• Opium Poppy
  • Morphine Tablets
  • Heroin
  • Hydrocodone Tablets
  • Oxycodone Tablets
  • Opium Tea Ceremony
  • Heroin Abuse
(1) Opium Poppy (2) Morphine Tablets (3) Heroin (4) Hydrocodone Tablets (5) Oxycodone Tablets (6) Opium Tea (7) Heroin Abuse

Opiates Fact Card

  • Drug Class:
    Narcotic Analgesics, Antitussives, Antidiarrheals
  • DEA Class:
    Schedule 1: Codeine Methylbromide, Dihydromorphine, Etorphine (Except HCl), Heroin, Hydromorphinol, Morphine Methylbromide, Morphine Methylsulfonate, Nicocodeine, Pholcodine, Thebacon
  • DEA Class:
    Schedule 2: Codeine, Dihydrocodeine, Etorphine HCl, Ethylmorphine, Hydrocodone, Hydromorphone, Morphine, Opium (Granulated), Opium (Powdered), Opium (Raw), Opium Extracts, Opium Fluid Extract, Opium Poppy, Opium Tincture, Oxycodone, Oxymorphone, Poppy Straw, Poppy Straw Concentrate, Thebaine
  • DEA Class:
    Schedule 3: Codeine and Isoquinoline Alkaloid, Codeine Combination Product, Dihydrocodeine Combination Product, Ethylmorphine Combination Product, Morphine Combination Product, Opium Combination Product
  • DEA Class:
    Schedule 5: Codeine Preparations, Dihydrocodeine Preparations, Ethylmorphine Preparations, Opium Preparations
  • Availability in US:
    Prescription Forms, Illicit Forms
  • Variations:
    Natural Opiates, Semi-synthetic Opiates, Opium Tinctures, Raw Opium
  • Synonyms:
    Painkillers, Methylmorphine (Codeine), Codethyline (Ethylmorphine), Dihydrocodeinone (Hydrocodone), Dihydromorphinone (Hydromorphone), Paramorphine (Thebaine)
  • Brand Names:
    Anexsia (Hydrocodone), Astramorph (Morphine), Dilaudid (Hydromorphone), Duramorph (Morphine), Embeda (Morphine), Exalgo (Hydromorphone), Fioricet with Codeine, Fiorinal with Codeine, Hysingla (Hydrocodone), Infumorph (Morphine), Kadian (Morphine), Mitigo (Morphine), Morphabond (Morphine), MS Contin (Morphine), Norco (Hydrocodone), Obredon (Hydrocodone), Opana (Oxymorphone), Oxaydo (Oxycodone), Oxycet (Oxycodone), OxyContin (Oxycodone), Percocet (Oxycodone), Percodan (Oxycodone), Prometh VC with Codeine, Reprexain (Hydrocodone), Rezira (Hydrocodone), Roxicet (Oxycodone), Roxicodone (Oxycodone), Trezix (Dihydrocodeine), Triacin (Codeine), TussiCaps (Hydrocodone), Tussigon (Hydrocodone), Tuxarin (Codeine), Tuzistra (Codeine), Tylenol with Codeine, Vituz (Hydrocodone), Xtampza (Oxycodone), Zohydro (Hydrocodone), Zutripro (Hydrocodone)
  • Street Names:
    Pain Pills, Blues (Oxycodone), Dillies (Hydromorphone), H (Heroin), Oxy (Oxycodone), Percs (Oxycodone), Roxies (Oxycodone), Smack (Heroin), Tar (Opium

What are opiates?

The opiates are a group of narcotic analgesic drugs derived from the opium poppy plant, belonging to the broader opioid drug family. The poppy's seed pod contains a milky sap, which is dried and cultivated. This raw opium, in addition to the poppy straw (whole plant material), provides the raw material for the natural opiates and the semi-synthetic opiates[1] Opiates are highly addictive and are at the center of much controversy regarding their medical use as a solution in chronic pain management.

Opium Poppy
Opium Poppy

Opiates take on many forms and can have both licit and illicit origins. Licit forms are available in the US only by prescription and for use by licensed medical facilities, indicated as analgesics, as antitussives, and to some extent as antidiarrheals. Licit opiates include, most notably: morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone, buprenorphine, and opium tinctures. Illicit opiates include heroin, raw opium, and any licit prescription opiates that are diverted prescriptions or the subjects of other forms of diversion.

