What is it?
Opioids are psychoactive (mind-altering) drugs that can alter your perceptions of pain and slow down your breathing, heart rate, thoughts and actions. They are called opioids because they either are derived from the opium poppy or produced from chemicals to provide or intensify the effects of natural opium. Morphine derivatives such as heroin are made from the chemical processing of morphine. Other opioids are man-made (produced synthetically) in laboratories.
There are many different opioids, including morphine, heroin, fentanyl and codeine (e.g., Tylenol #3). They can be manufactured in regulated labs and used for medical treatment in and outside of hospitals, for example prescription drugs like oxycodone (e.g., Percocet) and fentanyl. Most opioids are given out only by prescription because they are considered ‘controlled’ drugs. They may come as tablets, capsules, liquids, suppositories, skin patches or as clear fluid that can be injected into a vein.
Opioids can also be made in illicit labs by people with varying degrees of competence. Opioids made in illicit labs, even those that look like pills available from pharmacies, are often impure and vary in strength. This means opioids purchased illegally can be very dangerous.
The purest form of heroin (also known as diacetylmorphine) is a fine, white, bitter-tasting powder. On the street, heroin is often mixed or “cut” with other substances to increase its weight and effects. Street heroin is often brown and lumpy. Sometimes it looks like dark, sticky gum.
Fentanyl is an opioid which is about 100 times stronger than morphine. It has become a leading cause of opioid overdose in recent years. It is available by prescription as a skin patch, but most fentanyl available on the street in Canada is produced illicitly, and appears as a fine, white, bitter-tasting powder in pure form, but is sometimes sold compressed into tablets, or as skin patches stolen from, or sold by the person for whom the medication was originally prescribed. Sometimes fentanyl is mixed with or “cut” with other substances, and sold as heroin or cocaine. Users may ingest fentanyl without realizing it, and overdoses have occurred because they did not realize the substance they were taking was contaminated with fentanyl.
People use opioids for a variety of reasons. Some people use opioids for pain treatment or for temporary relief from anxiety, adverse experiences or difficult life circumstances. Others use opioids to experience a feeling of euphoria or out of curiosity about drugs that are perceived as risky and out of the mainstream. And still others use prescription opioids like methadone or buprenorphine (e.g. Suboxone®) to help reduce dependence on street opioids. Some users unintentionally expose themselves to opioids mixed into another type of drug they buy from an unregulated supplier. Like all drugs, opioids can be harmful.
How does it work?
When swallowed, opioids are absorbed into your bloodstream through your stomach and small intestine. When you inject an opioid, the drug goes directly into your bloodstream. Sometimes opioids are snorted or smoked. When snorted, the drug is absorbed into your bloodstream through membranes in your nose, and when smoked, it is absorbed across the lining in your lungs. Once in the bloodstream, the drug travels to your brain. Some very powerful opioids (e.g. carfentanil) may be absorbed through your skin just by touching the drug or someone who has used the drug.
Like other substances with depressant effects, opioids slow down activity in your brain and central nervous system. In the brain, opioids mimic the action of endorphins (natural pain-killing chemicals the body produces when injured or in shock). When opioids bind to nerve cell receptors for endorphins, the painkilling effect is magnified.
After injection of heroin, the result is an intense rush that lasts for several minutes, followed by a warm sensation and feeling of contentment. This can last for an hour or more. The overall high may continue for up to five hours.
What are the associated risks and health effects?
Opioids can have positive effects but can also be harmful to your well-being. Opioids cause effects in the body, including dizziness and drowsiness, ‘pinpoint’ pupils, dry mouth, nausea and vomiting, constipation, slowed shallow breathing, slowed heart rate and cold skin. Small amounts of an opioid may help to soothe pain or anxiety. But using larger amounts, or even small amounts with high concentrations, may lead to extreme drowsiness or overdose. Not everyone who overdoses will die, but experiencing a drug-induced coma increase the risk of negative effects on the brain.
Using an opioid may help you feel more comfortable at a party, but repeatedly using the drug to address social anxiety may lead to harms to your health or relationships. And, while fentanyl and other prescription opioids are safe when used in ways that are well managed, it is impossible to manage the risks related to opioids obtained through an uncontrolled supply chain. Many people choose not to use opioids (or other drugs) manufactured in illicit labs because they can’t be certain about the contents and dosage of the drug they are taking.
If you choose to use an opioid, it is important to remember the potential risks involved in obtaining a drug outside of a regulated system. All opioid use is risky because the drug is unregulated and sold on the street and you can’t be sure what you’re really buying. Due to shortages of street heroin in the supply chain, many illicit manufacturers have turned to use of fentanyl or other drugs as a substitute. Unless you have access to checking/testing kits (which are still not 100% accurate), you have no idea what is in the drugs you buy or how much. Since it is not possible to know the purity of the drug, you can accidentally use too much.
Use of larger amounts of opioids, or small amounts at higher concentrations, can cause you to experience extreme drowsiness. They can also put you at risk of becoming comatose or having respiratory failure. This can shut down your coughing and gag reflex, causing you to inhale and choke on your own vomit.
