OPIOIDS – Part 1

Dear World

We have all heard opioids are becoming more popular and how addictive these drugs are.

We seem to lack the awareness and education that is needed to understand what these Drugs do and how they work.

Simple Living Global continue with their Real Truth series…

On the topic of Opioids – here is Part 1


Opioid is a substance used to treat moderate to severe pain 

Opioids are like opiates such as morphine and codeine but are not made from opium.

Opioids bind to opioid receptors in the central nervous system

Opioids used to be called narcotics (1)

Opium | Heroin | Methadone | Buprenorphine | Codeine


The latex of the opium poppy has been used as a painkiller for thousands of years
It contains the opiates codeine and morphine and from these we have also derived the synthetic opioids heroin, methadone and buprenorphine.

They target the endorphin receptors in the brain, creating a dreamy sense of well-being.

In medicine, they play an essential role in controlling physical pain and are given to people with traumatic injuries or after surgery and to enable peaceful deaths for people with terminal illness.

They also dull psychological pain and seem to be particularly attractive to people who have suffered psychological trauma such as child abuse or living through War.

Carrying out normal activities under the influence of opiates is pretty difficult and even mild opiates such as codeine are not recommended for people driving or operating heavy machinery.

Some are highly addictive and repeated use leads to physical dependence and powerful withdrawal symptoms. The main harms they do to the body are causing nausea, vomiting and chronic constipation and of course the risk of death from stopping breathing in overdose.
Professor David Nutt – 2012 (2)

Despite all our other staggering pharmaceutical progress, our reliance on the opium poppy plant has not changed much.

Poppies make two of the world’s most widely used painkillers – codeine and morphine and the cough suppressant noscapine. (3)

So the first thing we need to know is that painkillers have been used for thousands of years from the poppy plant.

This tells us we had pain and found a way to deal with it.
In other words, we wanted relief and we found a Solution.

Then we created synthetic versions and their job is to get to the part of the brain that is going to make us forget the pain and replace it with a “dreamy sense of well-being”.

What exactly is a “dreamy sense of well-being” and is it something we want more of?

Yes – we would all agree that painkillers are needed in medicine and are essential for pain control during surgery, traumatic injuries and end of life care where there is a terminal illness.

However how effective are they really when we use them to “dull psychological pain” as mentioned above?

Are we simply toning the pain down so it is not acute but nevertheless it is still there and not going to go away?

Are opioids the answer to our psychological pain or is there Another Way?

The fact that we cannot carry out normal activities, as it is difficult under the influence of opiates; even mild opiates affect our driving ability.
This in itself speaks volumes

Have we read this clearly – even a mild dose affects our brain chemistry

Add to this – one very important factor
These drugs are highly addictive, which means we get used to taking them and over time, we need more of it to keep the pain away because we are not at any point asking why we have the pain in the first place.

What we want is the pain to go away but it cannot simply disappear forever because we are not asking any Questions as to how we got the pain.

What we are asking for is a Solution to take away the pain so we can feel the relief of having no pain.

Is this making sense?


How serious is this –

  • These drugs are highly addictive
  • Repeated use leads to physical dependence
  • There are powerful withdrawal symptoms

So are we being Fooled into thinking there are drugs we can take to make the pain go away but the truth is the pain is just buried inside us and never goes away?

Could it be possible that while we try to deal with the pain by killing it – hence the name pain-killers, we are not really killing it but just pushing it further and deeper into our bodies?

Could it be possible that we get hooked and become dependent on these painkillers as we need them to keep the pain away, as we simply do not want to deal with whatever is coming up for us?

Could it be possible that we want the ‘quick fix’ method and so painkillers seem to do the job and we forget the long-term consequences?

Could it be as simple as tracing our steps back to see how we are living and moving that may have got us to this pain?


Why are we using a drug to suppress our cough?

Is the body communicating something to us with our cough?

Are we open to the possibility that the cough is needed to bring us back to balance as we had gone off track?

Are other illnesses and dis-ease in the body simply a correction – a healing to bring us back, as we deviated from our natural path?

Are these Questions too far-fetched, way off and out there, OR will the scholars of the future study this book and other writings from this website and know there were those who were presenting the Truth back in the early 21st century?

Endorphins: Natural Pain and Stress Fighters

Endorphins are among the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system.

They are found in the pituitary gland, in other parts of the brain or distributed throughout the nervous system.

Stress and pain are the two most common factors leading to the release of endorphins.

Endorphins interact with opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine.

In contrast to the opiate drugs, activation of the opiate receptors by the body’s endorphins does not lead to addiction or dependence.

In addition to decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones and enhancement of the immune response.

With high endorphin levels, we feel less pain and fewer negative effects of stress. Endorphins have been suggested as modulators of the so-called “runner’s high” that athletes achieve with prolonged exercise.

While the role of endorphins and other compounds as potential triggers of this euphoric response has been debated extensively by doctors and scientists, it is at least known that the body does produce endorphins in response to prolonged, continuous exercise. (4)

Opioids bind to and activate opioid receptors on cells located in the brain, spinal cord and other organs in the body, especially those involved in feelings of pain and pleasure. (5)


Can we learn something here about these brain chemicals called Endorphins?

They are already naturally present inside us and they have a job when we get Stress or pain – they release and we feel better.

Note –


Hello and Hello

Do we get it?

When our body gives us the natural painkiller by releasing endorphins – it is responding to Stress or pain and we get to feel better.

As it is a natural response coming from our body, which always knows what is best for us, we do not get addicted or dependent on it.

However, if we are not dealing with our Stress then we are going to want the same drug or something similar to take that pain away.

Bingo – we have created opioids but we did not sign up for the side effects and the fact that it is addictive and many who take the drug become dependent.

When we over exercise – we feel less pain and fewer negative effects of stress but does the pain actually go away or is it suppressed?

Does this mean we need to achieve prolonged exercise to get the same buzz and is this what the so called “runner’s high” means?

Is this why so many get addicted to exercise because it releases these endorphins that give us the intense Happiness and excitement and keeps the pain away?

In other words, we have found a form of self-medication that works because we get a euphoric response.

But does it really work or are we just simply fooling ourselves?

Does it last or do we need more of the same to feel what we want?

Are we ever considering if our need to push our body through over exercise is because deep down we are not feeling great at all?

In other words, we have buried stuff that is causing us pain and misery and this fitness business gives us some natural medicine, where we get to feel an intense happy state.

Whilst we seek this pleasure we are willing to take any drug to give us the repeated experience we desire.