Natural Opiates

The natural opiates are alkaloids that occur naturally in the opium poppy, most notably morphine, codeine, thebaine, and oripavine. These compounds are extracted from either the raw opium or the bulk poppy plant material known as poppy straw — defined as all parts of the opium poppy plant after mowing, except for the seeds. For the most part, poppy straw has replaced raw opium as the raw material used for the extraction of natural opiate alkaloids. Morphine is the predominant alkaloid found in the majority of opium poppy varieties, though some varieties are grown that favor the other alkaloids. [1]

Natural opiates provide the starting material for the synthesis of the semi-synthetic opiates and are monitored under tight international controls. Only morphine and codeine are found in the form of commercially available prescription drugs. [1]

Morphine

Morphine is the most abundant of the natural opiate alkaloids found in the opium poppy, and is used as a reference parameter for clinical comparisons involving other opioid drugs. Morphine can be converted into other narcotics and it can also be found in its end product form as a prescription drug. Approximately 87% of morphine manufactured globally is converted into other narcotic drugs. []

Prescription morphine can be found in the form of oral tablets, oral capsules, oral solutions, and injectable forms — indicated for the management of pain not responsive to non-narcotic analgesics.

Morphine Tablets
Morphine Tablets

Codeine

Codeine is a natural opiate alkaloid found in the opium poppy, though in much lower concentrations than morphine. Codeine can be converted into other narcotics, such as hydrocodone — and it can also be found in its end product form as a prescription drug. However, the majority of codeine is derived from morphine through a semi-synthetic process. [1]

Prescription codeine is available primarily in combination with other drugs (coformulations), in the form of oral tablets, oral capsules, and oral solutions. Some combinations are indicated for treating pain, and some are indicated for treating coughs and respiratory symptoms associated with allergies and the common cold. Codeine formulas indicated for treating varying levels of pain include codeine only (monoproduct) and codeine combined with one or more of the following ingredients: acetaminophen; aspirin, butalbital, caffeine; and carisoprodol. Formulas indicated for treating coughs and respiratory symptoms include codeine combined with one or more of the following ingredients: chlorpheniramine, phenylephrine; promethazine; pseudoephedrine, and triprolidine.

Purple drank, also known as sizzurp or lean, is a codeine-based concoction abused in many urban and suburban regions of the United States. Recipes vary, but typically begin with a codeine-based cough syrup, such as codeine with promethazine. The cough syrup is diluted with a sweet beverage, such as Sprite, 7Up, or Kool-Aid. Crushed candies, such as Jolly Ranchers, might be added. These liquid potions can be deceptively dangerous. As with any opioid, the potential for addiction and physical dependence is significant. In recent times, many high-profile athletes and musicians have been arrested and charged with possession of purple drank or codeine syrup.

Thebaine

Thebaine is a natural opiate alkaloid found in the opium poppy. Thebaine is not found in the form of an end product used for medical purposes. Though it is commonly used as the starting material in the manufacture of a number of semi-synthetic opiates, including hydrocodone, oxycodone, oxymorphone, buprenorphine, dihydrocodeine, and etorphine. In 2016, the United States accounted for 73.6% of the world's thebaine utilization. [1]

Oripavine

Oripavine is a natural opiate alkaloid found in the opium poppy. Oripavine is not found in the form of an end product used for medical purposes. Though it can be used as the starting material in the manufacture of other narcotics, including hydromorphone, oxymorphone, and buprenorphine[1]

Semi-synthetic Opiates

The semi-synthetic opiates are derived from the natural opiates, primarily morphine and thebaine. Example of semi-synthetic opiates include heroin, hydrocodone, hydromorphone, oxycodone, oxymorphone, and buprenorphine.

Heroin

Heroin is a semi-synthetic opiate derived from raw opium, which has been converted to morphine[2] Heroin is typically found in the form of a white to brown powder and is consumed by snorting or by injecting after the powder is liquefied. Many heroin addicts choose injection because it provides the most efficient manner of delivering the drug to the central nervous system, maximizing limited supplies and funds. However, many users choose to snort the drug due to social stigmas surrounding the practice of injecting narcotics.

