What Are Opiates?

Opiates are strong narcotic (sleep inducing) painkillers extracted or synthesized from opium. They are available only by prescription and are illegal for non-medical use, since they are highly addictive and may have dangerous side effects.

Opiates belong to a broader group of substances – opioids that can bind to opioid receptors in the body.

Opiate drugs may be natural or semi-synthetic.

NATURAL OPIATES

Natural opiates include opium, morphine and codeine.

Opium

Medical Use of Opium


Tincture of opium (oral liquid containing 1% morphine) is used for:

  • Relieving strong pain
  • Stopping severe diarrhea

Illegal Use of Opium

Opium is a white milky sap obtained from seed pods of the poppy plant. When dried, opium turns into a black hard substance, sold on streets as black powder or chunks (street names: Big O, block, joy plant, skee), intended for smoking or eating. Injecting of opium into a vein can be life dangerous.Opium chunks contain about 10% of morphine; other substances include codeine, thebaine and papaverine, and people abusing it commonly get addicted. Opium is cheaper than morphine or heroine so it is usually abused by poor people.

Morphine

Medical Use of Morphine

In medicine, morphine is used for:

  • Relief of moderate to severe acute pain (after surgery, heart attack) or chronic pain (cancer)
  • suppression of severe, dry cough

Morphine for medical use is usually in the form of capsules, tablets, oral solution or syrup containing morphine sulphate or other salt for oral use, suppositories for anal use, or ampules containing water solution of morphine salt intended for intramuscular or subcutaneus (under skin) injection. Intravenous morphine may be used in severe postoperative pain. Doses range from 10 mg to 200 mg (extended release morphine).

Illicit Use of Morphine

Morphine is illegal for non-medical use, but is sometimes abused by health professionals who have access to the drug.

On the black market, morphine may be sold as a morphine base in the form of brown chunks intended for smoking or eating. A white crystalline powder containing morphine hydrochloride is intended for eating, snorting, or (after dissolving in water) injecting into a muscle, vein or under the skin.

Street names for morphine: M, morph, Miss Emma.

Codeine

Codeine is used to relieve moderate to strong pain and to suppress severe dry cough, but is weaker than morphine and has less side effects. Still, it is highly addictive. Codeine can be extracted from opium, but it is usually synthesized from morphine.

Codeine for medical use is available as tablets, capsules, oral solution, or solution in ampules for intramuscular or under-skin injection. It is not used as an intravenous injection, since it may cause severe facial swelling.

Codeine in brand products is usually combined with other painkillers (2):

  • Tylenol-Codeine = codeine + acetaminophen + caffeine
  • Fiorinal with Codeine = codeine phosphate + aspirin + butalbital + caffeine

SEMI-SYNTHETIC OPIATES

Semi-synthetic opiates are synthesized from morphine, codeine, thebaine or other substances naturally present in opium. They are available as tablets, capsules, oral solutions, syrups or solutions in ampules intended for intramuscular or under-skin injections. They are used to relieve moderate to severe pain and to suppress irresistible dry cough. Except from heroin, they have less side effects than morphine, but they are all habit-forming. They include:

  • Heroin has quicker and stronger effect and is more addictive than morphine. It is illegal and not used for medical purposes in US and most other countries.
  • Hydrocodone in brand products (Anexia, Dolorex Forte, Hycet, Hycodan, Lorcet, Lortab, Norco, Vicodin) is usually combined with paracetamol or other mild painkillers.
  • Hydromorphone (Dilaudid, Hydal, Hydrostat, Hydromorphan, Laudicon, Opidol, Palladone, Sophidone) is usually used as a single drug.
  • Oxycodone alone is used in OxyContin. In Percocet it is combined with acetaminophen, and in Percodan with aspirin.

Opiates Effects

Opiate effects include:

  • Initial euphoria, especially after intravenous injection
  • Feeling of pleasure and relaxation
  • Pain relief
  • Drowsiness

Opiates effects onset and peak:

  • Intravenous injection: onset in 2-5 minutes, peak at 10 minutes
  • Intramuscular injection: onset within 5-10 minutes, peak at 30-45 minutes
  • Snorting: peak at 10-15 minutes
  • Ingesting: peak at 2 hours

Opiates effects duration:

  • Codeine: 3-4 hours
  • Morphine: 4-5 hours

Opiates Side Effects

Short-term side effects of opiates may include (incomplete list) (1):

  • Blurred vision, especially at night
  • Dizziness, fainting
  • Drowsiness
  • Dry mouth
  • Headache
  • Itchy, tingling, sweaty, clammy skin
  • Nausea or vomiting
  • Poor appetite
  • Shortness of breath

Long-term side effects:

  • Addiction
  • Constipation
  • Hearing loss
  • Irregular menstruation
  • Low levels of testosterone resulting in low sex drive, infertility, fatigue, loss of muscle mass

Opiates Overdose Symptoms

Opiates overdose symptoms may include:

  • Bloody urine
  • Constricted, pinpoint sized pupils
  • Drowsiness
  • Euphoria or dysphoria (unpleasant mood)
  • Fever
  • Flushed skin, hives
  • Seizures
  • Slow breathing or stopping breathing
  • Swollen face, lips, tongue or throat
  • Vomiting, which, in combination with suppressed cough reflex, may lead to aspiration pneumonia or suffocation
  • Coma, death

Opiate Tolerance and Dependence

Regular opiate users quickly develop tolerance toward the drug, so higher doses are necessary to achieve the same effect. Doses as high as 4 or 5 grams of morphine a day were reported.

Morphine causes psychological and physical dependence.

Opiate Withdrawal Symptoms

Symptoms appearing after opiates withdrawal resemble flu, may last 3-5 days, and are especially strong when opiates are stopped suddenly:

  • Anxiety and depression
  • Cold sweats
  • Craving for opiates
  • Diarrhea
  • Insomnia
  • Involuntary motions
  • Nausea
  • Tearing, runny nose
  • Yawning

WARNINGS About Opiates

  • Do not drink alcohol with opiates, since this combination may cause severe suppression of breathing, coma or even death.
  • Do not drive under influence of opiates.
  • Heroin is illegal in US (Schedule I drug). All other opiates are legal for medical use only (Schedule II drugs).
  • Opiates are FDA pregnancy category C – they may be harmful for an unborn baby, so they should be avoided in pregnancy.

Related Articles:

References:

  1. Medical reasons (indications) to use morphine, side effects  (mims.com)
  2. Codeine brand names (drugs.com)

Article reviewed by Dr. Greg. Last updated on December 4, 2011