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Harm Reduction TO

Prescription Opioids

Also known As:

M, morph (for morphine); juice and meth (for methadone); percs (for Percodan, Percocet); juice (for Dilaudid)

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What is it?

Opioids are a family of drugs that are usually prescribed to relieve pain, control coughs and diarrhea, and treat addiction to other opioids. Examples include codeine (in Tylenol No. 2, No. 3 and No. 4), oxycodone, morphine, hydromorphone (Dilaudid) and fentanyl. Other medical uses include controlling coughs and diarrhea, and treating addiction to other opioids. Opioids can produce euphoria, making them prone to abuse. Some people use opioids for their ability to produce a mellow, relaxed “high” (CAMH, 2012).

How does it work?

Opioids attach to opioid receptors in the brain, spinal cord, and other areas of the body. They reduce feelings of pain by reducing messages sent to the brain. Opioids are depressants, meaning that they slow down the central nervous system, which slows down breathing.

Prescription opioids are prescribed by licensed medical practitioners to people with acute or chronic pain, and to those with moderate to severe coughs and diarrhea. The opioids methadone and buprenorphine are also prescribed to treat addiction to other opioids (CAMH, 2012).

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What does it look like?

Prescription opioids come in various forms, including as tablets, capsules, syrups, solutions and suppositories. (CAMH, 2012)

Is there a safe dose?

A safe dose of a prescription opioid depends on the drug type and potency, as well as your history of previous use and health status.

If using drugs that have been prescribed to you, follow the advice of a physician or pharmacist when dosing. If you are using a prescription opioid that has not been prescribed to you, take caution, start with a low dose, and follow common guidelines for that particular drug (which can often be found online).

Note that under prohibition, illicit street drugs may look like or be labelled as prescription opioids. You cannot know the potency or quality of illicit drugs, and they may be cut with other dangerous substances such as fentanyl.

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Effects      

Low doses of opioids suppress the sensation of pain and the emotional response to pain. They may also produce euphoria, drowsiness, relaxation, difficulty concentrating, constricted pupils, a slight decrease in respiratory rate, nausea, vomiting, constipation, loss of appetite and sweating. With higher doses, these effects are more intense and may last longer (CAMH, 2012). 

EFFECTS INCLUDE:

  • Pain relief

  • Drowsiness

  • Confusion

  • Euphoria

PHYSICAL EFFECTS INCLUDE:

  • Nausea

  • Slowed Breathing

  • Constipation

Side effects and cautions

OVERDOSE

Prescription opioid overdoses are a leading cause of overdose fatalities. Opioids cause respiratory depression, and if a person consumes too much of an opioid, they can stop breathing, resulting in death. People who use large amounts of prescription opioids may want to get a naloxone kit, and ask that their family members and friends to get naloxone training. Naloxone can temporarily reverse an opioid overdose, allowing a person to breath normally and get medical attention.

Injection-related risks

Some people inject opioids to increase the intensity of the euphoric effect. Sharing needles carries a high risk of infection and disease (e.g., HIV, hepatitis). When pharmaceutical tablets or capsules are dissolved for injection, non-drug substances within these products can damage veins and organs (CAMH, 2012).

Pregnancy

Regularly using large quantities of opioids during pregnancy can increase the risk of premature delivery and infant withdrawal. Pregnant people who are addicted to opioids can be treated with methadone to prevent withdrawal symptoms (CAMH, 2012).

TOLERANCE

People who use opioids regularly for their pleasurable effects soon develop tolerance to opioids, which means they need to use more of the drug to achieve the desired effect. As the amount taken increases, so does the risk of overdose. If people with tolerance stop taking opioids, they lose their tolerance. If they then resume taking the same amount they took before they stopped, the risk of overdose is higher (CAMH, 2012).

ADDICTION

When opioids are used as directed under medical supervision, there is little risk of addiction. However, the risk appears to be higher in people with a history of substance use or addiction (CAMH, 2012).

Anyone who takes opioids regularly will develop physical dependence. Physical dependence is the result of the body adapting to the presence of the drug, and is not the same as addiction. A person who is physically dependent will experience withdrawal symptoms about six to 12 hours after last taking a short-acting opioid, such as hydromorphone, and about one to three days after last taking a long-acting opioid, such as methadone. With short-acting opioids, withdrawal comes on quickly and is intense; with longer-acting opioids, withdrawal comes on more gradually and is less intense (CAMH, 2012).

Symptoms of withdrawal include (CAMH, 2012):

  • Uneasiness

  • Yawning

  • Tears

  • Diarrhea

  • Abdominal cramps

  • Goosebumps

  • Runny nose

  • Craving for the drug

Symptoms usually subside after a week, although some, such as anxiety, insomnia and drug craving, may continue for a long time. Opioid withdrawal is rarely life-threatening (CAMH, 2012).

Therapeutic Uses?

Prescription opioids are regularly used therapeutically to relieve pain, control coughs and diarrhea, and treat addiction to other opioids (CAMH, 2012).

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Harm Reduction Tips

to reduce the possible harms of prescription opIODS, the following is suggested by The Harm reduction coAlition (2019):

  • Do not mix prescription opioids with other drugs. Mixing prescription opioids with other depressants, such as alcohol, benzodiazepines, or street drugs can be dangerous and even fatal

  • Use less, start low, and go slow

  • Don’t use alone. Have a friend with you who knows what drugs you’ve ingested, who may also respond in case of an emergency. If you must use alone, call a friend and ask them to check up on you

  • Carry naloxone. Get a kit and ask your friends and family to get trained in overdose response

Legal Status: Use, Possession, & Distribution

Prescription opioids are legal, and are typically prescribed by a doctor and distributed by pharmacists.

However, the over-prescription of opioids by doctors and pharmacists, brought on by pharmaceutical lobbying practices, has played a large role in Canada’s overdose epidemic. When people are no longer able to get opioids legally, it is common for individuals to turn to the illicit market, where drugs are contaminated with stronger opioids such as fentanyl. We need drug decriminalization and a safe supply of opioids to stop the overdose crisis, and start treating substance use and addiction as a public health issue.

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References

CAMH. (2012). Prescription Opioids. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/prescription-opioids

National Institute on Drug Abuse (NIH). (2018). Prescription Opioids. Retrieved from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids

Harm Reduction Coalition. (2019). Overdose Prevention Tips [PDF file]. Retrieved from https://harmreduction.org/wp-content/uploads/2012/11/HRC_ODprevention_worksheet9.pdf

United States Department of Housing and Urban Development. (2008). Indiana income limits [PDF file]. Retrieved from http://www.huduser.org/Datasets/IL/IL08/in_fy2008.pdf

Image Sources

Banner: Oxycodone pills. (2018). Choices Recovery. Retrieved from https://crehab.org/addiction/dangers-long-term-oxycodone-abuse/