Prescription opioids

fentanyl
codeine
methadone
morphine
oxycodone
biodone
physeptone
hydromorphone
jurnista
buprenorphine

Are opioids a problem for you?

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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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 can 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

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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

See full list

General Information

Short term effects

The immediate effects of opioids can last up to a few hours and may make you feel or experience the following:

feel relaxed and comfortable
physical pain disappear
lessen your ability to be attentive to children's' needs, to operate machinery safely or to drive safely
feel nauseous or vomit
make the pupils in your eyes get smaller (pinpoint pupils)
breathing becomes slow and shallow
feel sleepy
become comatose if overdosing

Long term effects

If you use opioids often for a long time you may:

overdose (the longer you use opioids, the greater your risk of overdose)
have long-term and severe constipation
have teeth problems
damage your veins from injecting a lot in the same site
lose your appetite
have your menstrual period irregularly or not at all (women)
develop skin abscesses (sores with pus)
find it difficult to get pregnant (women)
find it difficult to get an erection (men)
have heart and lung problems
get infections in your blood
if sharing needles, increase your risk of contracting Hepatitis C and HIV

Signs of opioid overdose

Opioid overdose can happen to anyone. Overdose can occur when using illegal opioids or when using pharmaceutical opioids, particularly when not used as prescribed by a doctor. Even small amounts of illegally obtained opioids may cause some people to overdose — for example, people who are new to injecting drugs or those who have started using again after a period of stopping or quitting.

When a person overdoses, they may show the following signs:

quick onset of very slow, difficult or shallow breathing, there may also be snoring
cold and clammy skin and low body temperature
confusion
fainting
slow heartbeat
muscle twitching
gurgling sound in the throat from vomit or saliva
bluish skin and nails because of low oxygen
coma and death

If you suspect someone has overdosed phone 000 (triple zero) immediately and tell the operator that the person has overdosed (the police will attend if a person becomes violent or dies).

Overdose related emergency

Always phone 000 (triple zero) for an ambulance and tell the operator that the person has overdosed (the police will not usually come unless the person dies or becomes violent). You should also:

put an unconscious person on their side, in the recovery position
try to stay calm
remove a pharmaceutical opioid patch immediately if on the skin, check their breathing, clear their airway
do mouth-to-mouth and CPR (cardiopulmonary resuscitation – chest compressions) if they stop breathing and their heart has stopped
administer naloxone (Nyxoid® or Prenoxad®) if available
stay with the person

Please note: COVID-19, rescue breathing and chest compressions. Refer to the Australian Resuscitation Council for NSW Health recommended advice during the COVID-19 pandemic.

What NOT to do

Do not inject the person with anything other than naloxone — no other substance will work against the opioid and can cause more harm
Do not put them under the shower

Do not put anything in their mouth as it can cause choking and stop them from breathing. Even if someone fits (has a seizure or convulsions), the best thing to do is move things from around them, so they don't hurt themselves.

Preventing opioid overdose

To help prevent overdose:

use pharmaceutical opioids only as prescribed
avoid using opioids by yourself
do not mix opioids with other drugs - opioids can be particularly dangerous if used with alcohol, sleeping tablets, antidepressants or anti-anxiety medication unless you have already discussed with your doctor or pharmacist and are very dangerous if already intoxicated
if you've never used opioids they will affect you more, and are at a higher risk of side effects and overdose
if using illegal opioids like heroin, try a small amount first to test the strength, you might overdose even if you think you'll be okay
if you start using opioids again after a period of stopping, have a much smaller amount than usual the first few times, as your tolerance will have changed
after a shot or spray of naloxone you should be taken to an emergency department, as naloxone only works for a short time, and opioids are still in your body. Also, the effect of opioids will return in a little while so using more opioids will put you at high risk of overdosing again

Take Home Naloxone (opioid overdose reversal)

Naloxone is a drug that reverses the effects of an opioid overdose by stopping the central nervous system slowing down and helping the person 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.

Find out more about the NSW Take Home Naloxone program.

How are opioids used?

Pharmaceutical opioids

Pharmaceutical opioids are generally prescribed for the treatment of medical conditions. When used according to the doctor or pharmacist's direction, they are usually safe and effective medicines.

Pharmaceutical opioids come in a variety of forms, including tablets, patches, sublingual (under the tongue) films, injections, long acting depot injections, lozenges or lollipops.

People may use pharmaceutical opioids in ways that they have not been prescribed by injecting or snorting opioids intended to be swallowed. This can be risky because the speed and rate at which your body absorbs opioids changes based on how the drug is taken.