Heroin
Heroin

Heroin is an illegal Schedule 1 drug in the United States, with no accepted medical purpose. Misuse has reached epidemic numbers in the US, with an estimated 435,000 heroin users during the year 2014. [3] Heroin is powerfully addictive and prone to producing strong physical dependence. Overcoming heroin addiction is extremely difficult, often requiring professional assistance, frequently with unsuccessful outcomes. From 2002 through 2013, heroin-related overdose deaths nearly quadrupled, with over 8,200 deaths in the US in 2013.

Hydrocodone

Hydrocodone is a semi-synthetic opiate derived from thebaine or codeine[1] available in the United States only by prescription and for use by licensed medical facilities. Prescription hydrocodone is found primarily in combination with other drugs (coformulations), in the form of oral tablets, oral capsules, and oral solutions. Some combinations are indicated as analgesics for treating pain, and some are indicated as antitussives for treating coughs and respiratory symptoms associated with allergies and the common cold. Hydrocodone formulas indicated for treating varying levels of pain include hydrocodone only (monoproduct) and hydrocodone combined with either acetaminophen or ibuprofen. Formulas indicated for treating coughs and respiratory symptoms include hydrocodone combined with one or more of the following ingredients: chlorpheniramine, guaifenesin, homatropine, and pseudoephedrine.

Hydrocodone Tablets
Hydrocodone Tablets

Hydrocodone is highly addictive and is one of the most widely used and misused drugs in the United States. In 2016, the US accounted for nearly 100% of the global manufacture and 99.1% of the global consumption of hydrocodone. [1] More than 24 million Americans are estimated to have used hydrocodone for non-medical use during their lifetime; [4] and in 2011, over 82,000 emergency room incidents were estimated to be related to non-medical use of hydrocodone in the US[5]

Hydromorphone

Hydromorphone is a semi-synthetic opiate derived from morphine[1] available in the United States only by prescription and for use by licensed medical facilities. Prescription hydromorphone is found in the form of oral tablets, oral capsules, oral solutions, and injectable forms, prescribed as an analgesic for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Hydromorphone is a potent opiate painkiller and produces strong euphoric effects similar to oxycodone. The US accounted for nearly 67.4% of hydromorphone's global manufacture and 49.3% of its global consumption in 2016. However, compared with oxycodone and other narcotic analgesics, US manufacture and consumption of hydromorphone are dramatically lower. [1] Like oxycodone, hydromorphone is powerfully addictive and prone to producing strong physical dependence. In 2011, in the US, approximately 18,000 emergency room incidents were estimated to be related to non-medical use of hydromorphone.

Oxycodone

Oxycodone is a semi-synthetic opiate derived from thebaine[1] available in the United States only by prescription and for use by licensed medical facilities. Prescription oxycodone is found in the form of oral tablets, oral capsules, and oral solutions, prescribed as an analgesic for treating varying levels of pain. Oxycodone is available in both monoproduct form and in combination with other drugs (coformulations), including acetaminophen, aspirin, and ibuprofen.

Oxycodone Tablets
Oxycodone Tablets

Oxycodone is a potent opiate painkiller and produces strong euphoric effects, making it highly sought-after in the United States. In 2016, the US accounted for 69.2% of its global manufacture and 72.9% of its global consumption. [1] Oxycodone is powerfully addictive and prone to producing strong physical dependence. Overcoming oxycodone addiction is extremely difficult, often requiring professional assistance, frequently with unsuccessful outcomes. In 2011, in the US, over 151,000 emergency room incidents were estimated to be related to non-medical use of oxycodone.

Oxymorphone

Oxymorphone is a semi-synthetic opiate derived from thebaine or morphine[1] available in the United States only by prescription and for use by licensed medical facilities. Prescription oxymorphone is found in the form of oral tablets, indicated as an Aaalgesic for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Oxymorphone is a potent opiate painkiller and produces strong euphoric effects. Oxymorphone is powerfully addictive and prone to producing strong physical dependence. However, oxymorphone use and popularity falls far short of other similar narcotic analgesics, as worldwide stocks of oxymorphone are significantly lower in comparison. [1] In addition, very few options are available in the United States by prescription.

