alcohol and other drugs, stimulants or other opiates, such as OxyContin. The Federal Drug Administration (FDA) is considering a ban on Darvon in the U.S.

A sign of the magnitude of the opioid problem is that the Internet is now littered with websites promising powerful prescription opioids or painkillers, even citing particular brand names, are available without a doctor’s prescription.

What opioids (prescription painkillers) are

Opioids, or prescription painkillers, are drugs that are prescribed for their analgesic effects, their ability to provide pain-killing relief. Opioids (and some of their associated brand names) include the following substances: oxycodone (OxyContin, Percodan and Percocet), diphenoxylate (Lomotil), hydromorphone (Dilaudid), morphine (Kadian, Avinza and MS Contin), Fentanyl (Duragesic), meperidine (Demerol), hydrocodone (Vicodin, Lortab and Lorcet), propoxyphene (Darvon, Darvocet), methadone, and codeine.

Common street names

Street names for opioids vary according to the drug. Codeine is called T-3s (Tylenol #3 with codeine), schoolboy and cough syrup. Fentanyl carries street names such as China white, drop dead, synthetic heroin and suicide packets. Darvon is called pinks, footballs, yellow footballs, 65’s and N’s. Demerol’s street name is demmies.

Hydromorphone (Dilaudid) has the street name of dillies. OxyContin’s common street names include: OCs, ox, oxy, 40, 80, blue, hillbilly heroin, kicker and oxycotton. Morphine is referred to as: grey ghosts (MS Contin), dreamer, emsel, first line, God’s drug, hows, M.S., Miss Emma, Mister Blue, morf, morpho and unkie. Morphine carries street monikers such as amidine, chocolate chip cookies, dollies, fizzies, and methadose.

How to identify opioids (prescription painkillers)

Opioids come in tablets, capsules and pills, as well as injectable liquids and skin patches. All pills approved by the Federal Drug Administration (FDA) are required to have a unique (to that formulation) shape, color and imprint. What you find on the streets, however, may or may not be recognizable by these attributes.

• Codeine with Tylenol is imprinted with a number on one side and “Tylenol” on the other.

• Darvon 32, a pink capsule containing 32 milligram (mg) of propoxyphene, has “Lilly HO3” and “Darvon” on it. Darvon N 100 is a light yellow pill in an oval shape that says “Lilly Darvon N 100” on one side.

• Demerol, available in 50 or 100 mg tablets is white, round and convex. The 50 mg version is scored. Demerol is also available in banana-flavored syrup.

• Dilaudid comes in tablets and injectable solutions.

• Fentanyl (Duragesic) looks like white powder.

• OxyContin is prescribed in dosages of 10, 20, 40 and 80 mg tablets. On one side, the tablet carries an imprint of the letters “OC” and the other side has the number of milligrams.

• Hydrocodone (Vicodin) is either blue or white, an oval or oblong scored tablet imprinted with “V,” and “35 97,” or various imprints, including: “M367,” “Watson 388,” “M362,” “M365,” “M363,” “M364,” “M366,” and “A345,” and “3594 V.”

• Methadone is prescribed in liquid form, sometimes in tablets or injectable ampules.

• Morphine sulfate in oral tablet form is white, round and scored and bears an imprint of “54 262” (for 15 and 15 mg IR) and “54 233” (for 30 and 30 mg IR).

How opioids are used

Persons who are prescribed opioids take them in an attempt to manage pain. Some medical conditions are unbearable without painkillers, including advanced stages of cancer. They are legitimately used for treatment of acute pain, such as that experienced by patients following surgery.

Opioids are also taken by persons (who have not been prescribed them by their doctor) for the purpose of attaining the “high” or pain-free euphoria the particular drug substance delivers. Opioids are taken in tablet, capsule or pill form, and are also injected into skin, muscle or vein, or swallowed in liquid form. Some users crush the drug and place it into drinks or food. Fentanyl, besides being injected, can also be smoked or snorted. OxyContin users chew or crush the tablets. When crushed, the drug can be snorted or injected after dissolution in water. Methadone is used as a substitute for heroin or other abused drugs.

Effects of opioids

Use of opioids is typically accompanied by one or more of these side effects: slowed breathing, drowsiness, itching, nausea, general depression of the nervous system and problems with urination. Opioids are also known to cause constipation, particularly among patients who are prescribed opioids to alleviate pain.

Why opioids are bad for you

All opioids are powerful drugs that cause severe or fatal results when abused, used in combination with prescription, over-the-counter or street drugs and/or alcohol. Propoxyphenes, for example, should never be used in combination with any sedative (such as Xanax or Valium), or an anti-depressant drug – especially if you are drinking alcohol. Propoxyphenes should also never be taken by an individual who has ever had suicidal thoughts or tried to commit suicide.

Serious side effects of Demerol include convulsions and seizure, slowed heart beat and breathing, confusion, cold and clammy skin, severe weakness or dizziness and fainting or feeling of light-headedness. Dangerous and potentially fatal results can occur if Demerol is taken in conjunction with any other narcotics, pain medications, sedatives, tranquilizers, muscle relaxers or any medication that slows your breathing or makes you sleepy.

Fentanyls have an analgesic potency that is 80 times that of heroin – a truly dangerous opioid when taken illegally or improperly. According to the National Institute on Drug Abuse (NIDA), fentanyl is primarily sold to heroin abusers. Depending on the individual’s weight and tolerance to the drug, even minor errors in cutting or diluting it can result in a fatal overdose.

Injection of opioids can lead to the risk of contracting HIV, hepatitis B and C, and other viruses carried in blood.

Addicting?

Opioids or prescription painkillers when taken for legitimate and medically prescribed short-term pain relief are generally safe and effective, rarely causing addiction. Addiction occurs when an individual uses opioids compulsively and uncontrollably, despite adverse consequences, and/or uses them for long periods.

Opioids used by persons for nonmedical purposes carry a strong potential for abuse and dependence or addiction. Sudden withdrawal from opioids can result in symptoms that range from merely unpleasant to severe or life threatening. Muscle and bone pain, diarrhea, insomnia, restlessness, involuntary leg movements, cold flashes accompanied by goose bumps and vomiting are some of the possible symptoms experienced during withdrawal.

Even a single large dose of an opioid can cause severe depression of the respiratory system ending in death.

Many opioids are classified as Schedule II drugs under the Controlled Substances Act. Schedule II drugs (which also include methamphetamine and cocaine) have a high potential for abuse, and abuse may lead to severe physiological and/or psychological dependence. Methadone, codeine, fentanyl, diphenoxylate, meperidine, hydromorphine, propoxyphene and oxycodone are classified as Schedule II drugs. Morphine is Schedule I. Hyrdocodone (Vicodin, Lortab, Lorcet) is Schedule III, as is codeine combination (Tylenol with codeine).