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Heroin

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What is heroin?

Heroin is a drug that comes from the opium poppy and is in the class of drugs called depressants, because it slows down the brain and the central nervous system. It is one of a group of very strong pain-killing drugs called narcotic analgesics or opioids.

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Heroin
Heroin

Heroin

(C21H23NO5)

Street heroin is usually mixed with other things, therefore, it is hard to know how strong the heroin is. This can lead to accidental overdose or death.

Immediate effects can include

  • feel relaxed and comfortable
  • make physical pain disappear
  • make you feel sleepy
  • feel nauseous or vomit

Effects depend on...

​What heroin does to you depends on how much you take, how often you have been using heroin (the longer you use, the more you may build up a tolerance to the effects), when you last took heroin, how pure the heroin is, your height and weight, your general health, your past experience with heroin, whether you use heroin on its own or with other drugs.

  • make your breathing become shallow

How heroin affects your body

Tap a body part to learn more of the effects Heroin places on your body.

Long term effects can include

  • loss of appetite
  • have heart and lung problems
  • overdose (the longer you use heroin, the more likely you are to overdose)
  • have your menstrual period irregularly or not at all (women)
  • have long-term constipation
  • find it difficult to get pregnant (women)
  • find it difficult to get an erection (men)

General information

Is heroin a problem for you?

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  • Whether you are having issues with alcohol or other drugs, are concerned about someone else’s alcohol or other drug use, or just have general questions about alcohol or other drugs, you can call ADIS any time of the day or week for support, information, counselling and referral to services in NSW.

    ADIS Web Chat is also available from Monday to Friday 8.30am – 5pm (including public holidays).

    24 hour support line

    1800 250 015

    More about Alcohol Drug Information Service (ADIS) NSW
  • The Alcohol & Drug Information Service (ADIS) Web Chat is a live online conversation with a professional counsellor. The service is free, confidential and open to anyone affected by alcohol and other drugs, including people concerned about their own use, or about a family member or friend. Web chat is only available for people living in NSW.

    The service is provided by ADIS at St Vincent's Hospital, in partnership with the NSW Ministry of Health.

    What to expect

    • A counsellor will chat with you about your alcohol or other drug concerns
    • A counsellor can provide a referral or contact information for relevant alcohol and drug services in NSW

    To start a web chat counselling session read and accept the 'Terms and Conditions of Use' below.

    Alternatively, if you would like to speak to a drug and alcohol counsellor over the phone, please call the National Alcohol and Other Drug helpline on 1800 250 015 which will direct you to your state service. The helpline is available 24/7 for anonymous and confidential support.

    Emergency Assistance

    Call Emergency Services on 000 if you:

    • require urgent medical attention or 
    • are in immediate danger or 
    • are at risk of harming yourself or someone else.

    Monday to Friday 8.30am – 5pm (including public holidays)

    Web Chat

    More about ADIS Web Chat
  • The NSW Opioid Treatment Program (OTP), also known as opioid agonist treatment or opioid substitution treatment, provides pharmacotherapy and support services to people with an opioid dependence. Treatment may be provided as a short term measure to assist people to stop using other opioids, or for long term maintenance.

    The OTP is provided through public clinics, private clinics, general practitioners (GPs) and community pharmacies, and correctional facilities, and may be provided alongside other treatments such as counselling or residential rehabilitation. The pharmacotherapy medicines used in the NSW OTP are methadone, buprenorphine – including depot buprenorphine, given in an injection under the skin weekly or monthly – and buprenorphine-naloxone.

    1. What is opioid dependence?
    2. What are pharmacotherapy medicines?
    3. NSW Opioid Treatment Program
    4. Mixing OTP medicines with other drugs
    5. Driving Safety
    6. Talk to someone about OTP

    What is opioid dependence?

    When some people experience pain, both physical and or psychological, they may rely on opioids to make their body and mind feel better. People who are dependent on opioids find it very hard to stop using or cut down because of withdrawal symptoms. Stopping opioid use abruptly can lead to withdrawal symptoms, these can begin to occur within only a few hours after last use.