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.

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

Heroin

Heroin usually comes in powder form. It can be different colours depending on how refined it is. Heroin is usually injected, smoked or snorted. It is absorbed into the blood and acts on the brain very quickly. People who sell heroin often mix or 'cut' the powder with other things that look the same. Some mixed-in substances may have unpleasant or harmful effects. It is difficult to tell what additives are actually in the drug.

Injecting opioids with unsterile injecting equipment makes you more likely to contract blood borne viruses such as HIV, hepatitis B and C, and get blood poisoning (septicaemia) and skin abscesses (sores with pus). NEVER share fits (needles and syringes), spoons, water, filters, alcohol swabs or tourniquets.

In NSW, free sterile injecting equipment is available from Needle and Syringe Program (NSP) outlets and from selected pharmacists. Call the Alcohol and Drug Information Service (ADIS) on 1800 250 015 for the nearest NSP outlet.

Safe storage & disposal of patches & other medication

Used fentanyl and buprenorphine patches can still contain a large amount of unabsorbed medicine after they are removed. New and used patches can be dangerous to children and adults.

Keep patches in a locked medicine cupboard or container. Do not let children see you apply patches or call them stickers, tattoos or Band-Aids.

Ensure you fold used patches in half with sticky sides together to avoid any unintended contact with the skin. Wash your hands with soap and water after disposing of the fentanyl or buprenorphine patch.

All expired or unwanted medications including used fentanyl and buprenorphine patches should be returned to a community pharmacy for safe disposal. Further information is available at Return Unwanted Medicines (The RUM Project) returnmed.com.au.

Mixing opioids with other drugs

You are at a higher risk of overdose if you use opioids at the same time as other drugs. Combining opioids with alcohol, minor tranquillisers or benzodiazepines such as diazepam, Valium or Antenex, alprazolam (Xanax) or antidepressants can lead to overdose and death.

If you are prescribed multiple sedating medicines, talk to your doctor or pharmacist about managing the different medicines. They can give you advice about the timings of medicines and possibly swap out a sedating medicine for a non-sedating medicine.

What is the Opioid Treatment Program (OTP)?

People experiencing opioid dependency can access treatment through the Opioid Treatment Program (OTP). Through the OTP they can access assistance in managing dependence as well as get help for any underlying medical conditions (e.g. chronic pain conditions, depression, infections, including Hepatitis C).

OTP is for both people who need treatment for the use of pharmaceutical opioids (prescribed for medical conditions or otherwise) and illicit or illegal opioids.

OTP pharmacotherapy, with methadone or buprenorphine, is provided to help people get more stable in their life, and healthier, regardless of how they became opioid dependent.

Specialist medical, nursing, allied health and pharmacy professionals work in OTPs, and provide medical care (including prescribing), case management and counselling, linking to social services, and supervised administration of the medication.

There are four settings for OTP in NSW:

Public health settings at specialist opioid treatment clinics or hospitals
Primary health settings with General Practitioner prescribing and community pharmacy supervised administration
Corrections based treatment in public and private correctional/detention facilities

Private addiction treatment facilities including private opioid treatment clinics.

Find out more about the NSW Opioid Treatment Program.

Withdrawal symptoms

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)

When these symptoms reach their peak will depend upon the opioid you have been using, If using a short acting opioid like heroin, the peak is day 2 or 3, but for a longer acting opioids the peak will occur later.

If you are experiencing problems with withdrawal contact your doctor or health service.

Are opioids legal?

Opioids prescribed by an appropriately authorised doctor or nurse practitioner for the treatment of a medical condition are legal. Pharmacists will only dispense opioids from a valid prescription.

It is illegal to use and possess pharmaceutical opioids without a prescription. It is illegal to inject methadone if it is not prescribed for injection (that is, methadone syrup or physeptone tablets). It is illegal to sell your medicines to other people. If you do not take all your prescribed medicines and do not wish to keep them, return them to your community pharmacy for safe disposal.

Illicit opioids, such as heroin, are illegal to use and possess. Supply or manufacturing opioids will generally attract higher custodial sentences (jail time) than possession or use. If you have a criminal conviction recorded for drug use, possession, supply or manufacture it can lead to many other problems such as trouble getting a job, a credit card, or obtaining a visa to travel overseas. Many overseas countries (e.g. Malaysia, Singapore, Thailand) have zero tolerance approach to drugs, and have harsh penalties for breaking the law, including the death penalty.

