According to the World Health Organization and others, codeine is the most widely used opiate in the world. It is one of the most effective orally-administered opioid analgesics. It is about one-fifth the strength of morphine. It is commonly mixed with other analgesics such as aspirin or acetaminophen, and in this combination it is listed as a Schedule III or V drug in the United States.
In the United States codeine is listed as a Schedule II controlled substance for products containing codeine alone or in a dose higher than 90 mg.
Beyond its analgesic effects, codeine's effects include euphoria, itching, nausea, vomiting, drowsiness, dry mouth, depression and constipation. Some people may also be allergic to codeine, with skin swelling and rashes.
Another side effect of codeine abuse is lack of sexual drive and increased complications with erectile dysfunction.
Tolerance to codeine develops with prolonged use, and this tolerance includes its therapeutic effects. A potentially serious adverse drug reaction is respiratory depression and the potential for a fatal overdose.
Codeine is metabolized into morphine, and morphine can be passed through breast milk in potentially lethal amounts, fatally depressing the respiration of a breast fed baby.
Codeine is often used as a recreational drug, and has similar potential for abuse with other opiates such as oxycodone or hydrocodone. In some countries cough syrups and tablets containing codeine are easily available without prescription.
Codeine is also available in a syrup with the anti-nausea medication promethazine (brand name Phenergan with Codeine). This medication is quickly becoming one of the most highly abused codeine preparations.
As with other opiate pain killers, chronic use of codeine can lead to physical dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops the medication. Withdrawal symptoms include: drug craving, runny nose, yawning, sweating, insomnia, weakness, stomach cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability, and pain.
Heroin addicts will take codeine to minimize the effects of heroin withdrawal, which will create additional withdrawal symptoms when codeine is no longer used.
To minimize withdrawal symptoms, long-term users should gradually reduce their codeine use through medical detox under the supervision of a doctor or addiction professional.
Opium is a dried liquid obtained from opium poppies which contains up to 12% morphine. Morphine is the alkaloid that is used to produce heroin for the illegal drug trade.
Being of similar structure, the opiate molecules occupy many of the same nerve-receptor sites and bring on the same analgesic effect as the body's natural painkillers.
Opiates first produce a feeling of pleasure and euphoria, but with their continued use the body demands larger amounts to reach the same sense of well-being. Malnutrition, respiratory complications, and low blood pressure are some of the illnesses associated with long-term use. Morphine is also responsible for harmful effects such as lung edema, respiratory difficulties, and even cardiac or respiratory collapse.
Long-term use of morphine in chronic pain management can lead to physical dependence. Chronic pain patients will find that, at an appropriate dose of medication, tolerance to the euphoric effects develops while pain is successfully controlled for years at the same dose. A drug abuser posing as a pain patient will quickly develop tolerance to the euphoric side-effects of the opiate he is prescribed for pain. As a result, such patients will demand an increase in their dose more often.
Opium, like almost all illicit substances, causes withdrawal symptoms when use is stopped or temporarily interrupted. The desire to avoid the sometimes intolerable feelings of withdrawal keeps many opium users using despite the negative consequences.
Opium withdrawal symptoms include: nausea, sweating, diarrhea, mood swings, insomnia, depression and muscle twitching.
Pharmacologically based treatments are available, including naltrexone, methadone or ibogaine. However, it should be emphasized that these treatments are for those suffering from true opioid addiction, and not from physical dependence resulting from the appropriate use of opioids for chronic pain.
In the event that a patient with chronic pain no longer suffers from the same degree of pain, it is not difficult for the patient and treating physician to gradually taper down the prescribed opioids until the patient has entirely discontinued opioids use. Of course this is only possible if the patient's underlying pain has been mitigated, successfully treated, or otherwise been resolved.
Morphine is an extremely potent opiate analgesic drug. In clinical medicine, morphine is regarded as the benchmark for analgesics used to relieve pain due to its effectiveness. Like other opioids OxyContin, Percocet, Percodan,Dilaudid, and diamorphine (heroin), morphine acts directly on the central nervous system to relieve pain.
