Also Known As: Morphine, Diamorphine, Dihydrocodeine, Buprenorphine
Opiate/opioid painkillers are medicines with effects similar to opium. They act by stimulating opioid receptors in the brain and nervous system. There are a large number of opiate/opioid medicines including codeine, morphine, dihydrocodeine, methadone, buprenorphine and diamorphine (also known as heroin).
Opiate painkillers are available either from doctors on prescription or, in relatively low doses, over-the-counter at a pharmacy, combined with aspirin, ibuprofen or paracetamol. They are intended to be used for a limited period of time to treat pain that does not respond to standard effective painkillers like aspirin, ibuprofen and paracetamol.
Opiate painkillers are available in a wide range of forms and various colours. The most common are tablets, capsules and syrups/linctus, and as solutions for injection. Less common forms include lozenges, nasal sprays, suppositories and skin patches.
Opiate painkillers can be swallowed, injected, snorted, sucked or absorbed through the skin or bowel. They are used mainly to treat moderate to severe pain. This can range from relieving acute back pain, to use for broken bones, and for people who are being treated for cancer.
Although opiate painkillers will vary in how powerful they are, they are all sedative painkillers that can depress the nervous system, and so, slow down body functions and reduce physical and psychological pain. They can also be highly addictive.
Although we have not listed all their medical uses, they are often aimed to have the following effects:
- Relief of pain
- Reduced coughing
- Feelings of well-being, relaxation and sleepiness.
An opiate painkiller that has been properly prescribed or has been obtained from your local pharmacy is subject to stringent controls, as with any other medicine, so you can be sure of its strength and that it has not been tampered with. But you can’t be sure about this with opiate painkillers that have been obtained from unreliable or illegal sources. The risks associated with taking an opiate painkiller, especially in high dose, purchased from a source outside the legitimate supply chain (for example, a website – particularly if hosted overseas) may include:
- Nausea or vomiting
- Mood swings
- Feelings of lethargy
- Dizziness or fainting
- In overdose, suppression of normal breathing, and risk of respiratory arrest (when you stop breathing altogether).
Certain opiate painkillers have additional specific non-opioid effects, which may be described by the prescriber, and will be described in the patient information leaflet.
Overuse of codeine when it is taken already combined with one of the simple analgesic drugs, can lead to paracetamol, aspirin or ibuprofen poisoning and even death. Whilst paracetamol, ibuprofen and aspirin may seem harmless in normal doses, they can cause really serious problems in high doses – with risks of kidney failure, liver failure, and of severe damage to, or bleeding from, the stomach, which can be fatal.
There is a greater risk of overdose and death if you are mixing opiate painkillers with other drugs that suppress breathing such as alcohol, benzodiazepines (like diazepam or Valium), and/or other opiate drugs. There’s a particular risk of death due to inhaling vomit – because opiate painkillers can sedate you, can add to the risk of vomiting, and can stop you from coughing properly. The vomit blocks the airways or later leads to pneumonia.
In pregnancy, regularly having taken high doses of opiate painkillers for a continuous sustained period of time in the lead up to delivery can lead to withdrawal symptoms for the newborn baby. For pregnant women who have been using substantial amounts of opiates daily for a period of time, it’s not a good idea to stop using them suddenly without proper advice. This is because this might increase their risk of having a miscarriage or having a premature labour. Women in such circumstances should seek medical advice before stopping.
Injecting any opiate painkiller can do nasty damage to your veins and arteries, and this can lead to gangrene (death of body tissue, usually a finger, toe or a limb), blood clots/thromboses and infections.
There are also risks from sharing needles, syringes and other equipment used for injecting – with the danger of developing serious tissue infections or sharing viral infections like hepatitis B, hepatitis C or HIV.
Opiate painkillers and alcohol
Mixing any opiate painkillers with alcohol, or with other sedatives such as benzodiazepines, can have serious consequences: an overdose is more likely, and this can lead to a coma or respiratory failure and death.
Can you get addicted to opiate painkillers?
Yes, any opiate painkiller can be addictive and produce ‘cravings’ and a psychological desire to keep on using.
Although they are normally safe to take if you follow your doctor’s/pharmacist’s instructions, some people who have used opiate painkillers regularly become dependent on them. If opiate painkillers are taken primarily to get high or to manage psychological pain, the risk of becoming dependent on the drugs is greater.
Opiate painkillers carry warnings on the packs about the risk of addiction and advise that the non-prescription medicines should only be used for up to three days at a time without medical advice.
Tolerance can also build, so that users have to take more just to get the same effects or to avoid unpleasant withdrawals. This is one of the reasons opiates can become ineffective for long-term chronic pain.
Physical dependence is common in regular users. The withdrawal symptoms include tremors, anxiety, yawning, sweating, runny nose, sleep disturbance, nausea, goose-bumps, restlessness, diarrhoea, abdominal cramps and muscle spasms.
Strong opiate painkillers are only available on prescription and most are controlled under of the Misuse of Drugs Act and are classified as Class A or B drugs. So unless an opiate painkiller has been prescribed to you, it’s illegal to have, it’s also illegal to give away or sell opiate painkillers. The Government is currently considering a recommendation to make tramadol illegal.
Depending on the circumstances, possession of a class A opiate painkiller which has not been prescribed for you, could get you community service or up to 7 years in prison and/or an unlimited fine. The unauthorised possession of a class B opiate painkiller, not prescribed, could get you community service or up to 5 years in prison and/or an unlimited fine.
Depending on the circumstances, supplying someone else with a class A or B opiate painkiller, including your friends, could get you the maximum penalty of a jail sentence, ranging from 14 years to life and/or an unlimited fine.
Remember: Having a criminal record can make it difficult for you to get a job or visa if you want to travel abroad.
What’s the difference between possession & supply (dealing)? What happens if you’re under 16? Learn more about drugs and the law.