In other words, we want to feel certain feelings and we want other ugly feelings to just go away and we will do what it takes for that to happen.

Opiates or Opioids

Some people carefully distinguish between these two groups of narcotic drugs.
Others use the two terms interchangeably or prefer one over the other.

As our language is changing – many including journalists and politicians refer to all of these drugs as “opioids.”

Both opiates and opioids are used medically and are prescribed for –

  • Pain relief
  • Anaesthesia
  • Cough suppression
  • Diarrhea suppression
  • Treatment of opiate/opioid use disorder

Both opiates and opioids are used illicitly by those with a substance use disorder.

The main difference is in how opiates and opioids are made. (6)

This is serious stuff

We are using these drugs to relieve us from the pain we feel

We are also using them to knock us out by anaesthesia. That means artificially induce before surgery.

This confirms how potent and powerful these drugs are as they can totally take us out where we are not awake or coherent.

Next – they are used to suppress a cough or diarrhea

Again, we get assistance to stop something that disturbs our body and we leave it at that.

Do we ask how on earth did we get to the point where we have diarrhea?

Are we putting it down to a bad eating moment or is there something more that our body might be communicating?

Are we prepared to dig a bit deeper and ask some more Questions or is life just too overwhelming to get all forensic with the detail stuff?

Now the next is a real big HELLO

We use opiates and opioids as treatment of opiate or opioid use disorder

How can we use the same drugs to deal with the disorder that it created in the first place?


Let us not forget there is a huge demand and so we have an illicit market supplying those who have a drug addiction, also called substance use disorder.

It is a disease that affects the brain and the behaviour leads to an inability to control the use of drugs or medication, be it legal or illegal.

Important NoteAlcohol, Marijuana and Nicotine are considered drugs

Simple Living Global has delivered the Real Truth about all the above drugs to bring more awareness by way of education and understanding.


Opiates are chemical compounds that are extracted or refined from natural plant matter (poppy sap and fibers).

Examples of Opiates:

  • Opium
  • Morphine
  • Codeine
  • Heroin (6)

Heroin is one of the world’s most dangerous opioids (5)

People using heroin are at risk of contracting blood infections by sharing needles.
Injecting heroin can also damage the veins and arteries and may cause gangrene. (7)


For those who inject heroin – are they in a state to even consider the consequences of needle sharing or blood infections?

Do they need the pain to go away or are they going to think about the damage to arteries and veins and possibly getting gangrene?

Are our heroin users not interested in anything else, other than the next hit?


Opioids are chemical compounds that generally are not derived from natural plant matter.

Most opioids are “made in the lab” or “synthesized”

A few opioid molecules – hydrocodone, hydromorphone, oxycodone may be partially synthesized from chemical components of opium, other popularly-used opioid molecules are designed and manufactured in laboratories.

Note – nearly all opioids are synthesized

 500 different opioid molecules created by the pharmaceutical industry

Some are widely used medically and some are not.

Examples of well-known opioids used medically in the U.S.

  • Dextromethorphan
  • Dextropropoxyphene
  • Loperamide
  • Hydrocodone
  • Oxycodone
  • Oxymorphone
  • Meperidine
  • Methadone
  • Fentanyl/Fentanil
  • Carfentanyl/Carfentanil

Opiates and Opioids 

Both groups of drugs are narcotics

The word “narcotic” means sleep-inducing or numbness-inducing
From the Greek narkoun – “to be numb”

If a person is dependent on (addicted to) one particular opiate or opioid drug – whether it is medically prescribed or illicitly obtained, switching to a different opiate or opioid can maintain their dependency or addiction.

Substituting one opiate or opioid for another can prevent withdrawal symptoms

Many of us are aware of people with real, actual pain who became dependent on prescription pain-relieving narcotic drugs, then switched to illicit opioids or the opiate heroin when the medically-supplied narcotics run out. (6)

As with all Drugs we have opioids – made in the laboratories

Most of us have heard news stories with the rise in use of Fentanyl addiction

These groups of drugs are narcotics and does the origin of this word tell us something more…?

To be numb – numbness inducing

We all know we are human beings that feel and sense everything

If we want to ‘numb’ those feelings, we can with our drug of choice

But do we want to know WHY we want to be numb in the first place?

Is something bugging us, bothering us and we don’t deal with it?

Can this habit of not dealing with what we feel, lead to pain and misery?
Can that pain lead to even more pain just because we keep ignoring it?
Can that ignoring over time, bury the pain deeper inside our bodies?

Does this lead us to seek something to relieve us as the pain is too much?

Is this where we find the drug of choice and what we did not consider was all drugs have side-effects and all drugs alter our natural state?

Could it be possible that in this altered state of being, we make choices that are not going to support our body to deal with whatever pain we have coming up?

Could it be possible that in this altered state of being we feel our head being fed with what we need to do next and it is in total dis-regard for our precious body?

Could it be possible that in this altered state of being we are not taking responsibility for everyday life tasks as we are simply not aware?

In other words, we have switched off and made a choice to be “numb” as these drugs give us that.

Could it be possible that we have gone way too deep with the drug of choice and we want more drugs to keep that pain at bay as things are not working?

Dear World

How serious is it when so called sensible, normal people take prescription pain-relieving narcotic drugs and never thought they would end up getting supplies from the illicit market as they have become addicted and they cannot go down the medical supply route anymore?

Types of Opioids

Opioids also bind to the opioid receptors in the gastrointestinal tract.

There are illegal opioids like heroin as well as legal opioids that are prescribed for pain relief.

There is a dangerous trend where those who have become addicted to prescription opioids begin using heroin because it is cheaper.

3 Main Types of Opioids

Alkaloids, nitrogen-containing base chemical compounds that occur in plants like opium poppy.

Natural opioids include morphine, codeine and thebaine.

Created in labs from natural opiates, semi-synthetic opioids include:

Hydromorphone | hydrocodone | oxycodone
Heroin is also semi-synthetic and is made from morphine

Fully Synthetic Man Made
Completely man made including:

Fentanyl | pethidine | levorphanol | methadone | tramadol | dextropropoxyphene (8)

The Body’s ‘Natural Opioids’ Affect Brain Cells Much Differently than Morphine

Scientists shows that brain cells or neurons react differently to opioid substances created inside the body; the endorphins responsible for the “natural high” that can be produced by exercise, for example – compared to morphine or heroin or to purely synthetic opioid drugs, such as fentanyl.