Driving safety & sedating medicines

Driving a vehicle or riding a motorcycle safely requires good co-ordination and mental alertness. Illicit drugs and many prescription and non-prescription medicines affect your ability to drive or ride safely.

Many medicines including opioids, cause sedation. If you are taking more than one sedating medicine, or drinking alcohol while taking a sedating medicine, you are at higher risk of causing an accident. It is important that you consider how safe you are to drive every time you plan on driving.

When starting a new medication it is important to ask your doctor or pharmacist whether it is safe to drive and always read and follow the instructions on the medicine's warning label.

During the induction phase of an Opioid Treatment Program (OTP), or while making changes to your treatment dose you should not drive or operate heavy machinery. Driving while being treated with methadone or buprenorphine on a stable dose, is not associated with increased risk of accident or injury, as long as you are not taking other sedating medicines like benzodiazepines or drinking alcohol.

Get the facts about driving safety and OTP.

Pregnancy & breastfeeding

Intending parents should be aware that it is important to talk to your doctor about any prescribed or illicit opioids you may be taking. Opioids cross the placenta and cause your baby to have neonatal abstinence syndrome (NAS), when a baby withdraws from opioids after birth. It is generally not a life threatening condition, and hospitals are experienced in treating this however it is best to take steps to minimise the risks.

If you are prescribed opioids for a medical condition, talk to your doctor about what alternative non-opioid medicine you can take to treat your condition, if suitable.

If you are taking illicit opioids and you want to stop for the health of you and your baby, you can start on the Opioid Treatment Program and start taking methadone or buprenorphine, and also get pregnancy and parenting support from the Substance Use in Pregnancy and Parenting Service (SUPPS). This service is available through local health districts.

Information & advice

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.

Other services

Opioid Treatment Line (OTL) provides information, referrals, support and a forum for pharmacotherapy concerns. Contact them on 1800 642 428 for information on treatment options, where and how to access treatment and any issues related to your current treatment.
Poisons Information Hotline is a 24/7 call centre service to NSW and after hours call centre across Australia. Call 13 11 26
NSW Users and AIDS Association (NUAA) is a peak drug user organisation in NSW providing harm reduction information and blood borne virus prevention peer education.
Drug and Alcohol Multicultural Education Centre (DAMEC) provides services for people from culturally and linguistically diverse communities. Contact them on (02) 8113 1301 or for counselling and support services for CALD communities call (02) 8706 0150.
Narcotics Anonymous Australia, a non-profit fellowship or society of recovering addicts who meet regularly to help each other stay clean via a program of complete abstinence from all drugs.
Aboriginal Health and Medical Research Council (AH&MRC) for Aboriginal community controlled health services across NSW. Go to Members/ Members regional map/ Member services or Member websites.
Alcohol and Drug Foundation for further facts and resources on alcohol and other drugs and information on Community Drug Action Teams in NSW.
Smart Recovery is a voluntary self-help group that assists people in recovering from alcohol, drug use and other addictive behaviours.
ReachOut is an Australian online youth mental health service with a mobile-friendly site and forums where you can access help, information and support.
NSW Sexual Health Info Link for free and confidential sexual health support and information.
Nepean Youth Drug and Alcohol Service (NYDAS) works within a holistic model of care to address a range of issues for young people (12 -20 years) of age related to their alcohol and other drug use. Call (02) 4734 2129 or (02) 4734 1333.
Headspace.org.au for mental health and wellbeing support, information and services for young people (12-25 years) and their family and friends.
Kids Helpline is a free, 24 hour counselling service for young people aged 5-25 years. Counselling is offered by web, email or call 1800 55 1800.
State Library of New South Wales Drug Info website provides up to date information for public libraries in NSW.

Are opioids a problem for you?

