Opiate Addiction Guide

Learn about opiates. Knowledge = Power

Lysis — Sun, 11 Oct 2009 02:30:51 +0000

We invite you to come learn about the history and science behind the class of drugs known as opiates. From the humble poppy to today’s synthetics, you will gain a deeper understanding of its history and the way it works in your body.

Codeine

Lysis — Sun, 11 Oct 2009 01:33:34 +0000

Codeine

Chemical Name: (5alpha,6alpha)-7,8-Didehydro-4,5-epoxy-3-methoxy-17-methylmorphinan-6-ol

Classification: Opiate

Primary Uses: Anagesia, cough suppression, diarrhea, irritable bowel syndrome (IBS)

Brand Names: Tylenol #3, Codate, Codephos

General Information

Codeine, a natural opiate found in opium and poppy plants, is a moderate strength opiate. Codeine content in opium is found in the range of 0.3 – 3.0%. Pharmaceutical grade codeine is not extracted from poppies, but rather converted from the much more abundant morphine. Codeine has a wide range of therapeutical uses including moderate to sever pain, diarrhea, cough suppression and irritable bowel syndrome. As with many other opiates, codeine is most often found compounded with acetaminophen (Tylenol) to provide synergistic pain killing properties.

Pharmacology & Pharmacokinetics

Codeine exerts its effects on the central nervous system and the bowel. Codeine itself only weakly binds to mu-opiod receptors, and correspondingly, a higher dose of codeine must be taken for an equivalent dose of morphine (200mg codeine is approximately equal to 30 mg of morphine in analgesia). While codeine itself has a weak binding affinity, 5 – 10% of codeine is converted to morphine, and other active compounds (codeine-6-glucuronide (~70%), norcodeine (~10%), and hydromorphone (~1%)).

Conversion of codeine to morphine occurs in the liver via cytochrome P450 enzyme CYP2D6. A point to keep in mind is that approximately 6-10% of the Caucasian population, 2% of Asians, and 1% of Arabic have poorly functional CYP2D6 and codeine is much less effective for these people, although it is speculated that codeine-6-glucuronide is responsible for a large percentage of the analgesia of codeine and thus these patients should experience some analgesia.

Some drugs may interfere with the effectiveness of codeine. Certain selective serotonin reuptake inhibitors (anti-depressants) are CYP2D6 inhibitors, which consequently reduces the efficacy of codeine. Combining codeine with gluthethimide, a sleeping agent, is said to act as an enzyme-inducer, allowing the body to convert up to 10% of codeine into morphine. Other drugs may reduce or raise the effectiveness of codeine, and care should be taken when mixing medications.

Legal Status

Under United States law, codeine can appear as both a Schedule II or Schedule III substance depending on the formulation. Here are the differences between the two:

Schedule II — Includes codeine products containing more than 90 mg per dosage unit. Written prescription required for refills.
Schedule III — Includes codeine products containing less than 90 mg per dosage unit. May be refilled using phoned prescription.

Schedule II substances meet the following criteria according to the Controlled Substances Act:

The drug or other substance has a high potential for abuse.
The drug or other substance has a currently accepted medical use in treatment in the United States (or) a currently accepted medical use with severe restrictions.
Abuse of the drug may lead to severe psychological or physical dependence.

Schedule III substances meet the following criteria according to the Controlled Substances Act:

The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.
The drug or other substance has a currently accepted medical use in treatment in the United States of America.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

Side Effects

Pain relief
Dizziness
Nausea and/or vomiting
Constipation
Headache
Sweating
Nervousness and anxiety
Euphoria or dysphoria
Urinary retention
Insomnia
Dry mouth

Withdrawal

Codeine withdrawal typically starts within 12-24 hours after the last dose. The time it takes for codeine withdrawal to begin varies due to factors such as frequency of use, dosage, and body chemistry. Acute withdrawal symptoms peak between 48 and 72 hours and are generally gone within a week; however, post-acute withdrawal syndrome (PAWS) can affect a person for weeks or months after the initial withdrawal phase.

Cravings
Muscle and bone pain
Restlessness
Goose bumps
Involuntary leg and arm movements
Profuse sweating
Insomnia
Nausea and vomiting
Depression

Sources

[1] Codeine: Pharmacology. Wikipedia, the free encyclopedia.

[2] Erowid Codeine Vault: Codeine FAQ. Erowid.