Researchers’ findings may help to explain why the use of synthetic opioids can lead to addiction.

Since both synthetic opioids and the natural “endogenous” opioids produced by the brain, bind to and activate opiate receptors on the surface of nerve cells, scientists have long assumed that both types of molecules target the same cellular systems.

However, new research reveals that these molecules also activate opioid receptors inside cells and that the locations of these activated intracellular receptors differ between natural and synthetic opioids.

‘There has been no evidence so far that opioid drugs do anything other than what natural opioids do, so it has been hard to reconcile the experiences that drug users describe – that opioid drugs are more intensely pleasurable than any naturally rewarding experience that they have ever had.
The possibility that these opioid drugs cause effects that natural opioids cannot is very intriguing because it seems to parallel this extremely rewarding effect that users describe.”
Mark von Zastrow – MD, PhD | Professor of Psychiatry | UCSF (9)

“Drugs, which we generally thought of as mimics of endogenous opioids, actually produce different effects by activating receptors in a place that natural molecules cannot access.”
Miriam Stoeber PhD (9)   

Morphine and synthetic opioids crossed cell membranes without binding receptors or entering endosomes. They travelled directly to the Golgi apparatus, reaching their target much more quickly than endogenous opioids got into endosomes, taking only 20 seconds compared to over a minute. This time difference could be important in the development of addiction, the researchers said, because typically the faster a drug takes effect, the higher its addictive potential.

New Study led by UC San Francisco

Do we always want the fast road to get away from pain, even if the faster drug has a higher addictive potential?

Are our lifestyle choices generally about getting things faster and faster and not giving any time or space for any real change?

Prescription Opioids

Pain relievers with an origin similar to that of Heroin

Opioids can cause euphoria and are sometimes used non-medically, leading to overdose deaths.

Common Commercial Names

various brand names

Street Names

Captain Cody | Cody | Lean | Schoolboy | Sizzurp | Pancakes and Syrup | Loads
Purple Drank with glutethimide: Doors & Fours

Common Forms


Common Ways Taken

Ingested (often mixed with soda and flavourings)


Street Names

Apache | China Girl | China White | Dance Fever | Friend | Goodfella | Jackpot | Murder 8 | Tango and Cash | TNT (10) | Great Bear | He-Man | Poison (11)

Common Forms

Sublingual Tablet
Buccal Tablet (10)

Sublingual and Buccal Medication Administration

Sublingual and buccal medication administration are two different ways of giving medication by mouth.

Sublingual administration involves placing a drug under our tongue to dissolve and absorb into our blood through the tissue there. Buccal administration involves placing a drug between our gums and cheek, where it also dissolves and is absorbed into our blood.

When Sublingual and Buccal Drugs are Given

 Doctors may prescribe sublingual or buccal drugs under any of the following circumstances:

  • the drug needs to get into our system quickly
  • patient has trouble swallowing medication
  • the medication does not absorb very well in the stomach
  • the effects of the drug would be decreased by digestion

The cheek and area under the tongue have many capillaries or tiny blood vessels. There drugs can be absorbed directly into the bloodstream without going through our digestive system. (12)

Common Ways Taken


Hydrocodone or Dihydrocodeinone

Street Names

Vike | Watson-387

Common Forms


Common Ways Taken



Street Names

D | Dillies | Footballs | Juice | Smack

Common Forms


Common Ways Taken

Rectally inserted


Street Names

Demmies | Pain Killer

Common Forms


Common Ways Taken



Street Names

Fizzies with MDMA: Chocolate Chip Cookies

Common Forms


Common Ways Taken

Injected (10)

Methadone also comes in the form of a dispersible tablet (tablet that can be dissolved in liquid), concentrate solution and solution. These forms can be taken by mouth.

It also comes as an injection that is only given by a doctor

Methadone oral tablet is used to treat pain

It is also used for detoxification or maintenance treatment of an opioid drug addiction. (13)

Various brand names

Street Names

M | Miss Emma | Monkey | White Stuff

Common Forms


Common Ways Taken



Street Names

O.C. | Oxycet | Oxycotton | Oxy | Hillbilly Heroin | Percs

Common Forms


Common Ways Taken 



Street Names

Biscuits | Blue Heaven | Blues | Mrs O | O Bomb | Octagons | Stop Signs

Common Forms


Common Ways Taken


Facing Addiction in America
Surgeon General Report on Alcohol, Drugs and Health | 2016

Prescription Opioids
Uses & Possible Health Effects

Short-Term Symptoms of Use

Pain relief | drowsiness | nausea | constipation | altered judgment and decision making | sedation | euphoria | confusion | clammy skin | muscle weakness | slowed breathing | lowered heart and blood pressure | coma | heart failure | death

For oxycodone specially:
Pain relief | sedation | respiratory depression | constipation | papillary constriction | cough suppression

For fentanyl specifically:
Fentanyl is about 100 times more potent than morphine as an analgesic and results in frequent overdoses (10)

Did we know prescription opioids are used as a short term high?

Are we aware those feelings of euphoria are temporary?

Who on earth comes us with these names on the street?

Are Pancakes and Syrup giving us that euphoric feeling and can we get the same buzz when we ingest or inject Codeine?

Is Fentanyl like winning the Jackpot for us as it gives us the intense excitement?

Why is Fentanyl called Murder 8 – is it trying to kill the soul of the human being?

Is Fentanyl associated with TNT as you can get an express delivery service?

Did we know that Fentanyl is 100 times stronger than morphine?

The fact that Fentanyl drug is so powerful – is this where the names Great Bear and He-Man come from?

Are we aware it is pure poison for our body hence the street name Poison?

Is there a link with the story of the film Goodfella and this potent drug?

What part of Methadone becomes Chocolate Chip Cookies to the user?

What is the feeling that we relate to with these cookies and the methadone ecstasy (MDMA) combo?

What are Analgesics

Analgesics are medicines that are used to relieve pain

They are also known as painkillers or pain relievers. Technically, the term analgesic refers to a medication that provides relief from pain without putting you to sleep or making you lose consciousness.

Many different types of medicines have pain-relieving properties and experts tend to group together those medicines that work in a similar way. Two of the most common groups of pain killers are non-steroidal anti-inflammatory drugs (NSAIDs) and Opioids (narcotics) and there are many more.

Sometimes experts will group analgesics together based on their potency or how strong they are.

