Opiates

Drug name	Brand name	Street name	Recommended adult daily dose
Buprenorphine	Temgesic.	Tems	200-400 micrograms (8-hourly)
	Subutex.	Super Teds	Varies - 400micrograms, 2mg, 8mg, up to 32mg daily
Diamorphine	Heroin	Smack, H	Varies - usually in range 5-30mg
Methadone	Physeptone.	Meth, Phy	5-10mg (6-8 hourly)
Dihydrocodeine	DF118 Forte. DHC Continus. Paramol.	DFs, Diffs	8-60mg
Dipipanone (with Cyclizine)	Diconal.	Dikies, Dikes	10-30mg (6-hourly)
Dextromoramide	Palfium.	Palf, Peach Palf	5-20mg
Dextropropoxyphene	Co-proxamol* Distalgesic.* Cosalgesic.*	DGs	65mg hydrochloride (6-8 hourly)
Oxycodone	OxyContin.		10-30mg every 12 hours (increased if necessary according to severity of pain, usual max. 200mg every 12 hours)
Fentanyl	Durogesic.		25-100micrograms once every 3 days
Tramadol	Zydol., Tramake., Zamadol.		50mg (4-hourly)
Codeine	Codeine phosphate, Codeine linctus, Codis., Solpadeine.*, Co-codaprin		8-60mg (3 times a day)
Morphine/tincture of morphine	MST Continus. Cyclimorph. (with Cyclizine), Kaolin & Morphine Mixture	Morph, Cyclimorph	Varies - starting dose 10mg (4-hourly)
Opiate tincture of squill (contains tinct of opium)	Gee's Linctus		5-15ml daily

Products marked * also contain paracetamol. As little as 10-16G (20-30 tablets containing 500mg) may cause severe hepatocellular necrosis and, less frequently, tubular necrosis. Patients who have taken an overdose of products containing paracetamol should be transferred to hospital urgently. Since paracetamol overdose may not cause any features of toxicity in the early stages, the person may not realise a toxic dose has been taken until it is too late for effective treatment.

Street use
Smoked, sniffed, inhaled or injected, depending on the drug and preparation.

Drug effects
Analgesic (painkilling) properties. Also reduce breathing rate and heart rate, hunger and anxiety. These effects, combined with an increase in blood flow to the skin, give the warm contented and sometimes euphoric feeling that is often reported. First time users may vomit but this stops with repeated use. At low doses, opiates do not interfere with physical co-ordination or mental alertness. After high doses, opiates produce a stupor.

Dependency
Tolerance to opiates develops very quickly and, after a few weeks of regular use, doses must be increased to produce the same effect. Dependence takes longer to develop, but after taking opiates regularly for some months there are physical withdrawal symptoms when the drug is stopped. The speed with which dependence develops and the severity of withdrawal symptoms experienced depends upon the quantity and type of drug taken, the route of administration and, to some extent, the expectations of the user.

Withdrawal
Withdrawal usually begins 8 to 48 hours after the last dose of drug, peaks after 3 to 5 days and then fades after 5 to 14 days. Withdrawal from opiates can be unpleasant and uncomfortable but it is not dangerous. Symptoms are similar to a bad bout of flu and include sweating, stomach cramps, muscular pain, running nose and diarrhoea. Most symptoms fade fairly quickly but sleeplessness and feelings of weakness may continue for some months.

Long term use
The physical effects of long-term opiate use are not often serious in themselves. Common side-effects include constipation, irregular periods and weight loss. However, the use of unsterile equipment and the injecting of adulterated heroin, crushed tablets or the contents of capsules can lead to more serious problems, including abscesses, vein collapse, loss of limbs, hepatitis A, B and C and HIV infection.

Overdose risk
Deaths from opiate overdoses are relatively rare although the intravenous use of Diconal. is particularly dangerous. The risk increases after a period of abstinence as this leads to lack of tolerance, and when opiates are mixed with other drugs such as cocaine, benzodiazepines, barbiturates or alcohol.

Risk in pregnancy
Many women do not have periods when they are using opiates regularly, but as soon as they cut down or stop periods return, and many drug users become pregnant at this time. There is no evidence that opiates cause birth defects, although they may possibly increase the risk of miscarriage and still births, and women may give birth to small babies. However, opiate use should not be stopped suddenly because this also increases the risk of miscarriage or premature labour. Gradual withdrawal over 12 weeks may be advised. Babies born to mothers who continue to use throughout the pregnancy show withdrawal symptoms within 3 days of birth (possibly longer if the mother has been using methadone). Symptoms include excessive restlessness, shrill crying, sleeplessness, constant sucking, diarrhoea, yawning and sneezing. In severe cases, babies may suffer convulsions which can be fatal.

Legal status
Prescription Only Medicines
Most are controlled drugs - Class A or B, Schedule 2. Buprenorphine is Class C, Schedule 3. Illegal to possess or sell without a prescription or authority - see individual drugs for further details. Some drugs are Schedule 5

Maximum penalty
Class A: Possession - 7 years, Supplying - Life
Class B: Possession - 5 years, Supplying - 14 years
Class C: Possession - 2 years, Supplying - 5 years