Morphine has a high potential for addiction because tolerance and dependence develop very rapidly.
Morphine was the most commonly abused analgesic in the world until diamorphine (heroin) was synthesized. Morphine became a controlled substance in the U.S. in 1914. Possession without a subscription is a criminal offense.
The common effects of morphine euphoria, heightened ambition, nervousness, relaxation, and drowsiness. when taken in large doses a very serious narcotic habit can develop in a matter of weeks.
The withdrawal symptoms of morphine are usually experienced within 6 to 12 hours of the last administration. Symptoms include watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, sweating and in most cases a strong drug craving. As withdrawal progresses, severe headache, restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea, and uncontrollable tremors may occur. Craving for the drug continues to increase, and severe depression and vomiting are very common.
If withdrawal becomes acute, heart rate and blood pressure increase significantly, leading to possible heart attack or stroke.
Chills or cold flashes with goose bumps ("cold turkey") alternating with flushing (hot flashes), kicking movements of the legs ("kicking the habit") and excessive sweating are also characteristic symptoms. Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms.
Major withdrawal symptoms peak between 48 and 96 hours after the last dose and subside after about 8 to 12 days. Psychological withdrawal from morphine, however, is a very long and painful process. Addicts often suffer severe depression, anxiety, insomnia, mood swings, amnesia, low self-esteem, confusion, paranoia, and other psychological disorders.
Without treatment, the psychological dependence on morphine can last a lifetime. There is a good chance that relapse will occur unless a change occurs in both the physical environment and behavioral motivators that contributed to the abuse. Abusers of morphine (and heroin), have one of the highest relapse rates among all drug users.
In addition, opiate addicts show increased risk of infection such as increased pneumonia, tuberculosis and HIV. This has led scientists to believe that morphine may also affect the immune system, further indicating a need for medically supervised detoxification.
Self detoxification from morphine is rarely successful and can be dangerous. Morphine addiction withdrawal can cause physical and emotional trauma. Methadone or other illicit drugs are often used to ease the distress of morphine withdrawal, creating a potential for further abuse.
The most successful detoxification and withdrawal scenario involves an inpatient setting removed from the normal stresses of living and the routines of the patient's morphine addiction. Medically supervised detoxification, followed by social therapy and psychotherapy, offers the best chance for a full recovery.
Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from two naturally occurring opiates, codeine and thebaine. It is an oral narcotic pain reliever and cough suppressant, commonly available in tablet, capsule, and syrup form. It is often compounded with other analgesics like paracetamol or ibuprofen.
Hydrocodone is one of the most addictive pharmaceutical drugs in common use today.
Hydrocodone and related compounds are marketed under a variety of names including Vicodin, Hydrococet, Symtan, Anexsia, Dicodid, Hycodan (or generically Hydromet), Hycomine, Hycet, Lorcet, Lortab, Norco, Novahistex, Hydrovo, Duodin, Kolikodol, Orthoxycol, Mercodinone, Synkonin, Norgan, and Hydrokon.
Hydrocodone is most commonly used as an intermediate analgesic and strong cough suppressant, especially in those for whom excessive itching from codeine is a problem.
Mixing Hydrocodone with alcohol, cocaine, amphetamines, methylphenidate, benzodiazapines, barbiturates, or other medications can have severe adverse reactions including heart failure, heart attack, respiratory distress, pulmonary failure, liver or kidney failure, jaundice, amnesia, seizures, blackouts, and coma.
Common side effects include dizziness, lightheadedness, nausea, sweating, drowsiness, constipation, vomiting, and euphoria. Vomiting in some patients is so severe that hospitalization is required. Some less common side effects are allergic reaction, blood disorders, changes in mood, itching, racing heartbeat, mental fogginess, anxiety, lethargy, difficulty urinating, irregular or depressed respiration, and rash.
Hydrocodone has been shown to cause long term hearing loss over extended periods of use.