World Health Organization Analgesic Ladder – step wise approach to pain relief recommends non-opioid analgesics such as acetaminophen and NSAIDs for mild-to-moderate pain; weak opioids such as codeine, dihydrocodeine or tramadol, for moderate-to-severe pain; and stronger opioids such as oxycodone and morphine for severe pain. (14)

So let us look at this section on Analgesics and keep it simple

Technically this word is telling us these are a group of medicines that relieve our pain – kill it but we will not lose consciousness or fall asleep.

Note the key word here is technically

If we use the word Reality and read this whole tablet of Truth being presented – what can we learn?

Who are the experts grouping medicines together that work?

Can we get their support to unite and work together to find out WHY anyone has pain in the first place, instead of seeking more ways to keep the pain away?

What we do know is that our world now has an Opioid crisis and that means SOMETHING IS NOT RIGHT.

The World Health Organization has this ladder – a scale

Question – is it a ‘wise approach’ if we have a world where many are addicted to strong opioids like morphine for severe pain?

Would a truly wise approach be putting all our experts, researchers and scientists on the job to find out WHY we get pain?

In other words, what is the root cause – where did it start?

Would it be a wise movement if we made sure ALL research and funding was independent and that means for the people as it is about the people?

Long-Term Consequences of Use and Health Effects

Heart or respiratory problems

Abuse of opioid medications can lead to psychological dependence

Extended or chronic use of oxycodone containing acetaminophen (non-opioid analgesic) may cause severe liver damage.

Other Health-Related Issues

Miscarriage | low birth weight | neonatal abstinence syndrome 

Older adults:
Higher risk of accidental misuse or abuse because many older adults have multiple prescriptions, increasing the risk of drug-drug interactions and breakdown of drugs slows with age. Also, many older adults are treated with prescription medications for pain.

Risk of HIV | Hepatitis | Other infectious diseases from shared needles

In Combination with Alcohol

Dangerous slowing of heart rate and breathing leading to coma or death

Withdrawal Symptoms

Restlessness | anxiety | muscle and bone pain | insomnia | diarrhea | vomiting | cold flashes with goosebumps | muscle tremors

Medical Use

Used for pain relief
Methadone is also used to treat opioid use disorders

Treatment Options


Naltrexone (oral and extended-release injectable)

Behavioral Therapies

Behavioral therapies that have helped treat addiction to heroin may be useful in treating prescription opioid addiction.


Statistics as of 2015

Lifetime:            36 million persons aged 12 or older have misused pain relievers in their lifetime.

Past Year:         12.5 million persons aged 12 or older have misused pain relievers in the past year.

Average Age of Initiation

Prescription Opioids:  25.8 (10)

Common Prescription Opioids

  • Codeine
  • Fentanyl
  • Morphine
  • Oxycodone
  • Hydrocodone
  • Oxymorphone

Mis-use of Prescription Opioids   

  • Taking medicine in a way or dose other than prescribed
  • Taking someone else’s prescription medicine
  • Taking the medicine for the effect it causes to get high

When mis-using a prescription opioid, a person can –

  • Swallow medicine in its normal form
  • Crush pills
  • Open capsules
  • Dissolve the powder in water
  • Inject liquid into vein
  • Snort the powder (5)

If we just look at this section –

How are we mis-using prescription opioids and how serious is this?

Taking medicine that is for someone else – how can that be true?
Taking medicine that is different to what we are supposed to take
Taking medicine just to get the side effects – the buzz we need

We are willing to snort and inject it, as both of these will get into the body faster and quicker than just swallowing the normal way.

How serious is this?

Prescription Opioids – Side Effects on Brain and Body

Opioid misuse can cause slowed breathing, which can cause hypoxia – a condition that results when too little oxygen reaches the brain.

Hypoxia can have short and long-term psychological and neurological effects including coma, permanent brain damage or death.

Researchers are investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

Prescription Opioids Overdose

Opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death.

When people overdose on an opioid medication, breathing often slows or stops

This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage or death. (5)

What is this section spelling out to us and do we get it ?

By mis-using opioids that are prescribed for us, it can affect our breathing because the brain has a lack of oxygen.

How serious is this?

ADD to that the ill effects of hypoxia and we have psychological and neurological effects.

While we wait for researchers to investigate long-term effects of opioid addiction on the brain and whether it can be reversed or not, can we re-read what this tablet of truth has presented thus far and start to ask some serious questions about our behaviour, which is leading some of us to mis-use prescribed drugs that are not designed for the human frame to assimilate long-term?

Treatment for Opioid Overdose

Naloxone is a medicine that can treat an opioid overdose when given right away

It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs.

Available in the following forms:

  • Injectable needle solution
  • Hand-held auto-injector
  • Nasal spray (5)

How Intelligent are we really that we create a drug that can quickly block an overdose and yet we have not found a way to deal with why we have pain in the first place?

Imagine finding the root cause and nailing it, so that we do not end up with dependency, addiction and mis-use.

Could that be the very thing this world needs or are we going to continue demanding more Solutions to our ill ways of living that cause us pain?

Next – if we continue repeating this mis-using then we can end up with substance use disorder. Now it gets really serious…

Prescription Opioids Addiction

Repeated mis-use of prescription opioids can lead to substance use disorder (SUD), a medical illness which ranges from mild to severe and from temporary to chronic.

Addiction is the most severe form of a SUD

A substance use disorder develops when continued mis-use of the drug changes the brain and causes health problems and failure to meet responsibilities at home, work and school.

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include severe cravings.

As the symptoms are extremely uncomfortable, many people find it very difficult to stop using opioids.

There are medicines being developed to help with the withdrawal process and the U.S. Food and Drug Administration (FDA) approved sale of a device that can help ease withdrawal symptoms; a small electrical nerve stimulator placed behind the person’s ear that can be used for up to five days during the acute withdrawal phase.

The FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

Buprenorphine and methadone work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms.

Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from having an effect. (5)


Opioid-Related Disorders

Opioid Use Disorder
Opioid Intoxication
Opioid Withdrawal
Other Opioid-Induced Disorders
Unspecified Opioid-Related Disorder


Opioid Use Disorder

Diagnostic Criteria

A. A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Opioids are often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

4. Craving, or a strong desire or urge to use opioids.

5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school or home.

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

8. Recurrent opioid use in situations in which it is physically hazardous.

9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following:

       a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.

       b. A markedly diminished effect with continued use of the same amount of an opioid.

       Note:  This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

11. Withdrawal, as manifested by either of the following:

       a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal)

       b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

       Note:  This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

Specify if:
In early remission:
After full criteria for opioid use disorder were previously met, none of the criteria for opioid use
disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use opioids,” may be met).

