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Here are tips and tools that can help reduce the potential harms of taking prescription drugs. These are practical steps that apply to people taking pharmaceuticals, even if you’re getting them from your doctor with a prescription. If you work with people who use prescription drugs, feel free to copy these or use them however you’d like.
The single most important thing to know is what pill you are taking.
There are thousands of different pills out there. This may be obvious, but: How do you identify what pill you are taking? Here are five questions, in order of importance, that offer the most efficient way to identify your pill:
You may be used to getting a tablet that looks a certain way because you’ve been getting it from one source or one pharmacy. However, there can be dozens of generics of the very same drug, each of which may look different. Don’t get duped – know what you’re getting and know what you’re using!
You may want to draw or write down a few distinguishing things about the pill that you use most often and put it in your wallet. Or, send yourself a text message that mentions the letters and numbers of the pills that you like to use (if you’re afraid of incriminating yourself, use codes that you’ll remember or hide it in the body of another text).
Know how much drug ("active ingredient") is in a pill.
It's not enough to only know the name of the drug. Use the tools above to be sure you also know how many milligrams of the active drug is in each pill. For example, a Percocet can have between 2.5mg and 10mg of opioid – that leaves potential for there to be four times more drug between pills that can both be called "Percocet." How high do you want to get and how much can your body manage?
Know the difference between “immediate-release” and “extended-release” formulations.
Extended-release (also known as modified-release or controlled-release) pills contain much more drug than immediate-release (also short acting, rapid onset) pills. The difference is, when taken in pill form by mouth, extended release pills are designed to release the drug into your body over a longer period of time and immediate release pills put the full dose into your body all at once. If you haven't been taking Rx opioids or heroin regularly, snorting a 40mg, 60mg, or 80mg OxyContin can be enough to kill you. If you’re not opioid tolerant, chewing a Durgesic/Sandox/Mylan fentanyl patch can overdose you. Some extended-release formulations, such as Opana ER and Kadian, will stay in your system for 24 hours if you swallow them whole, so think about how long you actually want to be high.
Some painkillers also contain dangerous amounts of Tylenol.
Ever notice how big Vicodin and Percocet tablets are? The bulk of the tablet is made up of Tylenol, also called acetaminophen or abbreviated “APAP” on the bottle. Some brand name opioid painkillers that include Tylenol are: Vicodin, Percocet, Tylox, Lorcet, Lortab, Norco, Darvocet and Ultracet. Taking Tylenol every day for weeks can damage your liver, which means that so can taking Vicodin or Percocet every day. This can be especially serious if you have hepatitis C, are drinking alcohol a lot, or have liver problems. Avoid taking more than 4 g or 4000 mg of Tylenol per day. If you are still in pain after taking several Vicodin a day for more than 10 days, you should seriously consider seeing a doctor to prescribe you something without Tylenol. If you can’t see a doctor and are treating your own pain, try to find painkillers that don’t have “acetaminophen” or “APAP” written on the label.
Take laxatives - prescription opioids can constipate you.
If you are taking prescription opioids (or heroin) every day, you may get constipated. Drinking more water and eating high fiber foods can help relieve constipation (popcorn is a tasty choice, as are leafy green vegetables like collard greens). Ask a pharmacist for gentle laxatives, like those containing sena, that you can buy over the counter.
Drink water, chew gum and/or brush your teeth to avoid dry mouth.
Taking prescription stimulants like Adderall or Ritalin during binges or long study sessions can give you a really dry mouth or make you grind your teeth. A dry mouth and grinding can really damage your teeth, just like when using other stimulants (cocaine, meth). There are some simple things you can do to keep producing saliva while taking prescription stimulants, such as drinking water, chewing gum, or brushing your teeth. The saliva will help protect your teeth from getting cavities and other dental damage.
Cut back on painkillers if you have a bad cold, asthma or if you snore a lot.
Overdose deaths are more likely to happen if you take a lot of opioid painkillers and have a chest infection (bronchitis, pneumonia), chronic obstructive pulmonary disease (COPD), or emphysema. If you are coughing up phlegm, it may be harder for you to recover from the slow breathing (respiratory depression) that comes with taking too much prescription opioid. Loud snoring or sleep apnea (waking up gasping for air) can put you at risk for a more severe overdose if you take too much painkiller. Unusual snoring after taking painkillers can be a sign of an overdose.
Use around other people, especially when trying a new medication.
If you are using prescription opioids for the first time, make sure there is someone around who can help you if you overdose. This is also true if you are trying more than you normally use, are trying a new drug, or haven't used in a while. If you overdose, you won’t be able to tell someone what’s happening, so it is important to teach those around you what to look for ahead of time. Make a plan with them about what you want them to do if you overdose (what to say to EMS, what to do with any leftover drugs, etc.). If you switch from regularly taking one painkiller to another, especially if it’s methadone or an extended-release opioid, be very careful during the first week to make sure you don’t nod out too quickly or experience trouble breathing after you take it – these are signs that your tolerance isn’t high enough and that you’re at higher risk of overdose.
