Opiate Fact Sheet 1
Learning Plan 8: Scoring Guide - Fact Sheet on Narcotic Analgesics (Opiates)
Jennifer Dohl
Physiological Complications and Psychopharmacology
Jerry Van Kirk
April 10, 2012
Opiate Fact Sheet 2
Definition of Opiates
Opiates are central nervous system (CNS) depressants. Opioid narcotics activate opioid
receptors in the brain and have high abuse potential. Their pharmacological features include
pain-relieving effects (analgesic), cough suppressants (antitussive), and reduction of intestinal
movement (Hanson, Venturelli and Fleckenstein, 2012).
Types of Opiates
Opioids are defined by their ability to bind to and influence opiate receptors on cell
membranes. They are divided into 3 classes:

Naturally occurring opioids: The classic natural opioids are opium and morphine.

Semi-synthetic opioids: These include heroin, oxycodone, oxymorphone, and
hydrocodone.

Synthetic opioids: Synthetic opioids are made using total synthesis; they include
buprenorphine, methadone, fentanyl, alfentanil, levorphanol, meperidine, codeine, and
propoxyphene (Preda, 2012).
Opiate Fact Sheet 3
Narcotic Opioids, Street Names and Therapeutic Uses
Narcotic Drug
Heroin
Common Name
Diamorphine
Street Name
Big H, Black Tar,
Chiva, Hell Dust,
Horse, Negra, Smack,
and Thunder
Dreamer, Emsel, First
Line, God’s Drug,
Hows, M.S., Mister
Blue, Morf, Morpho,
and Unkie
Therapeutic Uses
None. Used for Abuse
Morphine
MScontin
Methadone
Dolophine
Amidone, Chocolate
Treat narcotic
Chip Cookies, Fizzies, dependence, Analgesia
Maria,
Pastora, Salvia, Street
Methadone, and Wafer
Hydromorphine
Dilaudid
D, Dillies, Dust,
Footballs, Juice, and
Smack
Analgesia, Antitussive
Hydrocodone
Vike, Watson-387
Analgesia
Meperidine
Vicodin, loracet,
lortab
Demerol
Oxycodone
Oxycontin, Percodan
Hillbilly Heroin,
Kicker, OC, Ox,
Roxy, Perc, and Oxy
Propoxyphene
Darvon, Dolene,
Darvocet
Analgesia(half the
potency of Heroin)
Analgesia
Analgesia
Analgesia(half as
potent as codeine)
Analgesia, Antitussive
Codeine
Loperimide
Imodium A-D
Antidiarrheal
Diphenoxylate
Lomotil
Antidiarrheal
Opium tincture
Paregoric
Antidiarrheal
Buprenphine
Suboxone
Treat narcotic
dependence
Sufentanil, alfentanil
Fentanyl
(Hanson, Venturelli, Fleckenstein, 2012), (Drugs of Abuse, 2011).
Potent analgesia
Opiate Fact Sheet 4
Therapeutic Uses for Prescription Opiates
Prescription opiates are used mostly to relieve various types of pain including; visceral
(Internal organs) and somatic (skeletal muscles, bones, skin, and teeth). In high doses opiates can
relieve pain associated with certain types of cancer. Opiates are also used as antitussives (relieve
coughing), as an antidiarrheal and to treat narcotic dependence (Hanson, Venturelli and
Fleckenstein, 2012).
Physiological Effects from the Abuse of Opiates
Any narcotic drugs that activate opioid receptors in the brain have abuse potential.
Patients who are using opioid analgesics develop tolerance after 2-3 weeks of use and may
develop physical dependence to them even if they are not abusing the drugs. Psychological
dependence can develop with sustained use due to the euphoric and stress relieving effects of
opiates. There are two major stages in the development of a psychological dependence and
addiction to opiates, whether it’s a prescribed opioid analgesic or heroin. The first stage is the
rewarding stage where the effects are positive feelings that are increased with continued use. In
the next stage the user must keep using the drug to avoid unpleasant withdrawal symptoms. The
side effects of using opioids are constipation, drowsiness, mental fogginess, respiratory
depression (which can be fatal in cases of overdose), nausea, vomiting, dry mouth, pruritus,
anuria, hypotension, pupil constriction (Hanson, Venturelli and Fleckenstein, 2012).
Withdrawal Effects of Heroin and Opiate Abuse
Withdrawal effects from opiate abuse include craving within 6 hours of last dose,
followed by exaggerated pain responses, agitation, anxiety, stomach cramps, and vomiting,
insomnia and an overall flu-like feeling. Withdrawal symptoms from heroin may start 4-6 hours
after the last dose. The symptoms start with a runny nose, tears, mild stomach cramps,
Opiate Fact Sheet 5
alternating chills and fever, and goose pimples. Within 2-4 days the previous symptoms continue
along with aching bones and muscles, and powerful muscle spasms. After 4-5 days the
withdrawal symptoms start to decrease for both opiates and heroin and the user will start to
regain his/her appetite. Even after the initial withdrawal effects have stopped, the urge to use
stays strong (Hanson, Venturelli and Fleckenstein, 2012).
(Opioid Drug Abuse and Dependence, 2005)
Health Risks of Opiate Abuse
With the exception of overdose, usually through respiratory depression, and physical
dependence, most effects from opiates are reversible. The biggest danger comes from the use of
contaminated needles by intravenous users. The user is at risk for hepatitis B and C, bacterial
endocarditis, and HIV. The ingredients added to street drugs may contribute to nervous system
damage, including peripheral neuropathy, vision problems, myelopathy, and
leukoencephalopathy (disease of the white matter of the brain). Opioid use may lead to decreased
Opiate Fact Sheet 6
sex drive and problems in dealing with stress. Other hormonal changes include a decrease in the
release of thyrotropin (hormone produced by the thyroid gland) and increases in prolactin
(hormone that stimulates lactation) and possibly growth hormone (Lynch, McJunkin, Maloney,
2010).
The potential effects of Heroin abuse include Hepatitis B and C, HIV, collapsed veins,
bacterial infections, abscesses, infection of the heart lining and valves, arthritis and other
rheumatologic problems (Focus Adolescent Services).
Treatment Approaches to Opiate Abuse and Dependence
There are a variety of treatment options for opiate narcotics and heroin addiction.
Treatments include medications and behavioral therapies. Treatment usually starts with
medically assisted detoxification so the patient withdraws from the drug safely. Clonidine (an
oral antihypertensive also used as anti-emetic) and buprenorphine can be used to help minimize
symptoms of withdrawal. To prevent relapse long term, treatment needs to include behavioral
therapy as well.
Medications to help prevent relapse consist of the following:
 Methadone-Taken orally, it has a gradual onset of action and prolonged effects,
decreasing the craving for other opioid drugs and preventing withdrawal symptoms.
When taken appropriately methadone is not intoxicating or sedating, and its effects do not
interfere with normal day-to-day activities. Methadone maintenance treatment is usually
given through specialized opiate treatment programs. Methadone can also be appropriate
for addicted pregnant women when combined with prenatal care and a drug treatment
program.
Opiate Fact Sheet 7
 Buprenorphine is also taken orally for the treatment of opiate and heroin addiction.
Buprenorphine has less risk for overdose and withdrawal effects and produces a lower
level of physical dependence than oral methadone. Buprenorphine can be prescribed in a
doctor’s office which gives patients easier access and may be an incentive to some
addicts to get help sooner.
 Naltrexone is appropriate for treating heroin addiction but has not been extensively used
due to poor patient compliance. Naltrexone blocks opioids from binding to their receptors
and stops the effects of the drug from being felt. For opioid addiction, naltrexone is
usually prescribed in outpatient settings after detox in an inpatient facility. To prevent
withdrawal symptoms, patients must be medically detoxified and opioid-free for several
days before taking naltrexone.
 Naloxone is a shorter-acting opioid receptor blocker, used to treat cases of overdose
(Infofacts Heroin, 2010).
Another method of treatment is with ultra-rapid or anesthesia-assisted opioid detoxification
which involves giving an opioid antagonist drug to neutralize the effects of heroin while the
patient is under general anesthesia. This treatment is expensive, not covered by insurance, and
lacks good evidence to prove its effectiveness. There are also concerns about potential health
risks. The detoxification procedure is usually followed by longer term treatment with an
antagonist drug such as naltrexone ("Study says rapid-detox," 2005).
The best result of treatment for opiate or heroin addiction is for the individual to be able to
live a well-adjusted, productive life free from drugs. However, realistically, treatment is deemed
successful when the individual;