Buprenorphine (Suboxone, Subutex, Tamgesic, Buprenex)

Lysis — Sun, 11 Oct 2009 00:22:15 +0000

Buprenorphine

Chemical Name: 17-(cyclopropylmethyl)-alpha-(1,1-dimethylethyl)-4,5-epoxy- 18,19-dihydro-3-hydroxy-6-methoxy-alpha-methyl-6,14- ethenomorphinan-7-methanol

Classification: Partial opioid agonist

Primary Uses: Opiate dependency treatment, pain relief

Brand Names: Suboxone, Subutex, Buprenex, Temgesic

Slang: Bupe, subs

General Information

Buprenorphine is a partial opioid agonist, that is derived from thebaine, a natural constituent of poppies. Buprenorphine was first marketed as Buprenex as an injectable formulation, and was schedule V. More recently on October 7th, 2002, the DEA rescheduled the drug from V to III and approved the drug for treatment of opiate addiction under the brand names Suboxone(with naltrexone) and Subutex (no naltrexone).

Pharmacology & Pharmacokinetics

Buprenorphine binds to the mu-opioid receptor; however, it is only a partial opioid agonist, and it does not produce the same “high” or “rush” of full agonists (morphine, oxycodone, heroin), and also makes overdoses less likely, but still possible. It also has a high binding affinity, meaning once it attaches to the receptor, it does not leave for a while. This property makes it good for opiate treatment, but also complicates overdose cases. In addition, since it is a partial agonist, it can trigger precipitated withdrawal in opiate dependent persons if taken too closely to their last opiate dose.

Buprenorphine or buprenorphine hydrochloride can be administered via intravenous or intramuscular injection, transdermally with a patch, or in the form of a sublingual tablet. The drug is broken down into norbuprenorphine, which is an active metabolite, and glucuronidation. This is completed via N-dealkylation mediated by cytochrome P-450 3A4 isozyme. The average elimination half-life of buprenorphine is 37 hours.

Method of Administration	Bioavailability	Peak Plasma	Half-Life
Sublingual	13 – 51.4%	2 hours	37 hours
Intraarterial	100%	—	—
Intravenous	98%	1.5 minutes	< 37 hours
Intrahepatoportal	49%	—	—
Intraduodenal	9.7%	—	—
Buccal	27.8%	—	—

Legal Status

This drug is a Schedule III substance, making it illegal to use or possess without a prescription. Schedule III substances meet the following criteria according to the Controlled Substances Act:

The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.
The drug or other substance has a currently accepted medical use in treatment in the United States of America.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

Side Effects

Pain relief
Sedation
Nausea
Vomiting
Dizziness
Headache
Constipation
Sweating
Insomnia
Urinary retention
Miosis
Confusion
Euphoria or dysphoria

Withdrawal

As with any opiate, extended use of buprenorphine will lead to withdrawals upon discontinuation. These can be unpleaant due to the long half life (it takes longer to fully leave your system). This does not mean that the drug is causing the agony, rather, it takes longer for your body to up its natural supply.; however, buprenorphine withdrawal is generally milder than that which is experienced from full agonist. Buprenorphine must be tapered slowly due to its long half-life, which can cause withdrawal to kick in later than with the traditional fast-acting opiates. Buprenorphine withdrawal symptoms can linger for a few months, which is why a slow, modest taper is preferred to a quicker taper. Below are some possible withdrawal symptoms:

Depression/dysphoric mood
Nausea and vomiting
Muscle aches and cramps
Insomnia
Mild fever
Lacrimation
Rhinorrhea
Profuse sweating
Piloerection
Diarrhea
Frequent yawning
Drug craving

Sources

[1] Mendelson J, Upton RA, Everhart ET, Jacob P 3rd, Jones RT. Bioavailability of sublingual buprenorphine. J Clin Pharmacol [Entrez PubMed]. 1997 Jan;37(1):31-7.

[2] Brewster D, Humphrey MJ, Mcleavy MA. The systemic bioavailability of buprenorphine by various routes of administration. J Pharm Pharmacol [Entrez PubMed]. 1981 Aug;33(8):500-6.

[3] James J. Kuhlman, Jr., Shairose Lalani, Joseph Magluilo, Jr., Barry Levine, William D. Darwin, Rolley E. Johnson, and Edward J. Cone. Human Pharmacokinetics of Intravenous, Sublingual, and Buccal Buprenorphine. Journal of Analytical Toxicology, Volume 20, Number 6, October 1996, pp. 369-378.

