• Sara Bellum

    This past Drug Facts Chat Day, teens from across the country submitted their questions about drug abuse to NIDA scientists. A teen from Walter Johnson High School in Maryland asked, “What types of opioids are there?

    In general, opioids are psychoactive chemicals that work by binding to opioid receptors in the body. These receptors are found principally in the central and peripheral nervous system as well as the gastrointestinal tract and can produce both the good and bad effects of opioid use.

    Many teens don’t know that there are illegal opioids (like heroin) as well as legal opioids that are prescribed for pain relief (like hydrocodone, which has the brand name of Vicodin). This is why common painkillers like Vicodin are so often abused—because they provide a “high” while relieving pain.

    Here are the main types of opioids:

    • Natural opiates are alkaloids, nitrogen-containing base chemical compounds that occur in plants such as in the resin of the opium poppy. Natural opiates include morphine, codeine, and thebaine.
    • Semi-synthetic opioids are opioids created in labs from natural opiates. Semi-synthetic opioids include hydromorphone, hydrocodone, and oxycodone (the prescription drug OxyContin), as well as heroin, which is made from morphine.
    • Fully synthetic opioids are opioids that are completely manmade, including fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene.

    Some opioids (e.g., morphine, codeine, OxyContin) are used by doctors to treat various things, such as pain after surgery. But opioids also have addictive properties and negative health effects that make them dangerous when abused.

    Do you have other questions about types of drugs? Tell us in comments.

    Want to learn more? Read the blog post, “What Does It Mean to ‘Misuse’ Opioids?”

    Categories: 
    Archived
    Tags: 
    Opioids
    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.
  • The NIDA Blog Team

    Did you know that one way illegal opioids enter the United States is through international mail? Drug traffickers have learned that if they send very small packages of opioids in powdered form, like fentanyl, the drug sometimes goes unnoticed.  

    Not only does this bring dangerous drugs into the United States, it also poses risks for the people who handle the mail. For example, if a package breaks and a postal worker accidentally inhales some fentanyl powder, it can be very harmful.

    Science to the rescue

    The good news is that scientists and technology experts are working to find easier ways to detect these drugs. While NIDA and others are researching health issues related to opioid use, other institutions of the federal government have launched the Opioid Detection Challengea global prize competition for tools and technologies that can quickly detect illegal opioids in international mail.

    In Stage 1 of the Challenge, a call went out to universities and technology leaders asking for detailed ideas—and 83 ideas came in. A panel of experts selected eight finalists, who now move on to the next stage of the Challenge.

    Here are the ideas from three of the finalists:

    1. Use x-rays and "smart" algorithms: This tool uses machine learning algorithms to “learn” from experience (without help from people) how to detect suspicious items. It applies those algorithms to images captured by two x-ray beams that scan a package from different angles.    
    2. Detect nitrogen: This solution uses radio-frequency pulses to find specific molecules that contain nitrogen. Opioid molecules contain nitrogen, and illegal opioids resonate at different radio frequencies—so they can be detected.
    3. Use x-ray diffraction: This technology diffracts (spreads) a broad-spectrum x-ray beam over a package to quickly detect its contents. (X-rays can detect chemicals by “seeing” how the atoms in a substance are arranged.) Then, the diffraction patterns are compared with patterns that are created by illegal drugs.

    To see all the finalists’ ideas, visit the Opioid Detection Challenge website.

    What happens next?

    In Stage 2 of the Challenge, the finalists will develop their plans into real tools. Then, they’ll test the tools for a panel of judges.

    The winning ideas may help reduce the flow of illegal opioids through the mail—just one more way that science is helping to save lives every day. When the winners are announced, we’ll tell you about it!

    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.
  • Sara Bellum

    Learn more about the different types of opioids in this updated post from 2013.

    During the 2013 Drug Facts Chat Day, teens from across the country submitted their questions about drug abuse to NIDA scientists. A teen from Walter Johnson High School in Maryland asked:

    “What types of opioids are there?”

