Harm Reduction for Prescription Opioid Users

Safety and keeping people alive are the two biggest concerns we have at Project Lazarus. Regardless of your relationship with prescription opioids, these guidelines and steps apply to you if you use prescription opioids; prescribed or not. These tips are designed to reduce harm and overdose from prescription opioids. By being aware of your medications and practicing safe techniques when using, combined with keeping naloxone on hand, you can ensure the safety of you and your family.

What Kind of Pill Are You Taking?

With so many different types of medication available, it can seem overwhelming to try to properly identify your exact medication. While the following questions to ask yourself may seem obvious, these are the most effective and efficient ways to accurately identify your medication.

1. What color is the pill?

2. What are the letters, numbers, or logo on the pill?

3. What is the shape of the pill? Round, Oblong, Hexagonal, or a Capsule?

4. How large is the pill? You can use a fingernail as a reference.

5. Is there any “scoring” on the pill, such as lines or seams where different colors meet?

With every brand name medication comes multiple generic versions. It is okay to take a generic medication if this is what your prescriber and pharmacy recommends; however, be aware that pharmacies often change generic brands for the same name brand medication. Always consult your pharmacist upon pickup to find out if your medication has changed brands and read all cautions, side effects, and interactions that are included with your medication and on the label. Different generic brands for the same brand name medication can have various effects on your body. They are not all the same. Always be sure that you know exactly what you are receiving and using. You can write down the answers to the above questions and draw a copy of the pill to help remember what your pill looks like exactly. Keep this in a safe place that you can refer back to if you are ever unsure of a new medication you have received.

How Much of the Drug or "Active Ingredient" is in the Pill?

The answers to the questions above are extremely important; however, you must also be very aware of how much of the drug or "active ingredient" the pill contains. The amount of milligrams of opioid in your pill effects the entire way you take the pill and how your body responds to the medication. An opioid pain reliever of any kind can range from 2.5mg to 10mg of opioid, yet the pill may still look relatively the same. This means that there is a potential for there to be four times more drug or "active ingredient" between pills that can both be called and look the same as your pill. In order to remain safe, you must know exactly how many milligrams your body can handle and how often.

What is the Difference Between “Immediate-Release” and “Extended-Release?"

The terms "immediate-release" and "extended-release" do exactly as their title suggests. Immediate-release pills are also known as short-acting or rapid onset pills. This means that when taken by mouth, the immediate-release pills discharge the entire dosage of the drug into your body all at once. Extended-release pills are also known as modified-release or controlled-release pills. These pills contain a much higher dosage of the drug than immediate-release pills. When extended-release pills are taken by mouth, they release smaller dosages of the drug into your body over an extended period of time. If your body does not have an opioid (or heroin) tolerance, orally taking or snorting a 40mg, 60mg, or 80mg opioid can kill you. The same is true for chewing a Durgesic, Sandoz, or Mylan (fentanyl) patch; you can overdose and die from this. Please know that some extended-release pills can stay in your system for 24 hours. Keep this in mind when considering taking another dose or combining with other substances.

Tylenol/Acetaminophen Can be Found in Prescription Opioids.

Some prescription pain relievers can be remarkably large. This is due to the large amounts of acetaminophen, abbreviated  as "APAP," found in the pill. Because acetaminophen is the main ingredient in Tylenol, it is not recommended to take Tylenol or acetominophen with prescription opioids, as this will result in an over dosage of acetaminophen. Vicodin, Percocet, Tylox, Lorcet, Lortab, Norco, Darvocet and Ultracet are all prescription opioids that contain acetaminophen. Acetaminophen found in Tylenol and pain relievers/opioids can damage the liver if taken daily for a prolonged period of time. If you have hepatitis C, drinking alcohol frequently, or have liver problems, taking tylenol and acetaminophen containing opioids can lead to serious health issues. Avoid taking more than 4 g or 4000 mg of Tylenol or acetaminophen per day. If you find that your pain reliever containing acetaminophen is not working after 10 days of usage, please consult your doctor about switching to a medication that does not contain acetaminophen.

Prescription Opioids Can Cause Constipation.

By taking prescription opioids (or using heroin) every day, you can expect to experience some constipation. In order to help relieve constipation you should drink lots of water, exercise, and eat high fiber foods, such as leafy green vegetables. Popcorn is also a popular choice. You may get over-the-counter gentle laxatives from a pharmacy or even drink an herbal tea that contains Senna leaf extract for relief.

Prescriptions Can Cause a Harmful Dry Mouth.

When using prescription stimulants like Adderall or Ritalin it is important to not let your mouth become dry, as this can be damaging to your teeth and cause you to grind your teeth. Drinking plenty of water, chewing low-sugar gum, and brushing your teeth are all effective ways to keep your mouth moist and healthy. The saliva produced from these activities can help protect your teeth from getting cavities and other dental damage caused by a dry mouth. Cocaine and Meth are also stimulants that can cause a dry mouth.

Colds, Asthma, and Snoring Can Lead to an Increased Risk of OD.

