Opioids

Substance

Opioids are naturally occurring substances found in the milky sap of the opium poppy (opium) or structurally similar to it. They have diverse effects, acting both centrally and peripherally. Among other properties, they possess analgesic, sedative, calming, and psychotropic effects and are used therapeutically primarily for pain, cough suppressant, and in anesthesia.

They are very potent and can therefore lead to potentially dangerous and life-threatening situations, as well as addiction. Furthermore, tolerance can develop, meaning the effects of the drugs may be very strong at first and decrease with repeated use over time.

Be careful when mixing substances!

alcohol
Ketamine
Opioids (painkillers)
Benzodiazepines
Antidepressants/antipsychotics

Codeine

Codeine is a chemical compound found in opium and belongs to the group of opiates. In medicine, codeine is used as a pain reliever (usually in combination with paracetamol) and as a cough suppressant (possibly in combination with antihistamines).

Makatussin is a cough syrup containing dihydrocodeine and diphenhydramine (antihistamines). A mixture of codeine/makatussin with sweetened beverages is called Lean, Texas Tea, Purple Drank, or Sizzurp. This mixture has calming and euphoric properties.

Naloxone

Naloxone is an opioid antagonist. It partially or completely reverses the effects of opioids.

Naloxone is used in emergency medicine as an antidote for opiate overdoses caused by corresponding substances or medications (e.g., heroin and methadone). For example, it prevents respiratory depression (respiratory arrest).

Naloxone triggers a withdrawal syndrome in patients with opiate dependence. Furthermore, it is often combined with certain centrally acting analgesics (tilidine), partly to prevent misuse.

group

Downer

Substance groups

Forms of appearance

Opioids are manufactured in the form of tablets, capsules, drops, orally disintegrating tablets, as injections, or patches, and are used as painkillers, cough suppressants, or anesthetics. In substitution therapy for heroin addiction, the preparations methadone (e.g., Ketalgin®), morphine (e.g., Sevre Long®, MST®), or buprenorphine (e.g., Subutex®) are used.

Consumption patterns

Buprenorphine is taken directly as a medicine, snorted, rarely injected, or administered rectally as a suppository. It is also available as a melt-in-the-mouth tablet that dissolves under the tongue.

dosage

Highly dependent on the preparation and the dosage form.

Methadone :

Methadone : 10 mg–20 mg, max. 60 mg/day.

Codeine

Low dose: 20 – 50 mg

Average dose: 50 – 150 mg

High dose: 150 – max. 200 mg/day

A strong calming effect occurs even at doses as low as 100mg.

Tramadol

Low dose: 50–100 mg

Average dose: 100 – 200 mg

High dosage: 200 – 250mg, caution: respiratory arrest at high dosages.

Effect

The effects of opioids are individual and vary from pain relief to calming, self-confidence, anxiety reduction, sedative, soothing effects to feelings of ecstasy.

Codeine

The effects are individual and dose-dependent. They range from calming effects and mild sedation to euphoria or excitement. In high doses (100-200 mg), codeine is strongly sedating.

Tramadol

Pain-relieving, calming/sedating, euphoric and mood-stabilizing.

Tilidin

Strongly analgesic, mildly sedative, disinhibiting, and anesthetic. In higher doses, euphoric and anxiolytic.

Onset of action

Depending on the preparation, after 30–90 minutes (oral), rectally or by snorting after 10 minutes. Injected after a few seconds.

Duration of effect

Depending on the preparation, 2–12 hours

Aftereffects

up to 24 hours

Risks and side effects

Nausea, vomiting, dizziness, itching, sweating, constipation, feeling cold, dry mouth, headache, loss of appetite, abdominal cramps, slowed pulse, fatigue and rapid heartbeat.

At higher doses (overdose or in combination with other downers), severe side effects can occur: numbness, slowing and suppression of breathing to respiratory arrest, severe drowsiness to unconsciousness, life-threatening shock.

Tramadol

The risk of seizures and the development of serotonin syndrome (excitation, confusion, profuse sweating, muscle cramps, muscle twitching) is possible at higher doses. Severe forms of serotonin syndrome are life-threatening and are increased at higher doses and in combination with antidepressants.

Long-term risks

Tolerance development is the process of becoming accustomed to an opiate, whereby its effect decreases with repeated or chronic use over a certain period of time.

Addiction is accompanied by physical and psychological symptoms and can develop with regular use. Withdrawal symptoms in the case of addiction could include: compulsive cravings for opioids, anxiety or agitation, nausea, vomiting, diarrhea, sleep disturbances, runny nose, and sneezing.

After opioid withdrawal, tolerance to opioids is lost, meaning one becomes as sensitive to opioids as before the addiction. The risk of intoxication is particularly high if the dose consumed again is not drastically reduced compared to the doses taken before withdrawal.

Safer Use

Opioids are highly potent medications and should only be used for a short period of time and preferably under medical supervision.
Start with a low dose and wait to see how it affects you and how well you tolerate it before increasing the dose. Do not exceed the maximum daily dose.
Do not consume opioids with other depressants, especially substances that inhibit breathing: e.g., alcohol, cannabis, benzodiazepines/sleeping pills, GHB/GBL.
Caution when combining with sweet drinks: The dosage is harder to determine, the effect occurs faster and is more intense.
If you inject opioids, dose even more carefully, as the range between the desired effect (rush) and a dangerous overdose is even more difficult to judge. Avoid injecting fentanyl; the risk of overdose is particularly high. Always use new (clean and sterile) injection equipment! Never share syringes, filters, water, or disinfectant swabs to prevent the transmission of hepatitis and HIV.
Take longer breaks (several days) between uses.