Opioid painkillers

Opioid painkillers are medicines that may be prescribed short-term to help with moderate or severe pain relief. Some opiates, such as codeine, when combined at low doses with other painkillers like paracetamol, ibuprofen or aspirin can be bought over the counter in pharmacies.

Counterfeit medicines, which are purposely made to look like real ones, can be very hard to tell from real medicines. You can only be sure that an opioid painkiller is real if obtained from a pharmacy registered in the UK.

Some drugs are increasingly cut with dangerous synthetic opioids like nitazenes , which are killing people across the UK. This is happening in a wide range of drugs, including dodgy opioid painkillers. You can never really know what is in any street or counterfeit drug. It’s especially important to avoid falsified oxycodone tablets marked with “OP” and “40”, “OP” and “80” or “Percocet” as some have been found to contain nitazenes. Find out more about the risks and what to do here.

Also called:

Codeine
Morphine
OP 40s
OP 80s
Oxycodone
Oxycontin
Oxys
Percocet
Percs
Tapentadol
Tramadol

What does it look like?

Opioid painkillers are available in a wide range of forms and colours, with different labels and marks.

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.

Physical health risks

Opioid painkillers, legitimate or counterfeit, carry a risk of overdose, especially if consumed by people not used to the effects and in high doses. A high dose of a synthetic opioid could be as small as a grain of salt. Side effects from use could include:

constipation
itching
nausea and retching
lethargy
dizziness or fainting
in overdose, suppression of normal breathing, and risk of respiratory arrest (when you stop breathing altogether)

Certain opioid 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 more common painkiller 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 opioid painkillers with other drugs that suppress breathing such as alcohol, benzodiazepines (like diazepam or Valium), and/or other opioid drugs. There's a particular risk of death due to inhaling vomit because opioid painkillers can stop you from coughing properly. The vomit blocks the airways or later leads to pneumonia.
In pregnancy, regularly having taken high doses of opioid painkillers 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 opioids daily for a while, 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 opioid 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 to 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.

What is Opioid painkillers cut with?

If the opioid painkiller has been prescribed properly as a medicine (alone or mixed with other drugs such as paracetamol or ibuprofen), or obtained properly from your local pharmacy, then it’s almost certain it hasn’t been cut with another substance.

If the opioid painkiller has been sourced illegally, online or on the street, you cannot be sure what is in it and what effect it will have. There is currently a high risk of some of these tablets containing synthetic opioids, which can be fatal. Read more here. Fake oxycodone (Oxycontin or Percocet) are especially something to avoid and can contain nitazenes that are linked to deaths.

Can you get addicted?

Yes, any opioid painkiller can be addictive and produce 'cravings' and a psychological desire to keep on using.

Although they are safe to take if you follow your prescriber’s/pharmacist's instructions, and take the recommended dosage for the time recommended, some people who have used opioid painkillers regularly for some time, have become dependent on them.

If opioid painkillers are taken primarily to get high or to manage psychological pain, the risk of becoming dependent on the drugs is greater.

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 opioids 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.

Class: Mixed

Additional law details

Strong opioid painkillers are only available on prescription and most are controlled under the Misuse of Drugs Act and are classified as Class A or B drugs. So, unless an opioid painkiller has been prescribed to you it’s illegal to have, it’s also illegal to give away or sell opioid painkillers.

Depending on the circumstances, possession of a class A opioid 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 opioid 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 opioid 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.

If you possessed or supplied a tablet that contained a synthetic opioid, even if you didn’t know its content, you could be charged with possession or supply of that more dangerous substance.

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Opioid painkillers

What does it look like?

How does it make you feel?

Physical health risks

What is Opioid painkillers cut with?

Is it dangerous to mix with other drugs?

What happens if I mix Opioid painkillers and

Can you get addicted?

Additional law details

Opioid painkillers

How it looks, tastes and smells

How do people take it?

How it feels

Duration

The risks

Mixing

Addiction

The law