    Symptoms can include:

    • Sweats and chills
    • Sleeplessness and broken sleep
    • Uneasiness/anxiety
    • Feeling restless
    • Diarrhoea
    • Restless legs
    • Stomach and leg cramps
    • Nausea
    • Runny nose and eyes
    • Joint pain
    • Cravings (wanting opioids very badly)

    Some people may experience withdrawal after they have been on strong medicines prescribed by their doctor, such as oxycodone (Endone) or codeine. While others may experience it after using illicit drugs like heroin. Dependence is a medical condition, regardless of how people become dependent or what drug they use, everyone is entitled to treatment.

    What are pharmacotherapy medicines?

    Methadone, buprenorphine and buprenorphine-naloxone belong to a group of sedating and strong pain-killing drugs called opioids. Both methadone and buprenorphine are long-acting opioids, therefore only one dose per day is usually needed to prevent the uncomfortable symptoms of opioid withdrawal. Methadone and buprenorphine may also be prescribed by clinicians to patients to treat severe or chronic pain or in palliative care settings.

    The effects of methadone and buprenorphine can include relief from pain and a feeling of wellbeing, but can also cause nausea, sleepiness and long term use can have effects on male reproductive health, libido and cause sweating and constipation.

    Buprenorphine is effective at blocking the effect of other opioids, as it binds tightly to the opioid receptors in the brain. It comes in three different forms, a tablet (Subutex) or film (Suboxone) which are dissolved under the tongue, and a long acting injection (depot- Buvidal and Sublocade). For depot buprenorphine, injections last a week or a month.

    Buprenorphine may also be mixed with naloxone (buprenorphine-naloxone) to discourage people injecting.

    NSW Opioid Treatment Program

    The purpose of the OTP is to provide patients with access to treatment for opioid dependency, with a focus on improving patients’ health, wellbeing and engagement with their families and community.

    Patients can access treatment through public drug and alcohol services, private clinics, GPs and community pharmacies. The type of treatment they access will depend on the complexity of the care they need and their location.

    Treatment through public clinics is free for patients with the most complex care needs or for those needing supervised dosing.

    In many cases, patients can be treated in community settings such as private GP clinics with management of methadone or buprenorphine dispensed daily through community pharmacies.

    Most patients are required to start the program with a nurse or a pharmacist watching them take the methadone or buprenorphine every day. After some time patients may be able to have some of the medication to take at home, but this is only after the patient and the doctor are comfortable with how the treatment is progressing, and it is safe to do so.

    Long-acting depot buprenorphine does not require supervision because once the medication is injected it is slowly released over days or weeks, depending on the formulation.

    Patients and doctors will decide together what treatment plan and medication is best. Some patients may want to take the medication for a short amount of time, other patients may feel they need the medications for longer, each patients’ needs are different.

    Clinicians delivering the OTP are guided in practice by the NSW Clinical Guidelines: Treatment of Opioid Dependence.

    Only patients with opioid dependence are suitable for the OTP program. Similar opioid treatment programs are available in all states and territories.

    Mixing OTP medicines with other drugs

    Methadone and buprenorphine alone are not risky to take but it is necessary to understand how they interact with other sedating substances – particularly benzodiazepines and alcohol. There is a risk of over-sedation when taking sedating medications or alcohol while being treated with methadone.

    It is important that patients discuss with their clinicians (doctor, nurse or pharmacist) about all their prescriptions and their other substance use. Doctors can choose a different combination of prescription medication to reduce the risks.

    Driving Safety

    It is not risky to drive when on a stable dose of methadone or buprenorphine, as long as you are not taking other sedating substances or drugs at the same time.

    In the first two weeks of buprenorphine and first four weeks of methadone treatment, and any time where the dose is changed by 5mg or more, you are strongly advised NOT to drive or operate heavy machinery.

    For more information, visit drivingsafety.com.au.

    Pregnancy and child safety

    Babies and children can die from taking methadone or buprenorphine. It is important that any takeaway doses are stored in a locked cupboard or drawer, and to never take the medicines in front of children. Depot buprenorphine is a good alternative for parents, as there are no takeaway doses and therefore no chance of exposing children to the medicines.

    Methadone and buprenorphine must never be given to babies or children, unless prescribed to them. If a child has taken it call 000 (triple zero) immediately.