    Opioids are psychoactive chemicals that occur naturally (in the resin of the poppy plant) or can be made in a laboratory. They work by binding to opioid receptors in the central and peripheral nervous system and the gastrointestinal tract.

    There are illegal opioids (like heroin) as well as legal opioids that are prescribed for pain relief (like hydrocodone, which has the brand name of Vicodin). In fact, there is a dangerous trend where people that have become addicted to prescription opioids begin using heroin because it’s cheaper to get.

    There are 3 main types of opioids:

    1. Natural opiates are alkaloids, nitrogen-containing base chemical compounds that occur in plants such as the opium poppy. Natural opiates include morphine, codeine, and thebaine.
    2. Semi-synthetic/manmade opioids are created in labs from natural opiates. Semi-synthetic opioids include hydromorphone, hydrocodone, and oxycodone (the prescription drug OxyContin), as well as heroin, which is made from morphine.
    3. Fully synthetic/manmade opioids are completely manmade, including fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene.

    Prescription opioids (e.g., morphine, codeine, OxyContin) are prescribed by doctors to treat pain and provide millions of people with much needed relief when used as prescribed. However, opioids can produce a “high,” so some people abuse them. This has led to thousands of overdose deaths. In 2008, prescription opioids were responsible for 14,800 overdose deaths and in 2009, for more than 475,000 emergency room visits.

    Do you have other questions about types of drugs? Tell us in comments.

    Update: What does it mean to “misuse” opioids? Find out here.


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    Archived
    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.
  • All materials appearing in the Research Report Series are in the public domain and may be reproduced without permission from NIDA. Citation of the source is appreciated.

  • All materials appearing in the ​Research Reports series are in the public domain and may be reproduced without permission from NIDA. Citation of the source is appreciated.

  • Spoon full of cough and cold medicine

    Some over-the-counter (OTC) and prescription cough and cold medicines contain active ingredients that are psychoactive (mind-altering) at higher-than-recommended dosages and are frequently abused for this purpose. These products may also contain other drugs, such as expectorants and antihistamines, which are dangerous at high doses and compound the dangers of abuse.

    Two commonly abused cough and cold medicines are:

    • Dextromethorphan (DXM), a cough suppressant and expectorant found in many OTC cold medicines. It may produce euphoria and dissociative effects or even hallucinations when taken in quantities greater than the recommended therapeutic dose.
    • Promethazine-codeine cough syrup, a medication that contains codeine, an opioid that acts as a cough suppressant and can also produce relaxation and euphoria when consumed at a higher-than-prescribed dose. It also contains promethazine HCl, an antihistamine that additionally acts as a sedative. Although only available by prescription, promethazine-codeine cough syrup is sometimes diverted for abuse.

    How Are Cough and Cold Medicines Abused?

    Cough and cold medicines are usually consumed orally in tablet, capsule, or syrup form. They may be mixed with soda for flavor and are often abused in combination with other drugs, such as alcohol or marijuana.

    Because they are easily purchased in drugstores without a prescription, cough syrups, pills, and gel capsules containing DXM—particularly “extra strength” forms—are frequently abused by young people (who refer to the practice as “robo-tripping” or “skittling”). To avoid nausea produced by high doses of the expectorant guaifenesin commonly found in DXM-containing syrups, young people may instead abuse Coricidin® HBP Cough & Cold capsules (street name C-C-C or triple-C), which contain DXM but lack guaifenesin.

    Drinking promethazine-codeine cough syrup mixed with soda (a combination called syrup, sizzurp, purple drank, barre, or lean) was referenced frequently in some popular music beginning in the late 1990s and has become increasingly popular among youth in several areas of the country. A variation of “purple drank” is promethazine-codeine cough syrup mixed with alcohol. Users may also flavor the mixture with the addition of hard candies.

    How Does Abusing Cough and Cold Medicines Affect the Brain?