In sustained remission:
After full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use opioids,” may be met).

Specify if:
On maintenance therapy:
This additional specifier is used if the individual is taking a prescribed agonist medication such as
Methadone or buprenorphine and none of the criteria for opioid use disorder have been met for
that class of medication (except tolerance to, or withdrawal from, the agonist). This category also
applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or a full
antagonist such as oral naltrexone or depot naltrexone.

In a controlled environment:
This additional specifier is used if the individual is in an environment where access to opioids is restricted.


The “on maintenance therapy” specifier applies as a further specifier of remission if the individual is both in remission and receiving maintenance therapy.

“In a controlled environment” applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment).

Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

Diagnostic Features

Opioid use disorder includes signs and symptoms that reflect compulsive, prolonged self-administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition. (For example, an individual prescribed analgesic opioids for pain relief at adequate dosing will use significantly more than prescribed and not only because of persistent pain). Individuals with opioid use disorder tend to develop such regular patterns of compulsive drug use that daily activities are planned around obtaining and administering opioids.

Opioids are usually purchased on the illegal market but may also be obtained from physicians by falsifying or exaggerating general medical problems or by receiving simultaneous prescriptions from several physicians.

Health care professionals with opioid use disorder will often obtain opioids by writing prescriptions for themselves or by diverting opioids that have been prescribed for patients or from pharmacy supplies. Most individuals with opioid use disorder have significant levels of tolerance and will experience withdrawal on abrupt discontinuation of opioid substances.

Individuals with opioid use disorder often develop conditioned responses to drug-related stimuli (e.g., craving on seeing any heroin powder-like-substance) – a phenomenon that occurs with most drugs that cause intense psychological changes. These responses probably contribute to relapse, are difficult to extinguish, and typically persist long after detoxification is completed. 

Associated Features Supporting Diagnosis

Opioid use disorder can be associated with a history of drug-related crimes (e.g., possession or distribution of drugs, forgery, burglary, robbery, larceny, receiving stolen goods).

Among health care professionals and individuals who have ready access to controlled substances, there is often a different pattern of illegal activities involving problems with state licensing boards, professional staffs of hospitals, or other administrative agencies.

Martial difficulties (including divorce), unemployment and irregular employment are often associated with opioid use disorder at all socioeconomic levels.

Development and Course

Opioid use disorder can begin at any age, but problems associated with opioid use are most commonly first observed in the late teens or early 20s.

Once opioid use disorder develops, it usually continues over a period of many years, even though brief periods of abstinence are frequent. In treated populations, relapse following abstinence is common. Even though relapses do occur, and while some long-term mortality rates may be as high as 2% per year, about 20% – 30% of individuals with opioid use disorder achieve long-term abstinence. An exception concerns that of military service personnel who became dependent on opioids in Vietnam; over 90% of this population who had been dependent on opioids during deployment in Vietnam achieved abstinence after they returned, but they experienced increased rates of Alcohol or Amphetamine use disorder as well as increased suicidality.

Increasing age is associated with a decrease in prevalence as a result of early mortality and the remission of symptoms after age 40 years (i.e., “maturing out”). However, many individuals continue to have presentations that meet opioid use disorder criteria for decades.

Risk and Prognostic Factors

Genetic and physiological

The risk for opiate use disorder can be related to individual, family, peer and social environmental factors, but within these domains, genetic factors play a particularly important role both directly and indirectly. For instance, impulsivity and novelty seeking are individual temperaments that relate to the propensity to develop a substance use disorder but may themselves be genetically determined. Peer factors may relate to genetic predisposition in terms of how an individual selects his or her environment.

Diagnostic Markers

Routine urine toxicology test results are often positive for opioid drugs in individuals with opioid use disorder. Urine test results remain positive for most opioids (e.g., heroin, morphine, codeine, oxycodone, propoxyphene) for 12 – 36 hours after administration.

Fentanyl is not detected by standard urine tests but can be identified by more specialized procedures for several days.

Methadone, buprenorphine (or buprenorphine/naloxone combination), and LAAM (L-alpha-acetylmethadol) have to be specifically tested for and will not cause a positive result on routine tests for opiates. They can be detected for several days up to more than 1 week. Laboratory evidence of the presence of other substances (e.g., cocaine, marijuana, alcohol, amphetamines, benzodiazepines) is common. Screening test results for hepatitis A, B and C virus are positive in as many as 80% – 90% of injection opioid users, either for hepatitis antigen (signifying active infection) or for hepatitis antibody (signifying past infection). HIV is prevalent in injection opioid users as well. Mildly elevated liver function test results are common, either as a result of resolving hepatitis or from toxic injury to the liver due to contaminants that have been mixed with the injected opioid. Subtle changes in cortisol secretion patterns and body temperature regulation have been observed for up to 6 months following opioid detoxification.

Suicide Risk

Similar to the risk generally observed for all substance use disorders, opioid use disorder is associated with a heightened risk for suicide attempts and completed suicides.

Particularly notable are both accidental and deliberate opioid overdoses. Some suicide risk factors overlap with risk factors for an opioid use disorder. In addition, repeated opioid intoxication or withdrawal may be associated with severe depressions that, although temporary, can be intense enough to lead to suicide attempts and completed suicides.

Available data suggest that nonfatal accidental opioid overdose (which is common) and attempted suicide are distinct clinically significant problems that should not be mistaken for each other.

Functional Consequences of Opioid Use Disorder

Opioid use is associated with a lack of mucous membrane secretions, causing dry mouth and nose. Slowing of gastrointestinal activity and a decrease in gut motility can produce severe constipation. Visual acuity may be impaired as a result of pupillary constriction with acute administration. In individuals who inject opioids, sclerosed veins (“tracks”) and puncture marks on the lower portions of the upper extremities are common.

Veins sometimes become so severely sclerosed that peripheral edema develops and individuals switch to injecting in veins in legs, neck or groin.

When these veins become unusable, individuals often inject directly into their subcutaneous tissue (“skin-popping”), resulting in cellulitis, abscesses and circular appearing scars from healed skin lesions. Tetanus and Clostridium botulinum infections are relatively rare but extremely serious consequences of injecting opioids, especially with contaminated needles.