Due to its opiate-related side effects such as euphoria, sedation and somnolence, Hydrocodone is now one of the most common recreational prescription drugs in America. Recreational Hydrocodone use is particularly prevalent among teenagers and young adults because of the drug's widespread availability.
Like other opioids, long-term use of Hydrocodone may cause physical dependency leading to a severe withdrawal syndrome when the dose is lowered or discontinued.
The presence of acetaminophen in Hydrocodone-containing products should, in theory, deters users from taking excessive amounts. Many drug abusers ignore this danger, or try to get around the problem by using cold water extraction to remove most of this water-soluble element of the drug.
It is common for Hydrocodone abusers to have liver problems from consuming excessive amounts of the acetaminophen that is mixed with the drug.
If a regular hydrocodone user stops taking hydrocodone, he or she will experience withdrawal symptoms within six to twelve hours. Withdrawal effects include severe pain, pins and needles sensation throughout body, sweating, extreme anxiety and restlessness, sneezing, watery eyes, fever, depression, and extreme drug cravings.
Withdrawal from Hydrocodone is usually not life-threatening, but medically supervised detoxification (detox) is recommended.
The intensity of withdrawal symptoms from Hydrocodone depend on the degree of the addiction. Symptoms may grow stronger for twenty-four to seventy-two hours and then gradually decline over a period of seven to fourteen days. The duration of withdrawal symptoms from Hydrocodone varies greatly from person to person.
Symptoms of Hydrocodone withdrawal can be successfully managed with medically supervised detox. Hydrocodone detox normally takes about seven days and is usually followed by psychosocial treatment in a residential treatment center to address issues of psychological dependence and social readjustment.
Heroin (diamorphine) is a semi-synthetic opoid drug synthesized from morphine, a derivative of the opium poppy.
Heroin is typically a white crystalline powder, although it is commonly adulterated with various additives and may appear off-white or even brown. Heroin is used as both a pain-killer and a recreational drug. It is listed as a controlled substance under Schedules I and IV of the Single Convention on Narcotic Drugs. Under the name diamorphine, it is a legally prescribed controlled drug in the United States.
The most common methods of illicit heroin use is intravenous injection, called "slamming" or "shooting up." Recreational users may also take the drug via snorting or smoking by inhaling its vapors when heated.
The withdrawal syndrome from heroin may begin within 6 to 24 hours of discontinuation of the drug. This time can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. symptoms of withdrawal includes sweating, malaise, anxiety, depression, excessive yawning or sneezing, tears, insomnia, cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps and fever.
Heroin addiction withdrawal can last several weeks to several months. Attempting heroin withdrawal or detoxification without professional assistance is not only dangerous, it is potentially lethal.
Heroin addiction withdrawal can cause serious physical and emotional trauma including stroke, heart attack and even death. Methadone is often used to ease heroin withdrawal, though this typically ends with the individual acquiring an addiction to another drug.
Recovery from heroin addiction involves detoxification as the initial step. Secondly, the individual needs to be willing to participate in a rehabilitation program. The highest documented success rates for heroin addiction recovery are through long-term drug rehabilitation treatment lasting at least 3 to 6 months.
Fentanyl is a potent opiod narcotic analgesic known for its rapid onset and short duration. It is commonly used to treat chronic "breakthrough" pain of high intensity, and in surgical procedures.
Fentanyl is approximately 100 times more potent than morphine.
Intravenous Fentanyl is extensively used for anesthesia and analgesia, most often in operating rooms and intensive care units. It is often administered in combination with a benzodiazepine to produce procedural sedation for endoscopy, cardiac catheterization, oral surgery, etc. Fentanyl is also often used in cancer therapy and with other chronic pain conditions due to its effectiveness in relieving pain.
There is no known opiod better than Fentanyl in reducing cancer pain, which makes it the first choice for use in cancer patients.
Fentanyl's major side effects include diarrhea, nausea, constipation, dry mouth, somnolence, confusion, weakness, and sweating. Less frequent side effects include abdominal pain, headache, fatigue, anorexia, weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia indigestion, shortness of breath, and urinary retention.
