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Prescription opioids

  • fentanyl
  • codeine
  • methadone
  • morphine
  • oxycodone
  • biodone
  • physeptone
  • hydromorphone
  • jurnista
Are opioids a problem for you?
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What are opioids?

Opioids are natural drugs derived from the opium poppy or synthetic drugs, and have a depressant or sedating effect, causing the brain and central nervous system to slow down.

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Prescription opioids

Opioids have a strong pain-killing effect, therefore pharmaceutical opioids may be prescribed for medical conditions, particularly for acute or cancer pain management. Pharmaceutical opioids include morphine, oxycodone, fentanyl, hydromorphone, methadone, buprenorphine, tapentadol, tramadol and codeine.

Immediate effects can include

  • pain relief
  • feeling of wellbeing
  • reduced anxiety / calmness
  • sleepiness

Effects depend on...

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

Opioids come in the form of illicit or illegal drugs such as heroin or diverted pharmaceutical opioids used for non-medical purposes. Heroin or other illegally obtained opioids may be cut or mixed with other drugs or substances, it is therefore hard to know how strong the drug is and this can lead to accidental overdose or death. Using opioids in combination with other drugs (such as sleeping tablets, other sedatives and alcohol) can also lead to accidental overdose or death.

  • pupils of the eye become smaller
  • sweating
  • nausea or vomiting
  • shallow breathing

How opioids affects your body

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

Long term effects can include

  • overdose (the longer you use opioids, the greater your risk of overdose)
  • long-term and severe constipation
  • teeth problems
  • increased risk of contracting Hepatitis C and HIV
  • infertility (women)
  • impotence (men)
  • damaged veins from injecting
  • skin abscesses (sores with pus)
  • loss of appetite
  • irregular or no menstrual period (women)
  • heart and lung problems
  • infections of the blood

General Information

Are opioids 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

    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
  • 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)
Your Room > A-Z of Drugs > Prescription opioids