Buprenorphine

Buprenorphine is a semi-synthetic opiate derived from thebaine[1] available in the United States only by prescription and for use by licensed medical facilities. Prescription buprenorphine is found in a wide variety of forms: as oral tablets, sublingual or buccal films, injectable forms, transdermal patches, and subdermal implants. Buprenorphine is prescribed primarily for treating opioid use disorder (OUD) during medication-assisted therapy (MAT), most notably under the brand name Suboxone. Less commonly, buprenorphine might be prescribed as an analgesic for treating pain. Buprenorphine can be found in monoproduct form and in combination with naloxone to discourage misuse by injection.

Opium Tinctures

Opium tinctures are legacy solutions of anhydrous morphine in alcohol and water, dispensed as antidiarrheals for treating diarrhea. These tinctures are available by prescription in the United States. However, they are not FDA-approved drugs, as they predate the Food, Drug, and Cosmetic Act of 1938. As such, they have been grandfathered in, allowing them to remain on the US market.

Two types of opium tinctures are currently available in the United States: laudanum and paregoric. The most notable difference is that laudanum is 25 times more concentrated than paregoric. Hence, laudanum is tagged by the DEA with the more restrictive Schedule 3 designation. Paregoric is a Schedule 2 substance.

Raw Opium

Raw opium refers to the milky sap harvested from the opium poppy plant. This sap might be cultivated and used as raw material in the production of the natural opiates and the semi-synthetic opiates. However, the bulk poppy plant materials known as poppy straw has predominantly replaced raw opium for these purposes. [1]

Opium Poppy
Opium Poppy

Raw opium as a drug of abuse is not commonly encountered in the United States. However, in world regions where the opium poppy is cultivated, opium is consumed on a local level, where it might be smoked or consumed as a tea.

Opium Tea Ceremony
Opium Tea Ceremony

Opioid Abuse and Addiction

Over the years, opioid use and abuse has become endemic in the United States. As of 2011, the US accounted for approximately 75% of the world's opioid prescriptions. Opioids are attractive to recreational users due to the strong euphoric effects they produce. Opioids are also heavily targeted by opioid addicts, who require a continuous supply in order to avoid withdrawal symptoms. Many users are likely to combine opioid use with the use of a benzodiazepine such as Xanax, in order to enhance the effects of the opioid. When potent CNS drugs are combined in such fashions, or when combined with alcohol, results can be unpredictable and at worst fatal. [6]

Opioids can be powerfully addictive and are prone to producing strong physical dependence. Many opioid addictions begin with legitimate prescriptions for painkillers, such as oxycodone. When prescriptions are terminated, many patients have difficulty coping with the harsh withdrawal symptoms and continue using painkillers obtained through diverted sources. When high cost or lack of availability prevents this, many turn to cheaper opioid alternatives, such as heroin or diverted buprenorphine (Suboxone). For the opioid addicted attempting abstinence, withdrawal symptoms can be debilitating and long lasting, often requiring professional assistance.

Heroin Abuse
Heroin Abuse

Urine Testing for Opiates

Opiate urine tests target morphine, with possible cross-reactivity for a list of different opiates and metabolites, including morphine 3-B-D-glucuronide (M3G), codeine, hydrocodone, and hydromorphone. Morphine is prominent in the urine of those ingesting morphine or heroin[7][8] M3G is prominent as a metabolite in the urine of those ingesting morphine or heroin. [7][8] Codeine is prominent as unchanged parent drug in the urine of those ingesting codeine[9] Hydrocodone is prominent as unchanged parent drug in the urine of those ingesting hydrocodone[10] Hydromorphone is prominent as unchanged parent drug in the urine of those ingesting hydromorphone[11]

Opiates Drug Test
Opiates Drug Test

Opiate urine tests detect morphine and heroin use primarily due to their cross-reactivity with the metabolite morphine 3-B-D-glucuronide (M3G) and with free unchanged morphine. Although urine tests for opiates do target morphine, it's important to note that conjugated morphine in the form of M3G appears in significantly higher concentrations in the urine of those ingesting morphine or heroin. So, sensitivity to M3G, rather than sensitivity to morphine, will have a far greater impact on an assay's ability to detect the use of morphine or heroin. Following a morphine dose, approximately 45–55% is recovered in the urine as morphine 3-B-D-glucuronide (M3G), 10–15% as morphine 6-B-D-glucuronide (M6G), and less than 10% as free morphine. [7] Following heroin use, approximately 57% is recovered in the urine as conjugated morphine (primarily morphine 3-B-D-glucuronide (M3G) and morphine 6-B-D-glucuronide (M6G)), 5% as free morphine, and less than 1% as 6-monoacetylmorphine (6-MAM). [8]