The Big List of Opiate Drugs

Lysis — Sun, 11 Oct 2009 00:03:26 +0000

Below you will find a large list of *common* opiates. There are many others that are not listed, and many more to come. The structure of these can be tweaked and maniuplated to make new derivatives. Users of street drugs are at the greatest risk of ingesting unknown opiate analogues. This can potentially be disastorous as the new drug could be much more potent than the user is accustomed to, or it could have serious side effects (such as parkinson like symptoms from MDPV).

You can find general info such as dosage, slang terms, pharmokinetics and more by clicking on the drug name below. We will only have detailed information on the most common drugs at the present, but more will be added soon.

Natural opium alkaloids

* Morphine
* Opium
* Hydromorphone
* Nicomorphine
* Oxycodone
* Dihydrocodeine
* Diamorphine
* Papaveretum
* Morphine
* Oxycodone
* Dihydrocodeine
* Codeine

Synthetic opioids

Anilidopiperidines

* Fentanyl
* Alphamethylfentanyl
* Alfentanil
* Sufentanil
* Remifentanil
* Carfentanyl
* Ohmefentanyl

Phenylpiperidines

* Pethidine (meperidine)
* Ketobemidone
* MPPP
* Allylprodine
* Prodine
* PEPAP

Diphenylpropylamine derivatives

* Propoxyphene
* Dextropropoxyphene
* Dextromoramide
* Bezitramide
* Piritramide
* Methadone
* Dipipanone
* Levomethadyl Acetate (LAAM)
* Loperamide (used for diarrhoea, does not cross the blood-brain barrier)
* Diphenoxylate (used for diarrhoea, does not appreciably cross the blood-brain barrier)

Benzomorphan derivatives

* Dezocine
* Pentazocine
* Phenazocine

Oripavine derivatives

* Buprenorphine
* Dihydroetorphine
* Etorphine

Morphinan derivatives

* Butorphanol
* Nalbuphine
* Levorphanol
* Levomethorphan

Others

* Lefetamine
* Meptazinol
* Tilidine
* Tramadol
* Tapentadol

Prescription pharmaceuticals for easing withdrawal

Lysis — Sat, 10 Oct 2009 23:49:43 +0000

Below is a list of remedies endorsed by medical professionals. These require a prescription and guidance by a physician. This list is not comprehensive, and I do not condone one or the other. Make sure you research the particular treatment you would like to try extensively before starting. As always, consult with a qualified physician before starting any program.

Prescription remedies

	Other Names	Symptoms
Diazapam	Valium	Anxiety, Insomnia
Clonazapam	Klonopin	Anxiety, Insomnia
Zolpidem	Ambien	Insomnia
Lunesta	Lunesta	Insomnia
Clonidine	-	Blood pressure
Buprenorphine	Suboxone,Subutex	All
Methadone	Various	All

Natural and over the counter remedies for easing opiate withdrawal

Lysis — Sat, 10 Oct 2009 23:42:51 +0000

Below is a list of remedies that others have found useful in aiding in withdrawal. This list is not comprehensive, and I do not condone one or the other. Make sure you research the particular treatment you would like to try extensively before starting. As always, consult with a qualified physician before starting any program.

Natural and over the counter remedies

	Other Names	Symptoms
5-HTP	Various	Depression, insomnia
Diphenhydramine	Sominex, Tylenol PM	Insomnia
DLPA	D- & L-phenylalanine	Pain, depression, etc.
Ibuprofen	Advil, Motrin IB	Muscle/bone pain
Kava Kava	Various	Anxiety, insomnia
Kratom	Various	All
Ibogaine	Various	Mental
Loperamide	Imodium A-D	Diarrhea, etc.
L-tyrosine	Various	Depression, energy, mood
Melatonin	Various	Insomnia
Milk Thistle	Various	Liver health
Multivitamin	Centrum	General well-being
Omega-3 Fatty Acids	Various	Depression, general health
Valerian Root	Various	Insomnia, anxiety
Vitamin B6	Various	Energy, depression
Vitamin B12	Various	Energy, brain function

Opioid Conversion Calculator

Lysis — Sat, 10 Oct 2009 23:26:35 +0000

When switching medications, voluntarily or not, you need to make sure that you do not inadvertently take more than is needed, resulting in overdose. Below you will find a number of opioid conversion calculators.

DISCLAIMER

The opiate/narcotic dosage converters and charts listed on this page were not created by us; before changing medications, double check the calculations, start safely, and consult a doctor.

