Opioids

Types of commonly used opioids

General

Opioids include certain types of pain killers, known as ‘opioid pain medications’ and illegal drugs, such as heroin. Some opioids are plant-based and come from the opium poppy (opiates), while others are synthetic or ‘man-made’.

Opioid-based medications

Common types of opioid-based medications include codeine (Panadeine®, Panadeine Forte® and Nurofen Plus®), fentanyl, morphine, oxycodone (Endone® or OxyContin®), buprenorphine (Subutex® or Suboxone®), methadone and tramadol. They act in the same way as other opioids such as heroin to produce feelings of pain relief.

Opioid-based medications are commonly prescribed by doctors, and up until 2018 some lower strength opioids were available to buy over the counter in Australia. However opioid-based medications are now only available with a prescription.

Many people don’t realise that some medications prescribed for pain relief can cause dependence. If they are overused or combined with other depressant drugs, such as alcohol or benzodiazepines, they may also cause overdose.

Pharmaceutical opioids now account for more drug-related deaths in Australia than any other drug category.³

Heroin

Heroin is the common name for diecetylemorphine or diamorphine. Diamorphine is used in clinical settings and is used in prescription heroin programs internationally. Heroin is an opiate, meaning it comes from the opium poppy.⁴

Opiate substitution treatments

Methadone (Methadone Syrup® and Biodone Forte®) and buprenorphine (Suboxone® or Subutex®) are opioid-based medications used to treat dependence on heroin or other opioids. It’s also known as pharmacotherapy or opiate substitution treatment (OST).

OST is prescribed by a doctor to help people using opioids to reduce or stop their use. They manage cravings and withdrawal symptoms. Methadone is also used in clinical settings following heart attacks, trauma and surgery.

Newer psychoactive opioid substances

Newer psychoactive opioid substances include U-47700, AH-7921, O-desmethyltramadol, MT-45, acetylfentanyl and furanyl-fentanyl. These opioids have a very short history of human use and not much is known about the toxicity and potential for dependence.

It’s highly recommended to be very cautious and use harm reduction practices if using any of these substances.

Naloxone

Naloxone is classified as an opioid as it binds to opioid receptors, but it acts in the opposite way of most opioids. Naloxone blocks other opioids from binding to receptors, and can reverse opioid overdoses within minutes.

It does not have the same effect as other opioids and does not produce feelings of pain relief and pleasure.

Naloxone is only useful to reverse overdoses of other opioids, and will not effect overdoses due to alcohol, benzodiazepines, stimulant or hallucinogenic drugs, or non-opioid based medications.

Effects of opioids

There is no safe level of drug use. 

Use of any drug always carries some risk. It’s important to be careful when taking any type of drug.

Opioids effect everyone differently, based on:

• the person’s size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug.

Effects of opioids include:

• extreme relaxation
• drowsiness and clumsiness
• confusion, slurred speech,
• slow breathing and heartbeat.⁵

If a large dose is consumed, effects may include:

• cold, clammy skin
• slow breathing
• blue lips and fingertips
• falling asleep (‘going on the nod’)
• death by respiratory depression.⁵

Long-term effects include:

• increased tolerance
• constipation
• dependence
• damage to vital organs such as the lungs, brain and heart.⁵

Using opioids with other drugs

The effects of taking opioids with other drugs – including over-the-counter or prescribed medications – can be unpredictable and dangerous, and could cause:
Opioids + alcohol, cannabis or benzodiazepines: slow down breathing and brain activity, and increased risk of overdose.⁶
Opioids + ice, speed or ecstasy: enormous strain on the heart and kidneys, and increased risk of overdose.⁷

Reducing harm

Use of opioids is likely to be more dangerous when:

• combined with alcohol or other drugs, in particular benzodiazepines or other opioids, as these can slow breathing and increase the risk of overdose⁶
• driving or operating machinery, as a person’s ability to judge distance and space is extremely limited
• a person is alone (in case medical assistance is required). It’s recommended that an unaffected person is present incase assistance is required
• injecting equipment is not sterile.

If you or someone you know is using opioids, it would be a good idea to talk with your doctor about accessing naloxone, the drug that reverses opioid overdoses. Your friends or family members can be trained in overdose reversal in case of an emergency.

More information at Harm Reduction Victoria.

Pain management plans

If you’re prescribed opioid-based medications, ask your doctor about a ‘pain management plan’, and other non-medicine (such as physical therapy) and non-opioid strategies (such as paracetamol) you can use to complement your treatment and reduce your reliance on opioid-based medications.

Tolerance and dependence

There’s evidence that after using them for a long time, many drugs can cause dependence. People who use opioids regularly can develop dependence and tolerance to it. This means they need to take larger amounts of the drug to get the same effect.

Dependence on a drug can be psychological, physical, or both. People who are dependent on a drug find that using it becomes far more important than other activities in their life. They crave the drug and find it very difficult to stop using it.

People who are psychologically dependent on a drug may feel the urge to use it when they are in specific surroundings, such as socialising with friends.

Physical dependence occurs when a person’s body adapts to a drug and gets used to functioning with the drug present.

Getting help

If your use of opioids is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about a loved one, you can find help and support.

Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs

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If you're looking for other information or support options, send us an email at druginfo@adf.org.au