United States authorities classify Fentanyl as a narcotic.
Illicit use of pharmaceutical Fentanyl began in the mid-1970s and continues today. Over 12 different variations of Fentanyl produced clandestinely have been identified in the illegal U.S. drug traffic market.
The biological effects of Fentanyl is similar to that of heroin, with the exception that many users report noticeably less euphoric effects and stronger sedative and effects. Because the effects of Fentanyl last for a short time, it is considered by users to be more addictive than heroin. In addition, Fentanyl can be hundreds of times more potent than street heroin.
Fentanyl tends to produce significant respiratory depression, making it more dangerous than heroin to users.
Fentanyl is most commonly taken orally, but like heroin it can also be smoked, snorted or injected. Fentanyl is sometimes sold as heroin, often leading to accidental overdoses. Fentanyl is normally sold on the black market in the form of transdermal Fentanyl patches diverted from legitimate medical supplies. The patches may be cut up and eaten, or the gel from inside the patch smoked.
Use of Fentanyl by individuals who have not developed opiate tolerance can be very dangerous and has resulted in numerous deaths.
Even those with high opiate tolerance are at risk for overdose. Once the Fentanyl is in the user's system it is extremely difficult to stop its course because of the nature of absorption. Synthesized Fentanyl powder has also appeared in the illegal US drug market, and because of its extremely high strength it is very difficult to dilute appropriately. Often the resulting mixture may be unexpectedly strong and consequently very dangerous.
Some heroin dealers mix Fentanyl powder with heroin in order to increase potency or compensate for low-quality heroin.
In recent years illegally manufactured Fentanyl, often mixed with cocaine or heroin, caused an outbreak of overdose deaths in the United States. As a result of this reputation, this potentially lethal mixture of Fentanyl and heroin is known as "the bomb" on the street.
Dilaudid (hydromorphone) is a potent analgesic drug of the opioid class. It is a semi-synthetic derivative of morphine. It is both medically an opioid analgesic and legally a narcotic. Dilaudid inhibits ascending pain pathways in Central Nervous System. It also increases the pain threshold and alters pain perception.
Like all opioids, Dilaudid is highly addictive and is listed as a Schedule II drug in the United States.
Hydromorphone is prescribed medically as an alternative to morphine for analgesia, and as a second- or third-line narcotic antitussive (cough suppressant) for severe cases. It is generally considered the strongest of the antitussive drugs.
Dilaudid was developed when heroin was removed from clinical use in most of the world and banned outright in many countries.
Dilaudid is often called "drug store heroin" on the streets. While Dilaudid use may sometimes be prescribed for a legitimate ailment, it is more often purchased illegally in its prescription form. Because of its similarity to street heroin and other powerful opiates, short term abuse can lead to complete dependence in just a few days of continuous use.
Dilaudid abusers often turn to street drugs such as heroin when their preferred drug is no longer available.
Adverse effects of Dilaudid are similar to those of other opioid analgesics, such as morphine. Major hazards include respiratory depression and circulatory depression. Some more common side effects include light-headedness, dizziness, sedation, constipation, nausea, vomiting, and sweating.
Overdoses are rare in tolerant individuals, but when they do occur they can lead to complete circulatory system collapse. The effects of overdose are increased if the medication is taken with alcohol or benzodiazepines.
The euphoria produced by Dilaudid that is associated with relief from pain can lead to addictive reward-seeking behavior.
Withdrawal from Dilaudid is brief but intense. The symptoms are similar to morphine and heroin withdrawal, but they are compressed into a spike which will peak in 14 to 21 hours and resolve in 36 to 72 hours.
Withdrawal symptoms from Dilaudid can occur four to five hours after the last dose and usually last 7 to 10 days.
To avoid severe withdrawal, Dilaudid abusers should taper down slowly under a knowledgeable physician’s care, or participate in a medically supervised detoxification. In cases of long term use, an in patient detox in a hospital or medical supervised setting is highly recommended.