    If you are dependent on opioids and pregnant, or planning to become pregnant, it is important you consider getting treatment for opioid dependency. Substance Use in Pregnancy and Parenting Service (SUPPS) can coordinate treatment, call Alcohol and Drug Information Service (ADIS) on 1800 250 015, for counselling and referrals 24 hours a day, 7 days a week.

    Talk to someone about OTP

    The Opioid Treatment Line (OTL) is a phone based service that provides opioid pharmacotherapy information, referrals, advice and a forum for pharmacotherapy or treatment concerns. OTL assists people who want to know more about the system of opioid treatment in NSW, including how to get onto a program, and what they should expect from clinics and doctors providing the service.

    For more information contact the Opioid Treatment Line (OTL) on 1800 642 428, Monday to Friday 9.30am to 5.00pm (not available during public holidays).

    For information from a consumer led organisation, contact NSW Users and AIDS Association (NUAA).

    For free and confidential advice call the Alcohol and Drug Information Service (ADIS) on 1800 250 015. Counsellors are available 24/7 to provide information, referrals, crisis counselling and support. Or start a Web Chat with an ADIS counsellor online Monday to Friday, 8.30am – 5pm.


    More about Opioid Treatment Program
  • Naloxone provides a significant opportunity to save lives because opioid overdoses tend to happen gradually, rather than suddenly. Opioids include pain-relieving drugs legally prescribed by a medical professional such as oxycodone, morphine, codeine and fentanyl, as well as illegal drugs such as heroin. During an overdose, opioids slow down or stop a person’s breathing, which may eventually result in death (see ‘Signs of opioid overdose’ below). However, it is possible to prevent death by administering naloxone to reverse the effects of the overdose. For this reason it is best to avoid using opioids alone, as naloxone can only help if someone can administer it quickly. 

    Opioids are responsible for over three deaths in Australia per day (Australian Bureau of Statistics). Prescribed opioids account for 70 per cent of opioid-induced deaths either by accident or through misuse. In 2018 the highest number of heroin-induced deaths was seen since 2000.

    1. What is naloxone?
    2. Who is naloxone for?
    3. Take home naloxone in NSW
    4. Cost of naloxone
    5. Signs of opioid overdose
    6. Pharmaceutical opioid use
    7. More information

    What is naloxone?

    Naloxone is a drug that reverses the effects of an opioid overdose. In technical terms naloxone is a short-acting opioid antagonist that stops the central nervous system slowing down, giving a person experiencing an overdose the ability to breathe normally again. Naloxone only works if a person has opioids in their system.

    Naloxone can be given to a person experiencing an opioid overdose via a pre-filled injection or via a nasal spray. Traditionally, naloxone has only been administered by medical staff or emergency service officers, but with basic training it can be administered by anyone.

    Who is naloxone for?

    Naloxone is for anyone at risk of overdosing on opioid drugs or anyone who may witness an opioid overdose.

    People in the following circumstances should consider keeping a supply of naloxone close by: 

    • People on high doses of opioid pain medicines 
    • People who use opioid drugs 
    • People returning to opioid use after a period of stopping or quitting 
    • People who use opioids in combination with other drugs or medicines 
    • Family, friends or loved ones of people who use opioid drugs

    Take home naloxone in NSW

    Take home naloxone programs, for people at risk of witnessing or experiencing an opioid overdose, have been established in Australia and internationally to increase awareness of naloxone, and reduce harm and death from overdose. Having naloxone at home enables community members to access the medicine quickly when and where they need it to treat an opioid overdose.

    In NSW, take home naloxone was previously available as part of a research study in St Vincent's Health Network, five Local Health Districts (South Eastern Sydney, Sydney, Western Sydney, Hunter New England and Murrumbidgee) and the Medically Supervised Injecting Centre.

    The naloxone intervention is now being expanded across NSW and people are able to access free naloxone and training on how to administer the medicine. 

    Naloxone is also available on prescription by a doctor or over the counter from a community pharmacy.

    Cost of naloxone

    Nyxoid® nasal spray and Prenoxad® pre-filled syringe each cost more than $36 over the counter from a pharmacy.