Codeine, hydrocodone, and hydromorphone are detected in opiates urine tests as unchanged parent drug, as long as the drug concentration in urine is high enough to exceed the cross-reactivity cutoff level for the compound. In general, chronic, heavy use is far more likely to produce a positive reading compared with isolated, individual doses. According to "Disposition of Toxic Drugs and Chemicals in Man" (3rd ed): approximately 5–17% of a codeine dose is recovered in the urine as free unchanged codeine, [9] approximately 12% of a hydrocodone dose is recovered in the urine as free unchanged hydrocodone, [10] and approximately 6% of a hydromorphone dose is recovered in the urine as free unchanged hydromorphone. [11]

For detecting the opiate oxycodone, specific oxycodone urine tests are available.

For detecting the opiate buprenorphine, specific buprenorphine urine tests are available.

Related Pages

References

Links for references open in a new tab or window.

  1. (2018). "Narcotic Drugs — 2017". International Narcotics Control Board. Retrieved from: https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/narcotic_drugs_reports.html, [PDF file]
  2. Zerell U, Ahrens B, Gerz P. (2005). "Documentation of a Heroin Manufacturing Process in Afghanistan". United Nations Office on Drugs and Crime, Bulletin on Narcotics, Volume LVII, No. 1. Retrieved from: http://www.unodc.org/unodc/en/data-and-analysis/bulletin_2005-01-01_1.html, [PDF file]
  3. Hedden SL, Kennet J, Lipari R, Medley G, Tic P. (2015). "Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health". Substance Abuse and Mental Health Services Administration, HHS Publication No. SMA 15-4927, NSDUH Series H-50. Retrieved from: https://store.samhsa.gov/product/Behavioral-Health-Trends-in-the-United-States/sma15-4927, [PDF file]
  4. (2015, Sep 10). "Results from the 2014 National Survey on Drug Use and Health: Detailed Tables", [Table 1.89A]. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Retrieved from: https://www.samhsa.gov/data/report/results-2014-national-survey-drug-use-and-health-detailed-tables, [PDF file]
  5. Crane EH. (2015, Nov 5). "The CBHSQ Report: Emergency Department Visits Involving Narcotic Pain Relievers". Substance Abuse and Mental Health Services Administration. Retrieved Dec 12, 2018, from: http://www.samhsa.gov/data/sites/default/files/report_2083/ShortReport-2083.html
  6. Jones JD, Mogali S, Comer SD. (2012, Sep 1). "Polydrug Abuse: A review of Opioid and Benzodiazepine Combination Use". Drug and Alcohol Dependence, 125(1–2): 8–18. PMCID:PMC3454351, [PDF file]
  7. Glare PA, Walsh TD. (1991, Jan). "Clinical Pharmacokinetics of Morphine". Therapeutic Drug Monitoring, 13(1): 1–23. PMID:2057987
  8. Cone EJ, Welch P, Mitchell JM, Paul BD. (1991, Jan/Feb). "Forensic Drug Testing for Opiates: I. Detection of 6-Acetylmorphine in Urine as an Indicator of Recent Heroin Exposure; Drug and Assay Considerations and Detection Times". Journal of Analytical Toxicology, 15(1): 1–7. PMID:2046334
  9. Baselt RC, Cravey RH. (1989). "Disposition of Toxic Drugs and Chemicals in Man" (3rd ed, pp 214–216). USA: Year Book Medical Publishers, Inc.
  10. Baselt RC, Cravey RH. (1989). "Disposition of Toxic Drugs and Chemicals in Man" (3rd ed, pp 411–412). USA: Year Book Medical Publishers, Inc.
  11. Baselt RC, Cravey RH. (1989). "Disposition of Toxic Drugs and Chemicals in Man" (3rd ed, pp 415–416). USA: Year Book Medical Publishers, Inc.

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