When the body overdoses, the respiratory system begins to slow due to the opioid taken. If you are experiencing a bad cold, sinus infection, have asthma, snore loudly, or have sleep trouble, such as sleep apnea, it may be harder for you to overcome the respiratory depression that occurs during overdose. This is also true if you taking opioids and have a chest infection like bronchitis or pneumonia, have chronic obstructive pulmonary disease (COPD),  emphysema, or are coughing up phlegm. If someone around you has taken opioids and is snoring unusually, please check on them since this is a sign of overdose.

Have Someone With You When Using an Opioid for the First Time. 

When using prescription opioids for the first time, trying a higher dosage than you are used to, or using again after not using for an extended time, be sure to have someone with you who can help if you overdose. Have someone with you who knows the signs of an overdose, will call 911, and stay with you until help arrives. This person should also know what to do in an overdose situation, such as how to perform rescue breathing, place your body in the recovery position, and administer naloxone. Regardless of what your intentions are, whether it be to self-medicate to relieve pain or to get high, it is crucial that you have a plan that someone else can execute if you overdose. Project Lazarus Naloxone Rescue Kits provide vital information on creating a plan and provide a DVD with instructions on administering naloxone and recognizing the signs of overdose.

After taking opioids, methadone or an extended-release pill for the first time or after an extended period without opioids, be cautious during the 7 days to make sure you do not nod off or experience trouble breathing. These are both signs of intolerance and can lead to an increased risk of overdose.

Opioids and Alcohol are Dangerous Together.

Taking opioids, methadone, or extended-release pills with alcohol can cause fatal levels of the drug to be released into your body all at once. This practice of combining alcohol with pills is referred to as "dose dumping" and is fatally dangerous. Always avoid drinking alcohol when using medication.

Morphine Patches Do Not Exist.

Currently, in the United States, only two pain patches are available: a fentanyl patch (Duragesic, Mylan, or Sandoz) and a buprenorphine patch (BuTrans). Be cautious of BuTrans as it can cause your body to go into withdrawal if you are opioid dependent. These are the only patches for pain that are available; there is no such thing as a morphine patch. If you are offered a morphine patch by anyone, do not accept the offer.

Be Cautious with Fentanyl.

Unless your body has a high tolerance for strong opioids from regular use, the likelihood for overdose from fentanyl is high. Be aware of interactions with other drugs when using fentantyl and always consult your doctor before using more than your recommended dosage. Fentanyl comes in a variety of forms, such as a patch (Duragesic, Sandoz, Mylan), lollipop (Actiq), dissolvable tablet (Fentora, Abstral), and a film for under the tongue (Onsolis).

Methadone Gradually Builds in Your Body; Wait Before Taking More.

If you do not regularly take methadone, please be aware that it can take more than hour to feel results. Because methadone has a half life and builds gradually in your body as you receive more over time, it is severely dangerous to take additional opiates, depressants, heroin, anti-depressants, sleeping pills, alcohol, or more methadone. While the pain and withdrawal symptoms are excruciating, overdosing can be fatal and far more difficult to overcome. If after receiving methadone you are still feeling pain, use an aspirin, ibuprofen (Advil or Motrin), or acetaminophen (Tylenol). Consult your doctor to know how much aspirin, ibuprofen, or acetaminophen to take with your methadone.

New OxyContin OP Formulation

By the end of 2010, all OxyContin sold and shipped was under a new "abuse deterrent" or "tamper resistant" formulation. This new formulation was designed to be undesirable to inject and/or snort since, when crushed, the powder quickly absorbs water and becomes paste-like, making it difficult to use in a syringe. Do not use recipes that involve harsh chemicals to extract the drug out of the deterrent formula. This can lead to further dangers. Because of this change, many once OxyContin users have turned to heroin, Roxicodone, or Opana in place of the old OxyContin formulation.

Popular Opioids: Opana and Roxicodone.

Oxymorphone (Opana) comes in two formulations in the United States: an immediate release pill (Opana) that comes in 5mg and 10mg, and an extended-release pill (Opana ER)  that comes in 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg, and 40mg. While oxymorphone has been used in medicine since the late 1950s, Opana was not found in pharmacies until several years ago. Opana is nearly twice as potent as OxyContin, oxycodone, hydrocodone, Percocet, Tylox, Percodan, Vicodin and methadone, and about three times as potent as morphine. Since oxymorphone is twice as potent as many other opioids, there may be an increased overdose risk if users are not aware that the conversion is not on a one-to-one ratio.

Roxicodone is an immediate-release form of oxycodone that comes in 15mg and 30mg tablets. Since Roxicodone and OxyContin both contain oxycodone, when swallowing them whole, the milligram strengths will be about the same. If you are crushing them, snorting, or injecting, the Roxicodone will have less oxycodone than the same milligram strength OxyContin.  Naloxone should work to reverse oxymorphone and oxycodone overdoses.

Vicodin May Be Linked to Hearing Loss.

Emergency departments and poison control centers have reported that some people have experienced sudden hearing loss after injecting or snorting hydrocodone (Vicodin). While there has been little evidence to prove this as a side effect, some have experienced permanent hearing loss.