Injecting opioids increases your risk of infection and overdose. Sharing needles increases your risk of getting a blood-borne disease such as hepatitis C or HIV.
The effects of opioids can be different for different people. One person may feel relaxed and drowsy after taking an opioid while another may feel talkative and energetic. A lot depends on the amount you use at a given time and whether you have also consumed alcohol or other drugs. Other factors that influence how opioids will affect you include your past experiences with the drug, present mood and surroundings, and mental and physical health condition.
New opioid users sometimes suffer from severe nausea and vomiting. They may also experience muscle twitching. Since opioids affect nerve cells related to motor activity, users typically experience a heavy feeling in their arms and legs.
Frequent longer-term users of opioids can experience ongoing constipation and problems with the heart, lungs and liver. Both men and women may experience a decreased interest in sexual activity. Women may suffer from menstrual irregularities and infertility. The reduced desire for food can lead to an unhealthy diet and malnutrition.
People sometimes choose to use opioids over the long-term because they find the drugs helpful for managing ongoing health problems like chronic pain. But making good decisions about using an opioid involves regular consultations with a healthcare professional and weighing the benefits and risks of continuing use. For instance, while pain itself may impact our ability to remember and learn things, over time regular use of opioids is linked to a decline in cognitive function affecting verbal fluency, memory and decision-making. It is not clear if these deficits may improve when opioid use is stopped.
Because of the high costs of purchasing opioids illegally on the street, many long-term heavy opioid users go deeply into debt. Some become desperate for drug money and exploit their friends and family. Some turn to prostitution and criminal activity.
Opioid use can cause complications during pregnancy. This is because women who are dependent on opioids often lack adequate nutrition, rest and obstetrical care. Opioid use increases the risk of miscarriage, stillborn delivery and premature delivery. Babies born to opioid-dependent mothers are more likely to have a low-birth weight and health problems. Babies can be born with opioid dependence and may suffer withdrawal. Opioids can also be transferred into a baby’s system through breast milk.
One consequence of opioid use that can develop is tolerance – that is, it takes more of the drug to achieve the positive effects. If you develop tolerance to an opioid and stop using it, your tolerance is reduced. Overdose can happen if you try to use the same amount as before you stopped. If you use opioids regularly, you can develop another type of problem – dependence. This means feeling like you need the drug to function and feel normal.
Continuous regular use of opioids can lead to physical and psychological dependence. When a person who is physically dependent on opioids stops opioid use, withdrawal symptoms begin a few hours later. The symptoms include: hot and cold sweats, stomach cramps, muscular spasms, diarrhea, irritability and anxiety. This is typically more intense when withdrawing from strong opioids such as heroin or fentanyl. The severity of the withdrawal symptoms may be influenced by factors such as the person’s general health and how long they have been regularly using the drug. Some people continue using the opioids even when they don’t want to, to avoid the strong and unpleasant withdrawal symptoms.
Signs of overdoseOpioid overdose can result from a single excessive dose taken by someone who is not a regular opioid user. A long-term opioid user may also overdose on an unexpectedly strong dose. If a regular user with high tolerance to the drug stops using opioid, they will lose their tolerance. Overdose can happen if that person tries to use the same amount as before they stopped. Use of opioids with alcohol or other depressants, or with cocaine or other stimulants can also be very dangerous and can lead to overdose. In overdose, users your breathing slows, and death from respiratory arrest may result. Overdose victims require rescue breathing and use of a drug that reverses the effects of opioids (an opioid antagonist, such as naloxone (Narcan®)).
Signs of opioid overdose include:
• slow, shallow, irregular breathing, or no breathing
• slow or no pulse
• unusual snoring, gurgling sounds, choking
• unresponsive, can’t be woken up
• blue lips or nails, pale/cool skin
• tiny, ‘pinpoint’ pupils
• vomiting
If someone you know is showing signs of an opioid overdose, call 911 right away. In Canada, the Good Samaritan Drug Overdose Act exempts people at the scene of an overdose from being charged for personal use of an illegal substance, as well as from being charged for breach of probation or parole.
The current best response for an opioid overdose is the administration of naloxone (Narcan®), an antidote drug that can help reverse the effects of an opioid overdose by restoring breathing. If naloxone is not available, giving rescue breaths until emergency personnel arrive can help save the life of the person who has overdosed.
The duration of action of naloxone may be shorter than the action of the opioid the person overdosed on. If a person who has overdosed appears to have recovered after naloxone administration, they may remain at risk for overdose symptoms and effects on breathing to recur. Emergency care is still required following an overdose, and repeated administration of naloxone may be required.
Acknowledgments
[2014] This fact sheet was produced by the
Centre for
Addictions Research of BC
on behalf of the BC Partners for Mental Health and Addictions Information. An excerpt
has been reproduced here with permission. To read the full fact sheet and for more
helpful substance use and mental health resources, please visit
www.heretohelp.bc.ca