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The Alcohol & Drug Information Service (ADIS) is a free and confidential counselling helpline for NSW residents with concerns around alcohol and/or drug misuse and is available 24 hours a day, 7 days a week. ADIS is staffed by professional counsellors who provide education, information, counselling, support and referrals to other appropriate services in NSW.
Are you worried you could be drinking too much or consuming drugs in a way that has become a problem? Are you worried about your friends or family finding out and want to get help quickly and quietly? Are you worried about the drug use of someone close to you – maybe a family member or friend? Maybe you just want to know where someone can get help?
ADIS clinicians understand the difficulties of speaking out, seeking help and finding appropriate drug and alcohol treatment, and use their knowledge and experience to assist you and answer questions, such as:
- How can I cut-down or stop my alcohol or drug use?
- What help can I get?
- Do I have to wait long to get help?
- Can anyone ring ADIS?
- Who do I talk to when I ring ADIS?
- Will drug and alcohol treatments be difficult?
- What is this drug doing to me?
- What are the short and long term problems that could develop if I continue using?
- Will ADIS tell anyone that I rang?
- What can I expect when I ring?
- Does ADIS record calls?
You can call ADIS 24 hours a day, 7 days a week on 1800 250 015 or for Sydney Metropolitan 02 8382 1000 or alternatively you can start a Web Chat.
ADIS Web Chat is available from Monday to Friday 8.30am – 5pm (including public holidays).
ADIS also has a range of telephone lines offering specialised drug and alcohol information and support to particular groups.
24 hour support line
1800 250 015
More about Alcohol and 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
- Our chat is confidential unless you disclose any intention to harm yourself or others.
- WebChat is provided in English however if you prefer to speak in a language other than English we would be happy to arrange a telephone call with you through the Translating and Interpreting Service (TIS National). Please call the Alcohol and Drug Information Service on 1800 250 015 to arrange this.
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
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Family Drug Support (FDS) provides support and assistance to families throughout Australia who are experiencing difficulty with a family member using alcohol or other drugs.
FDS is a non-religious, non-judgemental and caring organisation of volunteers who have first-hand experience living with family members experiencing alcohol or drug dependency.
FDS supports families by providing information about alcohol and other drugs, dependence and treatment options, while also helping families to overcome stigma and reduce self-blame, provide mutual support and help families build skills to strengthen their relationships.
FDS provide a 24 hour, 7 days a week support line for families, support groups and meetings, the 'Stepping Stones' and 'Stepping Forward' courses, events and resources.
Find out how FDS can help you.
24 hour support line
1300 368 186
More about Family Drug Support (FDS)
Families, friends and loved ones can play a critical role in the recovery of people who experience alcohol and other drug problems, however they are often focused on the needs of others while they neglect their own their own health and wellbeing.
The Family and Friend Support Program (FFSP) is an online cognitive behavioural therapy program to support people who are caring for or supporting someone with alcohol and other drug use issues.
FFSP is based on a series of modules and includes information and activities on how families and friends can help their loved ones, with a specific emphasis on the person providing the support and their often unmet needs. The program is also suitable for health professionals.
For information on how to start a conversation with your loved one about their alcohol and or other drug use, tips on how to look after yourself and other resources visit our For Families mini-site.
Cost
The program is free and available 24 hours a day, 7 days a week.
Please note that for Health Professionals there are costs involved in the 5-step training. Details about the training can be found on the Health Professionals portal in FFSP (under the icon 5-step).
The FFSP is supported by funding from the Australian Government Department of Health.

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PeerLine is confidential service run by the NSW Users and AIDS Association (NUAA). NUAA works to improve the health, welfare and dignity of people who use drugs.
PeerLine is a free, confidential peer supported telephone service for people who use drugs, who are on the Opioid Treatment Program or seeking treatment. Trained peers will help you with information, advice and advocacy

PeerLine is available from 9.00am to 5.00pm Monday to Friday (excluding public holidays).
Call for free on 1800 644 413 or email peerline@nuaa.org.au to connect.
Monday to Friday 9am – 5pm
1800 644 413
More about NUAA PeerLine
The NSW Needle and Syringe Program (NSP) is an evidence-based public health program that aims to reduce the transmission of infections such as HIV and hepatitis C among people who inject drugs. NSP outlets provide sterile injecting equipment such as needles and syringes, Fitpacks and other injecting equipment (such as swabs, water, spoons and cotton balls) as well as disposal facilities free of charge.

NSP outlets are staffed by specialist workers who provide access to sterile injecting equipment, promote safe disposal practices and facilitate referrals to health, welfare and community services as needed. NSP outlets may also be able to assist with testing for blood borne viruses such as HIV and hepatitis C. You may not even require a blood test such as with the Dried Blood Spot (DBS) test. Ask your NSP staff member or visit dbstest.health.nsw.gov.au for more information.
Who is the program for?
The NSP is for people who inject drugs to avoid contracting or transmitting blood borne diseases and to provide a place for safe disposal of sharps containers (needles and syringes).
NSP Outlets in NSW
To help the community access the program, an interactive map has been developed listing all public NSP outlets across NSW. Use the map below to find your nearest NSP outlet or refer to the NSP listing by suburb page for details.
If you would like further information and/or advice call the Alcohol and Drug Information Service (ADIS) on 1800 250 015.

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