External Links

MedCalc Narcotic Equivalence Converter – Narcotic dosage conversion calculator (+ Buprenorphine)
GlobalRPh’s Calculator for Converting Various Narcotic Dosages to Fentanyl Patch Dosages
GlobalRPh’s Narcotic Dosage Converter – Calcuator for converting various narcotic dosages
GlobalRPh’s Equianalgesic Conversion Chart – Provides dosage conversion guidelines for common opioids/narcotics
Equianalgesic Dosing for Management of Acute or Chronic Pain – Provides narcotic dosage conversion in instances where the management of acute or chronic pain is necessary
Great conversion chart (choose your own dose) – http://www.globalrph.com/narcoticonv.htm
Bar graph of several opiates including IV, PO – http://codeine.50g.com/info/facts.html
Download an opiate conversion chart program – http://www.epocrates.com/products/me…converter.html

Conversion Chart

Drug

Duration

Half-life

Route

Equianalgesic
Dosage

Codeine

4–6 h

3 h

IM/IV/SC

120 mg

200 mg

Fentanyl

1–2 h

1.5–6 h

IM/IV

0.1 – 0.2 mg

Hydrocodone

4–8 h

3.3–4.5 h

20-30 mg

Hydromorphone

4–5 h

2–3 h

IM/IV/SC

1.3–1.5 mg

7.5 mg

Levorphanol

6–8 h

12–16 h

IM/IV/SC

2 mg

4 mg

Meperidine^æ

2–4 h

3–4 h

IM/IV/SC

75 mg

300 mg

Methadone

4–6 h

15–30 h

IM/IV/SC

1-10 mg^§Medline
Short term: 5-10mg
Chronic use: 1-4 mg
(2 mg)

2 – 20 mg^§ Medline
Short term use: 20 mg
Chronic dosing: 2-4 mg
(3mg)

Morphine

3–6 h

1.5–3 h

IM/IV/SC

10 mg

30–60 mg^#

Oxycodone

4–6 h

15-30 mg (20 mg)

Oxymorphone

3–6 h

IM/IV/SC

1 mg

Important Update: Opana™ and Opana ER™ oxymorphone immediate release and oxymorphone extended release tablets) have been approved by the FDA.

10 mg

Propoxyphene

4–6 h

6–12 h

130-200 mg *

^*	Propoxyphene HCL: 130mg; Napsylate: 200mg. Not recommended for chronic pain management and therefore not available in program above.
^#	^{Acute dosing (opiate naive): 60mg. Chronic dosing: 30 mg.}
§:	Many equianalgesic tables underestimate methadone potency – more studies are needed..
æ	Meperidine should be used for acute dosing only and not used for chronic pain management (meperidine has a short half-life and a toxic metabolite: normeperidine). Its use should also be avoided in patients with renal insufficiency, CHF, hepatic insufficiency, and the elderly because of the potential for toxicity due to accumulation of the metabolite normeperidine. Seizures, confusion, tremors, or mood alterations may be seen.

Share Your Story

Lysis — Sat, 10 Oct 2009 21:40:56 +0000

Find a Buprenorphine (Suboxone, Subutex) Treatment Doctor

Lysis — Sat, 10 Oct 2009 21:34:38 +0000

If you are planning to taper with Buprenorphine (Brand name Suboxone, Subutex), you first must find a doctor that is licensed to prescribe it and oversee your treatment. While becoming more common, some areas of the United States at least are still lacking. In addition, the maximum number of patients a physician may treat with buprenorphine is limited by law, so if you find a doctor, they may not be accepting new patients. The main site to find a buprenorphine doctor is at SAMHSA.GOV. If you cannot find a doctor near you, you may consider travelling. Also, new doctors are added weekly so be sure to check back often.

To find a doctor in your area, visit http://buprenorphine.samhsa.gov/bwns_locator/

In addition to finding a physician to prescribe buprenorphine (the only drug approved to treat addiction, that is prescribed by a physician), you can also search for addiction treatment centers (where both suboxone or methadone can be prescribed) as well as lookup drug treatment laws and policies for your state.

The Locator is an on-line resource designed to assist States, medical and addiction treatment communities, potential patients, and/or their families in finding information on locating physicians and treatment programs authorized to treat opioid addiction with buprenorphine (Suboxone® and Subutex®).

The Locator lists:

Physicians authorized to prescribe a class of medications for opioid (narcotic) addiction treatment, of which Suboxone® and Subutex® are the only ones approved at this time.

Treatment programs authorized to dispense (but not prescribe) opioid treatment medications, including Suboxone® and Subutex®.