    When taken as intended, cough and cold medicines safely treat symptoms of lower and upper respiratory congestion and discomfort caused by colds and flu. But when taken in higher quantities or when such symptoms aren’t present, they may affect the brain in ways very similar to illegal drugs.

    When taken in high doses, DXM acts on the same cell receptors as dissociative hallucinogenic drugs like PCP or ketamine. Users describe effects ranging from mild stimulation to alcohol- or marijuana-like intoxication, and at high doses, sensations of physical distortion and hallucinations.

    Codeine attaches to the same cell receptors targeted by illegal opioids like heroin. Consuming more than the daily recommended therapeutic dose of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs; people addicted to codeine may consume several times the recommended, safe amount. Also, both codeine and promethazine HCl act as depressants of the central nervous system, producing sedating or calming effects.

    When abused, both codeine and DXM directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain’s reward pathway. Repeatedly seeking to experience that feeling can lead to addiction—a chronic relapsing brain disease characterized by inability to stop using a drug despite damaging consequences to a person’s life and health.

    What Are the Other Health Effects of Abusing Cough and Cold Medicines?

    Abusing DXM can cause impaired motor function, numbness, nausea or vomiting, increased heart rate and blood pressure, and at high doses, extreme agitation, increased body temperature, and a buildup of excess acid in body fluids. High doses of acetaminophen, a pain reliever commonly found with DXM, can cause liver damage. On rare occasions, hypoxic brain damage—caused by severe respiratory depression and a lack of oxygen to the brain—has occurred as a result of the combination of DXM with decongestants often found in the medication.

    When abused, promethazine-codeine cough syrup presents a high risk of fatal overdose due to its effect of depressing the central nervous system, which can slow or stop the heart and lungs. Mixing with alcohol greatly increases this risk. Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.

    Learn More

    For more information on abuse of DXM, see
    http://www.deadiversion.usdoj.gov/drug_chem_info/dextro_m.pdf (PDF, 37KB)

    For more information on abuse of promethazine-codeine cough syrup, see
    http://www.drugabuse.gov/drugs-abuse/emerging-trends

  • Some medications have psychoactive (mind-altering) properties and, because of that, are sometimes abused—that is, taken for reasons or in ways or amounts not intended by a doctor, or taken by someone other than the person for whom they are prescribed. In fact, prescription and over-the-counter (OTC) drugs are, after marijuana (and alcohol), the most commonly abused substances by Americans 14 and older.

    Past year illicit use among 12th graders, Marijuana 36.4%, Amphetamines 8.7%, Synthetic Marijuana 7.9%, Adderall 7.4%, Vicodin 5.3%, Cough med 5.0%, Tranquilizers 4.6%, Hallucinogens 4.5%, Sedatives 4.8%, Salvia 3.4%, Oxycontin 3.6%, MDMA 4.0%, Inhalants 2.5%, Cocaine 2.6%, Ritalin 2.3%

    The classes of prescription drugs most commonly abused are: opioid pain relievers, such as Vicodin or Oxycontin; stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin; and central nervous system (CNS) depressants for relieving anxiety, such as Valium or Xanax.1 The most commonly abused OTC drugs are cough and cold remedies containing dextromethorphan.

    People often think that prescription and OTC drugs are safer than illicit drugs, but that’s only true when they are taken exactly as prescribed and for the purpose intended. When abused, prescription and OTC drugs can be addictive and put abusers at risk for other adverse health effects, including overdose—especially when taken along with other drugs or alcohol.

    How Are Prescription Drugs Abused?

    Prescription and OTC drugs may be abused in one or more of the following ways:

    Taking a medication that has been prescribed for somebody else. Unaware of the dangers of sharing medications, people often unknowingly contribute to this form of abuse by sharing their unused pain relievers with their family members. 

    Most teenagers who abuse prescription drugs are given them for free by a friend or relative.