Infections may also occur in other organs and include bacterial endocarditis, hepatitis and HIV infection. Hepatitis C infections, for example, may occur in up to 90% of persons who inject opioids. In addition, the prevalence of HIV infection can be high among individuals who inject drugs, a large proportion of whom are individuals with opioid use disorder. HIV infection rates have been reported to be as high as 60% among heroin users with opioid use disorder in some areas of the United States or the Russian Federation.

However, the incidence may also be 10% or less in other areas, especially those where access to clean injection material and paraphernalia is facilitated.

Tuberculosis is a particularly serious problem among individuals who use drugs intravenously, especially those who are dependent on heroin; infection is usually asymptomatic and evident only by the presence of a positive tuberculin skin test. However, many cases of active tuberculosis have been found, especially among those who are infected with HIV. These individuals often have a newly acquired infection but also are likely to experience reactivation of a prior infection because of impaired immune function.

Individuals who sniff heroin or other opioids into the nose (“snorting”) often develop irritation of the nasal mucosa, sometimes accompanied by perforation of the nasal septum. Difficulties in sexual functioning are common. Males often experience erectile dysfunction during intoxication or chronic use. Females commonly have disturbances of reproductive function and irregular menses.

In relation to infections such as cellulitis, hepatitis, HIV infection, tuberculosis and endocarditis, opioid use disorder is associated with a mortality rate as high as 1.5% – 2% per year. Death most often results from overdose, accidents, injuries, AIDs or other general medical complications. Accidents and injuries due to violence that is associated with buying or selling drugs are common. In some areas violence accounts for more opioid-related deaths than overdose or HIV infection.

Physiological dependence on opioids may occur in about half of the infants born to females with opioid use disorder; this can produce a severe withdrawal syndrome requiring medical treatment. Although low birth weight is also seen in children of mothers with opioid use disorder, it is usually not marked and is generally not associated with serious adverse consequences.

Differential Diagnosis

Opioid-induced mental disorders
Opioid-induced disorders occur frequently in individuals with opioid use disorder.
Opioid-induced disorders may be characterized by symptoms (e.g., depressed mood) that resemble primary mental disorders (e.g., persistent depressive disorder (dysthymia) vs. opioid-induced depressive disorder, with depressive features, with onset during intoxication). Opioids are less likely to produce symptoms of mental disturbance than are most other drugs of abuse. Opioid intoxication and opioid withdrawal are distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.

Other substance intoxication
Alcohol intoxication and sedative, hypnotic or anxiolytic intoxication can cause a clinical picture that resembles that for opioid intoxication. A diagnosis of alcohol or sedative, hypnotic or anxiolytic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases, the naloxone challenge will not reverse all of the sedative effects.

Other withdrawal disorders
The anxiety and restlessness associated with opioid withdrawal resemble symptoms seen in sedative-hypnotic withdrawal. However, opioid withdrawal is also accompanied by rhinorrhea, lacrimation and pupillary dilation, which are not seen in sedative-type withdrawal.

Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication. However, other signs or symptoms of opioid withdrawal such as nausea, vomiting, diarrhea, abdominal cramps, rhinorrhea, or lacrimation, are not present.


The most common medical conditions associated with opioid use disorder are viral (e.g., HIV, hepatitis C virus) and bacterial infections, particularly among users of opioids by injection. These infections are less common in opioid use disorder with prescription opioids.

Opioid use disorder is often associated with other substance use disorders especially those involving Tobacco, Alcohol, Cannabis, stimulants, and benzodiazepines, which are often taken to reduce symptoms of opioid withdrawal or craving for opioids, or to enhance the effects of administered opioids.

Individuals with opioid use disorder are at risk for the development of mild to moderate depression that meets symptomatic and duration criteria for persistent depressive disorder (dysthymia) or, in some cases, for major depressive disorder.

These symptoms may represent an opioid-induced depressive disorder or an exacerbation of a pre-existing primary depressive disorder. Periods of depression are especially common during chronic intoxication or in association with physical or psychosocial stressors that are related to the opioid use disorder.

Insomnia is common, especially during withdrawal.

Antisocial personality disorder is much more common in individuals with opioid use disorder than in the general population.

Post-traumatic stress disorder is also seen with increased frequency.

A history of conduct disorder in childhood or adolescence has been identified as a significant risk factor for substance-related disorders, especially opioid use disorder. 

Opioid Intoxication

Diagnostic Criteria

A. Recent use of an opioid.

B. Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.

C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use:

       1. Drowsiness or coma.
       2. Slurred speech.
       3. Impairment in attention or memory.

D. The signs of symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Specify if:
With perceptual disturbances:
This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.

Diagnostic Features

The essential feature of opioid intoxication is the presence of clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that develop during, or shortly after, opioid use (Criteria A and B).

Intoxication is accompanied by pupillary constriction (unless there has been a severe overdose with consequent anoxia and pupillary dilation) and one or more of the following signs: drowsiness (described as being “on the nod”), slurred speech, and impairment in attention or memory (Criterion C); drowsiness may progress to coma. Individuals with opioid intoxication may demonstrate inattention to the environment, even to the point of ignoring potentially harmful events.

The signs and symptoms must not be attributable to another medical condition and are not better explained by another mental disorder (Criterion D).

Differential Diagnosis

Other substance intoxication
Alcohol intoxication and sedative-hypnotic intoxication can cause a clinical picture that resembles opioid intoxication.

A diagnosis of alcohol or sedative-hypnotic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to a naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases the naloxone challenge will not reverse all of the sedative effects.

Other opioid-related disorders
Opioid intoxication is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in the latter disorders predominate in the clinical presentation and meet full criteria for the relevant disorder.

Opioid Withdrawal

Diagnostic Criteria                                                                                                       
292.0 (F11.23)

A. Presence of either of the following:

  1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer).

       2. Administration of an opioid antagonist after a period of opioid use.

B. Three (or more) of the following developing within minutes to several days after Criterion A:

       1. Dysphoric mood.
       2. Nausea or vomiting.
       3. Muscle aches.
       4. Lacrimation or rhinorrhea.
       5. Pupillary dilation, piloerection, or sweating. 
       6. Diarrhea.
       7. Yawning.
       8. Fever.
       9. Insomnia.

C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Diagnostic Features

The essential feature of opioid withdrawal is the presence of a characteristic withdrawal syndrome that develops after the cessation of (or reduction in) opioid use that has been heavy and prolonged (Criterion A1).

The withdrawal syndrome can also be precipitated by administration of an opioid antagonist (e.g., naloxone or naltrexone) after a period of opioid use (Criterion A2). This may also occur after administration of an opioid partial agonist such as buprenorphine to a person currently using a full opioid agonist.