Is no longer using heroin
Opiate Fact Sheet 8

Ceases to associate with dealers or users

Stays away from situations that put him/her at risk for temptation to use

Maintains employment

Avoids illegal activity

Is capable of appreciating and participating in normal family and social relationships
(Hanson, Venturelli, Fleckenstein, 2012).
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References
Focus adolescent services. (n.d.). Retrieved from http://www.focusas.com/INFOCUS.html
Hanson, G., Venturelli, G., & Fleckenstein, A. (2012). Drugs and Society. (Eleventh ed., Chapter
9). Burlington, MA: Jones and Bartlett Learning Company.
Preda, A. (2012, February 29). www.dea.gov. Retrieved from
http://www.justice.gov/dea/pubs/drugs_of_abuse.pdf
Lynch, P., McJunkin, J., & Maloney, J. (2010, June 28). Long Term Opioid Use. Retrieved from
http://www.paindoctor.com/treatments/medications/what-are-the-effects-of-long-termopioid-use
National Institutes of Health, NIDA. (n.d.). Retrieved from website:
http://www.drugabuse.gov/publications/infofacts/heroin
Study says rapid-detox method does not work, dangerous health risk significant for heroin
addicts. (2005, August 25). Retrieved from
http://alcoholism.about.com/od/issues/a/bljama050824.htm
Opiate Fact Sheet 10