    Taking a drug in a higher quantity or in another manner than prescribed. Most prescription drugs are dispensed orally in tablets, but abusers sometimes crush the tablets and snort or inject the powder. This hastens the entry of the drug into the bloodstream and the brain and amplifies its effects.

    Graphic showing the spectrum of Prescription Drug Abuse from improper use to abuse: 1 Taking someone else's prescription to self-medicate. 2 Taking a prescription medication in a way other than prescribed. 3 Taking a medication to get high.

    Taking a drug for another purpose than prescribed. All of the drug types mentioned can produce pleasurable effects at sufficient quantities, so taking them for the purpose of getting high is one of the main reasons people abuse them.

    ADHD drugs like Adderall are also often abused by students seeking to improve their academic performance. However, although they may boost alertness, there is little evidence they improve cognitive functioning for those without a medical condition.

    How Do Prescription and OTC Drugs Affect the Brain?

    Taken as intended, prescription and OTC drugs safely treat specific mental or physical symptoms. But when taken in different quantities or when such symptoms aren’t present, they may affect the brain in ways very similar to illicit drugs.

    For example, stimulants such as Ritalin achieve their effects by acting on the same neurotransmitter systems as cocaine. Opioid pain relievers such as OxyContin attach to the same cell receptors targeted by illegal opioids like heroin. Prescription depressants produce sedating or calming effects in the same manner as the club drugs GHB and rohypnol. And when taken in very high doses, dextromethorphan acts on the same cell receptors as PCP or ketamine, producing similar out-of-body experiences.

    When abused, all of these classes of drugs directly or indirectly cause a pleasurable increase in the amount of dopamine in the brain’s reward pathway. Repeatedly seeking to experience that feeling can lead to addiction.

    What Are the Other Health Effects of Prescription and OTC Drugs?

    Opioids can produce drowsiness, cause constipation, and—depending upon the amount taken—depress breathing. The latter effect makes opioids particularly dangerous, especially when they are snorted or injected or combined with other drugs or alcohol.

    Opioids and Brain Damage

    While the relationship between opioid overdose and depressed respiration (slowed breathing) has been confirmed, researchers are also studying the long-term effects on brain function. Depressed respiration can affect the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term psychological and neurological effects, including coma and permanent brain damage.

    Researchers are also investigating the long-term effects of opioid addiction on the brain. Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.

    More people die from overdoses of prescription opioids than from all other drugs combined, including heroin and cocaine (see "The Prescription Opioid Abuse Epidemic" below).

    The Prescription Opioid Abuse Epidemic

    Over 2 million people in the United States suffer from substance use disorders related to prescription opioid pain relievers. The terrible consequences of this epidemic include overdose deaths, which have more than quadrupled in the past decade and a half. The causes are complex, but they include overprescription of pain medications. In 2013, 207 million prescriptions were written for prescription opioid pain medications.

    Opiod deaths (per 100,000 population) by age group,  15-24 years old, Opioids 3.7, illegal drugs 2.2, 25-34 year olds, Opiods 7.1, Illegal 4.4, 35-44 year olds, Opiods 8.3, illiegal 5.3, 45-54 year olds, Opioids 10.4, Illegal 6, 55-64 year olds, Opioids 5, Illegal 2.5, over 65, Opiods 1, Illiegal .3

    Stimulants can have strong effects on the cardiovascular system. Taking high doses of a stimulant can dangerously raise body temperature and cause irregular heartbeat or even heart failure or seizures. Also, taking some stimulants in high doses or repeatedly can lead to hostility or feelings of paranoia.

    CNS depressants slow down brain activity and can cause sleepiness and loss of coordination. Continued use can lead to physical dependence and withdrawal symptoms if discontinuing use.

    Prescription Opioid Abuse: A First Step to Heroin Use?

    Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and research now suggests that abuse of these drugs may actually open the door to heroin abuse.

    Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids.

    Many of these young people also report that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration.