Opioid withdrawal is characterized by a pattern of signs and symptoms that are opposite to the acute agonist effects. The first of these are subjective and consist of complaints of anxiety, restlessness, and an “achy feeling” that is often located in the back and the legs, along with irritability and increased sensitivity to pain. Three or more of the following must be present to make a diagnosis of opioid withdrawal: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or increased sweating; diarrhea; yawning; fever; and insomnia (Criterion B).

Piloerection and fever are associated with more severe withdrawal and are not often seen in routine clinical practice because individuals with opioid use disorder usually obtain substances before withdrawal becomes that far advanced…

Meeting diagnostic criteria for opioid withdrawal alone is not sufficient for a diagnosis of opioid use disorder, but concurrent symptoms of craving and drug-seeking behavior are suggestive of comorbid opioid use disorder.

The speed and severity of withdrawal associated with opioids depend on the half-life of the opioid used. Most individuals who are physiologically dependent on short-acting drugs such as heroin begin to have withdrawal symptoms within 6 – 12 hours after the last dose.

Symptoms may take 2 – 4 days to emerge in the case of longer-acting drugs such as methadone, LAAM (L-alpha-acetylmethadol), or buprenorphine.

Acute withdrawal symptoms for a short-acting opioid such as heroin usually peak within 1 – 3 days and gradually subside over a period of 5 – 7 days. Less acute withdrawal symptoms can last for weeks to months. These more chronic symptoms include anxiety, dysphoria, anhedonia, and insomnia.

Associated Features Supporting Diagnosis

Males with opioid withdrawal may experience piloerection, sweating and spontaneous ejaculations while awake. Opioid withdrawal is distinct from opioid use disorder and does not necessarily occur in the presence of the drug-seeking behavior associated with opioid use disorder.

Opioid withdrawal may occur in any individual after cessation of repeated use of an opioid use disorder, whether in the setting of medical management of pain, during opioid agonist therapy for opioid use disorder, in the context of private recreational use, or following attempts to self-treat symptoms of mental disorders with opioids.


Among individuals from various clinical settings, opioid withdrawal occurred in 60% of individuals who had used heroin at least once in the prior 12 months. 

Development and Course

Opioid withdrawal is typical in the course of an opioid use disorder. It can be part of an escalating pattern in which an opioid is used to reduce withdrawal symptoms, in turn leading to more withdrawal at a later time. For persons with an established opioid use disorder, withdrawal and attempts to relieve withdrawal are typical.

Differential Diagnosis

Other withdrawal disorders
The anxiety and restlessness associated with opioid withdrawal resemble symptoms seen in sedative-hypnotic withdrawal. However, opioid withdrawal is also accompanied by rhinorrhea, lacrimation, and pupillary dilation, which are not seen in sedative-type withdrawal.

Other substance intoxication
Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication.

However, other signs or symptoms of opioid withdrawal, such as nausea, vomiting, diarrhea, abdominal cramps, rhinorrhea, and lacrimation, are not present.

Other opioid-induced disorders
Opioid withdrawal is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during withdrawal) because the symptoms in these latter disorders are in excess of those usually associated with opioid withdrawal and meet full criteria for the relevant disorder. (15)

Key Terms
Agonist – a chemical substance that binds to and activate certain receptors on cells, causing a biological response. Fentanyl and methadone are examples of opioid receptor agonists.

Antagonist – a chemical substance that binds to and blocks the activation of certain receptors on cells, preventing a biological response. Naloxone and naltrexone are examples of opioid receptor antagonists. (16)

The above section from the DSM manual is complex and that means not simple reading for most of us.

Complicated reading and does it make sense and is it really needed and if so, how come things are getting worse with the opioid epidemic worldwide?

Surely a manual spelling it all out should be helping those who read it but is seems not to be the case, as we are now aware of how bad things are getting with opioid use and nothing seems to be working to turn the tides.


Opioid Overdose

Key Facts


275 million worldwide used drugs

34 million used opioids

19 million used opiates

27 million suffered opioid use disorders

Majority dependent on opioids used illicitly cultivated and manufactured heroin but an increasing proportion used prescription opioids.

118,000 people died with opioid use disorders in 2015

Overdose deaths contribute to between third and a half of all drug-related deaths, which are attributable in most cases to opioids.

An opioid overdose can be identified by a combination of 3 signs and symptoms referred to as the “opioid overdose triad”

  • pinpoint pupils
  • unconsciousness
  • respiratory depression (17)

What are Pinpoint Pupils

In normal conditions, the pupils change size to let in the right amount of light

In the dark, they open wider or dilate to let in more light; in bright light, they get smaller or constrict to prevent too much light from getting in.

However, some medical conditions and the use of certain drugs can cause the pupils to shrink to a pinpoint size.

The medical term for pinpoint pupils is myosis, from an ancient Greek word muein meaning “to close the eyes.”

Other Symptoms of an Opioid Overdose:

  • pale or clammy face
  • blue or purple fingernails
  • slow breathing
  • slow heartbeat (7)

Combinations of Opioids, Alcohol and Sedatives are often present in fatal drug overdoses

Because of their capacity to cause respiratory depression, opioids are responsible for a high proportion of fatal drug overdoses around the world. The number of opioid overdoses has increased in recent years, in part due to the increased use of opioids in the management of chronic non-cancer pain.

USA | 2016

63,632 deaths due to drug overdose | 21% increase from previous years

This was largely due to a rise in deaths associated with prescription opioids. This group of opioids (excluding methadone) was implicated in 19,413 deaths in the country – more than double the number in 2015.

Pharmaceutical opioids, in particular strong opioids of the type that are typically involved in opioid overdoses, have been restricted in the past to the management of acute pain and cancer pain, such as is recommended in the WHO Cancer Pain Ladder. There has been a trend in the last 10 years to use opioids in the management of chronic non-cancer pain such as back pain.

45% of drug users experience non-fatal overdose

70% witness drug overdose (including fatal) during their lifetime

People at higher risk of opioid overdose:

  • Diagnosed with opioid dependence, in particular following reduced tolerance (following detoxification, release from incarceration, cessation of treatment)
  • Injectors of opioids
  • Users of prescription opioids, in particular those taking higher doses
  • Users of opioids in combination with other sedating substances
  • Opioids users who have medical conditions such as HIV; liver or lung disease; or suffer from depression
  • Household members of people in possession of opioids (including prescription opioids)

Risk factors for overdoses with prescribed opioids include:

  • History of substance use disorders
  • High prescribed dosage (over 100mg of morphine or equivalent daily)
  • Male gender
  • Older age
  • Multiple prescriptions including benzodiazepines
  • Mental health conditions
  • Lower socioeconomic status

USA – 50,000 naloxone kits distributed through local opioid overdose prevention programmes had resulted in more than 10,000 uses to reverse overdoses.