    Both products are on the Pharmaceutical Benefits Scheme (PBS) and cost around $6.50 on prescription with a concession card.

    NSW Health is providing these naloxone products for free to people at risk of experiencing or witnessing an opioid overdose.

    From 1 December 2019 naloxone will be available for free from a broader range of locations without prescription for 15 months as part of the Commonwealth Take Home Naloxone Pilot.


    Pharmaceutical opioid use

    There is a high risk of accidental overdose from pharmaceutical opioids such as fentanyl when used other than by your doctor's instructions, due to its potency and very fast action once inside the body. For example, fentanyl patches that attach to the skin can cause fatal overdose when heat is applied over the top, or if someone does not keep track of how much and how often it is being taken.

    If you are prescribed a pharmaceutical opioid only use it as prescribed by your doctor and pay attention to any warning or caution advice.

    More information

    Check out the A-Z of Drugs listing and Support Services pages, including the NSW Opioid Treatment Program page for further information.

    For further enquiries on the take home naloxone Intervention in NSW email MOH-naloxone@health.nsw.gov.au.

    For free and confidential advice give an Alcohol and Drug Information Service (ADIS) counsellor a call on 1800 250 015, they are available 24 hours, 7 days a week to provide confidential support and advice.


    More about Take Home Naloxone
  • Your Service Hub is an online directory of alcohol and other drugs support, health and welfare services. If you need support for your own or someone else's substance use, you should use terms in Find Services like:

    • drug and alcohol family support

    • drug and alcohol Aboriginal services 

    • drug counselling

    • drug and alcohol rehabilitation

    • drug and alcohol residential treatment

    along with your suburb name to narrow the search to services near you.

    Not sure what service you need? Call the Alcohol and Drug Information Service on 1800 250 015.

    More about Your Service Hub
  • Opioid Treatment Line OTL (formerly MACS)

    OTL provides information, referrals, support and a forum for pharmacotherapy concerns.  

    This is a helpline for people who:

    • are opioid dependent and want to know more about what is available for them; or

    • are currently on an opioid pharmacotherapy program (treatment using prescribed methadone or buprenorphine) or want to be on a program and have questions about treatment; or

    • are having issues with their opioid pharmacotherapy treatment and need information or assistance; or

    • want to know more about the system of opioid treatment in NSW; or

    • are health professionals seeking information, advice and referral 

     OTL also maintains a central register of complaints and concerns about opioid treatment and providers and ensures NSW Health hears your issues to help improve opioid pharmacotherapy treatment in NSW.

     OTL was established to assist and support opioid treatment in NSW. Listening to individual stories, answering questions, recording problems and treating clients and professionals with dignity and respect is the basis of OTL work.

     OTL is a confidential, anonymous service giving voice to those who would like to raise their issues privately or officially. OTL works with both the patient and the treatment provider in order to help clarify and resolve problems, or can act as an intermediary, explaining the reasoning behind certain decisions and how they relate to the Opioid Treatment Guidelines.

     OTL is often the first place opioid dependant people contact when trying to access treatment.  OTL can provide the contact details of services that are available. The availability of OTL means individuals can be helped through the understanding of the various treatment options.

     OTL also provides feedback to other organisations, involved with opioid pharmacotherapy  treatment including NSW Health, Justice Health, the Health Care Complaints Commission  (HCCC), NSW Pharmaceutical Regulatory Unit, NSW Users and AIDS Association (NUAA), Opioid  Treatment Managers' Group, and the Pharmacy Guild.

     OTL can collect information from callers to assist in resolving issues in treatment or accessing treatment.

     Frequent calls to OTL include questions around:

    • Types of treatment available

    • Where and how to access treatment

    • NSW Guidelines around treatment and clients' and providers' rights and responsibilities

    • Problems contacting or communicating with treatment providers

    • Transferring between areas, states and countries

    • Dissatisfaction with treatment

     Whatever your question or concern, OTL will listen and help wherever possible.

    Monday to Friday 9.30am to 5.00pm, NOT AVAILABLE PUBLIC HOLIDAYS

    1800 642 428

    More about Opioid Treatment Line OTL (formerly MACS)
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