    Dextromethorphan can cause impaired motor function, numbness, nausea or vomiting, and increased heart rate and blood pressure. On rare occasions, hypoxic brain damage—caused by severe respiratory depression and a lack of oxygen to the brain—has occurred due to the combination of dextromethorphan with decongestants often found in the medication.

    All of these drugs have the potential for addiction, and this risk is amplified when they are abused. Also, as with other drugs, abuse of prescription and OTC drugs can alter a person’s judgment and decision making, leading to dangerous behaviors such as unsafe sex and drugged driving.

    Learn More

    For more information on prescription and OTC drugs, please refer to the following sources on NIDA’s Web site:

    References

    1. These are proprietary names of particular drug products. Generic versions may also exist.
  • The NIDA Blog Team

    UPDATE (January 2017): The Drug Enforcement Administration (DEA) sought public comment on its decision to add kratom to Schedule I. The comment period has closed. The Drugs & Health Blog will provide an update when more information is available.

    UPDATE (September 2016): On August 31, 2016, the Drug Enforcement Administration (DEA) published in a notice of intent to temporarily place two opioid-like chemicals found in the kratom plant, mitragynine and 7-hydroxymitragynine, in Schedule I.

    Substances with a Schedule I classification, according to the DEA, could easily be abused and don’t currently have an accepted medical use in the U.S. (Other Schedule I substances include heroin, marijuana, and LSD.)

    The DEA received numerous comments from researchers, members of the public, and congress expressing concerns about this action. In response the DEA has withdrawn its notice of intent and is soliciting public comments on this issue. Instructions for providing comments can be found here.


    Kratom is a tropical tree found in Southeast Asia, with leaves that contain some of the same chemicals found in opioids. Some people—especially in areas of the world where kratom trees are common—use it as a stimulant.

    Kratom isn’t currently an illegal substance, and has been easy to order on the Internet in recent years. In spite of its easy availability, however, we’re still learning about kratom’s effects on a person’s brain and body. Here are some things we know about kratom—and just as important, what isn’t known yet.

    What’s known about it

    • People have used kratom leaves as a stimulant, for pain relief, or to improve mood. The leaves have a bitter taste, and are sometimes made into powder for tea, chewed or smoked, or eaten in food.
    • Kratom may also be sold as a leaf, powder (sometimes in packets labeled “not for human consumption”), or extract, with names like Herbal Speedball, Biak-biak, Ketum, Kahuam, Itrhang, or Thom. 
    • If you consume kratom, you could have some uncomfortable and possibly dangerous side effects: nausea, itching, sweating, increased sensitivity to sunburn, loss of appetite, and, for some users, psychotic symptoms (bizarre behavior, strange beliefs, hearing voices, etc.).
    • Kratom users might also experience long-lasting health effects: difficulty sleeping (insomnia), frequent urination, darkening of the skin, dry mouth, and anorexia (an intense fear of gaining weight, which can lead a person to dramatically reduce the amount of food they eat and resist maintaining a healthy weight).
    • Commercial forms of kratom are sometimes laced with other compounds that have caused deaths.

    What we don’t know

    • It isn’t clear yet whether kratom is addictive, but users can become dependent on it: Their bodies will have side effects if they try to stop using it.  Some users have reported becoming addicted to kratom, which means they go to great lengths to keep using it, even when there are negative consequences for their relationships, jobs, or health. Plus, a study in Thailand has found that people who use kratom over a period of several years have a much higher risk of using other substances—especially heroin, MDMA, and meth.
    • If kratom is addictive, we don’t know yet which kinds of treatment could help with the addiction.
    • It’s impossible to know what other ingredients may be mixed in with kratom that’s sold commercially. For this reason, the Food and Drug Administration (FDA) has warned people not to use any products labeled as containing kratom.

    Consider the potential risks before you decide to use any drug. As with synthetic marijuana and other unregulated drugs, what we don’t know about kratom could end up being the most important information of all.

    Categories: 
    Other Drugs
    Tags: 
    Opioids
    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.
  • Provides facts for teens about opioids, including prescription pain medicines and heroin. 