The treatment programs in the Locator are based on a list of treatment programs authorized under 21 U.S.C. Section 823(g)(1) to dispense (but not prescribe) opioid treatment medications. These treatment programs can admit patients and dispense methadone, Subutex®, or Suboxone®. Please note that CSAT is not a treatment referral agency and cannot make specific recommendations or endorsements regarding treatment programs on the Locator.

If you haven’t already, plase check out our buprenorphine page here at Opiate Addiction Guide.

Support Groups for Quitting Opiates

Lysis — Sat, 10 Oct 2009 21:22:05 +0000

Support groups can be an enormous benefit for someone who is considering quitting from opiates (even if you may not think so, if you are truly dedicated to quitting you should be able to at least see some benefit from such a group). You may have some misconceptions about such groups.

Narcotics Anonymous Logo

Narcotics Anonymous(NA) is probably the most widely known support group, is based on a 12 step program. This program may also involve appeals to a higher power. This may not be everyone’s cup of tea, but there are alternatives. These elements are not enforced on members, however, and NA is a top resource for recovering addicts. From the NA website:

Membership is open to all drug addicts, regardless of the particular drug or combination of drugs used. When adapting AA’s First Step, the word “addiction” was substituted for “alcohol,” thus removing drug-specific language and reflecting the “disease concept” of addiction. Narcotics Anonymous provides a recovery process and peer support network that are linked together. One of the keys to NA’s success is the therapeutic value of addicts working with other addicts. Members share their successes and challenges in overcoming active addiction and living drug-free, productive lives through the application of principles contained within the Twelve Steps and Twelve Traditions of NA. These principles are the core of the Narcotics Anonymous recovery program. Narcotics Anonymous itself is a non-religious program of recovery; each member is encouraged to cultivate an individual understanding-religious or not-of the spiritual principles and apply these principles to everyday life.

There are no social, religious, economic, racial, ethnic, national, gender, or class-status membership restrictions. There are no dues or fees for membership; most members regularly contribute in meetings to help cover the expenses incurred for the rent of a facility space.

Narcotics Anonymous is not affiliated with other organizations, including other twelve step programs, treatment centers, or correctional facilities. As an organization, NA does not employ professional counselors or therapists, nor does it provide residential facilities or clinics. Additionally, the fellowship does not provide vocational, legal, financial, psychiatric, or medical services. NA has only one mission: to provide an environment in which addicts can help one another stop using drugs and find a new way to live.

In Narcotics Anonymous, members are encouraged to comply with complete abstinence from all drugs including alcohol. It has been the experience of NA members that complete and continuous abstinence provides the best foundation for recovery and personal growth. NA as a whole has no opinion on outside issues, including prescribed medications. Use of psychiatric medication and other medically indicated drugs prescribed by a physician and taken under medical supervision is not seen as compromising a person’s recovery in NA.

Another option to consider is SMART (Self-Management and Recovery Training) Recovery. SMART Recovery is a nationwide, nonprofit organization which offers free support groups to individuals who desire to gain independence from any type of addictive behavior. This program adheres to four points:

1) Enhance and maintain motivation to abstain

2) Cope with urges

3) Manage thoughts, feelings, and behaviors

4) Balance momentary and enduring satisfactions

They also differ from traditional 12 step programs in that they approach addiction from a scientific standpoint, rather than through appeals from a higher power:

SMART Recovery® has a scientific foundation, not a spiritual one. SMART Recovery® teaches increasing self-reliance, rather than powerlessness. SMART Recovery® views addictive behavior as a maladaptive habit, rather than as a disease. SMART Recovery® meetings are discussion meetings in which individuals talk with one another, rather than to one another. SMART Recovery® encourages attendance for months to years, but probably not a lifetime. There are no sponsors in SMART Recovery®. SMART Recovery® discourages use of labels such as “alcoholic” or “addict”.

In addition to recovery groups such as these, there are many helpful communities online that encourage peer interaction. This helps when your resolve weakens, it often only takes a good listener at times. One such community is SupportGroups.com (not only focused on narcotics also).

SupportGroups.com is a growing online support groups community. Our goal is to bring people together around life’s challenges by providing concise, up-to-date information and a meeting place for individuals, their friends and families, and professionals who offer pathways to help.

If you are considering getting in touch with a support group, the contact numbers can be found below:

Narcotics Anonymous

PO Box 9999
Van Nuys, California 91409 USA
Telephone (818) 773-9999
Fax (818) 700-0700
Find A Meeting in Your Area

SMART Recovery

7304 Mentor Avenue
Suite F
Mentor, OH 44060
Toll free: 866-951-5357
Tel: 440-951-5357
Fax: 440-951-5358
Find Meetings in Your Area