Mixing painkillers with alcohol can be dangerous.
Mixing extended-release formulations and methadone with alcohol can lead to fatal
levels of the opioid being released all at once. This is sometimes called “dose dumping” and it increases the likelihood of overdose. This isn’t a high worth chasing. Don’t wash down prescription painkillers with alcohol.
There is no such thing as a "morphine patch."
Be careful if someone tries to give or sell you a "morphine patch." There are only two pain patches available in the United States. One is called Duragesic/Mylan/Sandoz and it contains fentanyl, which is about 25 times stronger than morphine – so be careful of overdose risk. The other is called BuTrans and it contains buprenorphine, which means that this patch will put you into withdrawal if you are opioid dependent!
Be extra careful with fentanyl.
Fentanyl is available in several forms. It comes as a:
Fentanyl is very strong and you your likelihood for overdose is high unless you have been taking other strong opioids regularly.
Wait before taking more methadone.
If you are taking methadone for pain or withdrawal, remember that it can take more than a hour to take effect. That means it may not be safe to take more even if what you have already taken is not working. This is especially true if you don't take methadone regularly.
If you are still in pain after taking your normal dose of methadone, try taking aspirin, ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). It’s best to either wait until your next regularly scheduled dose before taking more methadone or call your doctor or a poison center for advice. Being in pain or withdrawal sucks, but taking more and overdosing is worse.
Methadone stays in your body for nearly a day, and builds up in your system when you take it for a few days in a row. When this happens, you may not feel much of a buzz, but it's still there. Be careful if you decide to take heroin, prescription opioids, anti-depressants, sleeping pills or alcohol with methadone because these things put you at increased risk of overdose. If you are dosing yourself, wait as long as possible since you last took methadone, preferably more than a day before taking additional opiates or depressant drugs.
The new OxyContin OP is difficult to crush.
There has been considerable attention to the new OxyContin OP formulation. The old OC formulation stopped being shipped in August 2010 and most of the OxyContin sold by the end of 2010 was the new OP formulation. This makes OxyContin OP the newest entry in what is likely to be a trend of new drugs that are “abuse deterrent” or “tamper resistant”.
The new OP formulation has been changed in two ways with the specific goal of making it less desirable to inject and snort than the old formulation:
While there are complicated recipes online that talk about how to defeat the new formulation and get it prepared for injection, the process is complicated and/or will take too long for most people to do without a degree in chemistry. Also, street chemistry recipes try to get the drug out of the “abuse deterrent” formulations, but they can involve harsh chemicals. As a result, it has been suggested that people who had been using OxyContin are turning to heroin, Roxicodone or Opana instead.
Roxicodone (oxycodone) and Opana (oxymorphone) are prescription opioids that are popular right now.
Oxymorphone (brand name: Opana) comes in two formulations in the United States. One is an immediate release product (Opana) that comes in 5mg and 10mg. The second form is Opana ER and it's an extended-release version that comes in 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg, and 40mg.
Oxymorphone has been used in medicine since the late 1950s, but Opana only came to pharmacies a few years ago. It's about twice as potent as OxyContin, oxycodone, hydrocodone, Percocet, Tylox, Percodan, Vicodin and methadone, and about three times as potent as morphine. So, a 20mg Opana ER is roughly equivalent to a 40mg OxyContin. The high should feel similar to other opiates.
Overdose risk with oxymorphone is similar to OxyContin and other opioids, but since oxymorphone is twice as potent as many other opioids that folks are used to, there may be increased overdose risk based on an incorrect belief that there is a one-to-one conversion.
Roxicodone is an immediate-release form of oxycodone that comes in 15mg and 30mg tablets. Since Roxicodone and OxyContin both contain oxycodone, if you are swallowing them whole, the milligram strengths will be about the same. If you are crushing them and snorting or shooting them, the Roxicodone will have a little less oxycodone than the same milligram strength OxyContin.
Naloxone should work to reverse oxymorphone and oxycodone overdoses.
Fair warning: taking lots of Vicodin may be associated with hearing loss.
There have been reports from poison centers and hospital emergency departments that suggest that some people have experienced sudden, permanent hearing loss after shooting or snorting Vicodin (hydrocodone). There has been little research done in this area and evidence for this comes from just a few individual reports. We don’t know how or why this problem might occur, nor can we suggest specific ways to avoid it.
Visit the Project Lazarus blog for regularly updated news and events related to overdose prevention and chronic pain management.