  • Image courtesy of NIH.

    The NIDA Blog Team

    Americans’ misuse of opioids is a national health crisis. There were more than 42,000 drug overdose deaths involving opioids in 2016. (Remember, opioids can be prescription pain relievers or illegal drugs like heroin.)

    However, there’s a good reason to believe things may improve: Science is taking on the opioid crisis.

    The HEAL Initiative

    The National Institutes of Health (NIH) recently announced an initiative called Helping to End Addiction Long-term, or HEAL. It’s a massive plan involving many of the NIH Institutes (including NIDA) and other U.S. health agencies. The HEAL Initiative has two major goals:

    • Improve treatments for opioid misuse and addiction, so fewer people develop opioid use disorders or die from an overdose.
    • Improve ways to help people manage long-term pain, so they’re less likely to need prescription opioid pain relievers.

    New treatments and more

    To reach these goals, NIDA is stimulating some new research. It includes:

    • Developing new treatments for addiction and new ways to reverse an overdose.
      • For instance, naloxone can reverse an overdose from prescription opioids and heroin. Scientists are now trying to develop other medicines that can better reverse overdoses of stronger opioids like illegally produced fentanyl.
    • Learning how communities can work together to prevent and treat opioid addiction.
      • Researchers will try to coordinate care in communities hard-hit by the opioid crisis. This includes better coordination of different parts of the community, including health care, the justice system, and first responders like fire departments and emergency medical services.
    • Expanding the use of clinical trials to discover new treatments for addiction.
      • A clinical trial means doing research with people. NIDA will expand its Clinical Trials Network, so more people will have access to studies that test new medicines and other therapies for opioid addiction. This should help people in many rural areas, where it may be hard to access treatment.
    • Improving access to high-quality addiction treatment in justice settings.
      • Behaviors and decisions related to drug use are major reasons people get arrested. Researchers will work with people in jails, prisons, and other justice settings to find out what strategies help most as these people try to improve their situations, including getting treatment for their opioid use problems.   

    The NIH HEAL Initiative and its research are happening right now. We’ll keep you posted on the results.

    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.
  • Image by NIDA

    The NIDA Blog Team

    There’s been a lot of talk about the opioid crisis lately. You might be wondering: What exactly are opioids? And why are they such a problem?

    If you’ve had a sports injury or surgery, your doctor may have prescribed you an opioid for pain relief. When taken as prescribed by a medical professional, opioids are relatively safe and can be very good at treating pain. However, some people misuse opioids to get high—"misuse" means taking a medication that wasn’t prescribed for you, or taking more of it than your doctor prescribed.

    Here are some facts about opioids you should know:

    What are opioids?

    Opioids are naturally found in the opium poppy plant. Some prescription opioids are made from this plant, and others are synthetic (made in labs).

    What are the most commonly used opioids?

    The most commonly used prescription opioids are oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Some slang terms for misused opioid pills are “Oxy,” “Percs,” and “Vikes.”

    Another opioid, heroin, is not a medication and is often shot into the arm through a syringe to produce a high. Sometimes prescription opioids are misused by being crushed and injected.

    What are the risks of misusing opioids?

    Opioid misuse can cause harmful health effects like slowed breathing, which can lead to a fatal overdose.

    When misused repeatedly, opioid use can also change the brain, leading to addiction.

    Any other opioids I should know about?

    Yes. Fentanyl is an opioid drug that’s 50 to 100 times more powerful than heroin. Medically, it’s used to treat extreme pain and for pain related to surgeries. But it’s also made illegally and mixed with other drugs. Illegal fentanyl is responsible for many fatal overdoses in people who thought they were taking another drug.

    For your own safety, use an opioid only under the care of a doctor and only as prescribed. Learn more opioid facts for teens here.

    Comments posted to the Drugs & Health Blog are from the general public and may contain inaccurate information. They do not represent the views of NIDA or any other federal government entity.