A number of countries and jurisdictions have started to adopt this approach – a policy of providing naloxone to people at risk of opioid overdose as well as to people likely to witness an opioid overdose has been in place in Scotland since 2011 and in a number of jurisdictions in the USA.

An evaluation of the impact of the policy in Scotland, which included people leaving prison as a target population, found that the proportion of opioid overdoses occurring within four weeks of leaving prison had halved since the introduction of naloxone. (17)

Opioids are not sleep aids and can actually worsen Sleep | New Study

Evidence that taking opioids will help people with chronic pain to sleep better is limited and of poor quality, according to an interdisciplinary team of psychologists and medics from the University of Warwick in partnership with Lausanne Hospital, Switzerland.

Many people suffering from long-term chronic pain, use opioids as a sleep aid to take away pain and stop their sleep being disrupted.

However, a new study led by the Department of Psychology at the University of Warwick with Warwick Medical School suggests that not enough research has been done to assess the benefits and risks of using painkillers for the purpose of improving sleep quality. 

The study, a systematic review of existing research on the effects of opioids on sleep, has been published in Sleep Medicine Reviews.

Long-term chronic pain has a debilitating impact on people’s life. Sleep disruption is a particularly frequent issue for patients with chronic pain, with a vicious cycle building between bad nights and increased pain. Patients with chronic pain are often empirically prescribed opioids to reduce their pain enough to get a good night’s sleep but there has been little investigation of whether this is a safe and effective intervention.

The researchers conducted a comprehensive systematic review of existing literature that examined the effects of opioids on sleep quality. As part of this, they conducted a meta-analysis of data from these studies, combining the results of 18 studies which were then narrowed down to 5 comparable data.

They found that research on opioid effects on sleep quality was limited and of poor quality, often with potential publication bias and conflicts of interest and rarely testing patients for sleep apnoea prior to and during the study.

Patients reported a small improvement in sleep quality when using opioids but that was not consistent with results derived from sleep assessment technologies, such as the total time and the percentage of time in deep sleep, which did not show an improvement.

Certain studies reported calmer sleep with less movement but the examined articles frequently did not examine the wider effects of opioid therapy such as subsequent functioning during the day. Where they did, reports of sedation and daytime sleepiness were very frequent.

Opioids are known to affect the brain mechanism that controls breathing. This can potentially create sleep apnoea events where individuals experience pauses or obstructions in breathing, like a choking sensation, resulting in snoring, gasping for air, dry mouth and headache in the morning.

42% – insomnia likely in people with chronic pain prescribed opioids than controls without opioids.

Despite this, there was some evidence that low-medium dosed opioids could help improve sleep quality in some patients in the short term but the effect was small and requires more investigation.

Researchers are calling for better quality research into the effects of painkillers on sleep quality as well as better information for patients from clinicians when considering opioid therapy. (18)

Dear World

So here we have it – a clear presentation to start our Real Truth about Opioids series.

So what is this article telling us

What is it spelling out to us all

Can we agree it is Complicated

Can we agree it is not Simple

Can we join the dots


Can we get Real and Honest that our world is needing more and more Drugs to deal with our pain.

Can we be truth-full and admit our pain is getting worse and our Solutions are not working.

Have we ever considered how we got the pain in the first place and where it has come from.

Are we ready to ponder deeply on the Questions presented in this tablet of Truth, as it may just get us to the root cause of why we have pain that is not going away.

Are we ready to admit that in Truth, nothing is really working and our Solutions are simply not cutting it, so could there be Another Way?




(1) (n.d). Opioid. National Cancer Institute. Retrieved June 18, 2019 from

(2) Nutt, D. (2012). Drugs Without the Hot Air. Cambridge, England: UIT

(3) Nemo, L. (2018, August 30). How Did Opium Poppies Get their Painkilling Properties? Live Science. Retrieved June 22, 2019 from

(4) Conrad Stoppler, M. (2018, June 13). Endorphins: Natural Pain and Stress Fighters. MedicineNet. Retrieved June 24, 2019 from

(5) (2018, June 7). Prescription Opioids. NIDA. Retrieved June 24, 2019 from

(6) Opiates or Opioids – What’s the Difference? Oregon.gov. Retrieved June 24, 2019 from

(7) Weaver, B. (2018, March 15). Seven Causes of Pinpoint Pupils. Medical News Today. Retrieved June 19, 2019 from

(8) Bellum, S. (2014, June 16). Real Teens Ask: What are the Different Types of Opioids? NIDA for Teens. Retrieved June 22, 2019 from

(9) Bai, N., & Smith, D. (2018, May 10). Body’s ‘Natural Opioids’ Affect Brain Cells Much Differently than Morphine. UCSF. Retrieved June 24, 2019 from

(10) (2016). Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs and Health. U.S. Department of Health & Human Services. (HHS). Washington DC (pp. 73 – 74)

(11) (n.d). Fentanyl. DEA. Retrieved June 24, 2019 from

(12) (n.d). Sublingual and Buccal Medication Administration. Healthline. Retrieved June 19, 2019 from

(13) (n.d). Methadone, Oral Tablet. Healthline. Retrieved June 19, 2019 from

(14) (2018, April 12). Analgesics. Drugs.com. Retrieved June 19, 2019 from

(15) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, V A, American Psychiatric Association, 2013 (pp. 540 – 549) 

(16) Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. U.S. Department of Health & Human Services (HHS). (pp. 18, 23). Retrieved June 22, 2019 from

(17) (2018, August). Information Sheet on Opioid Overdose. World Health Organization. Retrieved June 19, 2019 from

(18) (2019, June 4). Opioids are Not Sleep Aids and Can Actually Worsen Sleep Research Finds. Neurosciencenews.com Retrieved June 25, 2019 from





Comments 31

  1. The Guardian – 27th April 2019

    Revealed: Aggressive Tactics Used to Sell Opiates Online.

    A Guardian investigation revealed that online pharmacies have been accused of failing to carry out proper ID checks and using inappropriate marketing tactics to sell strong and addictive opiate drugs.

    At least two online pharmacies – registered with the UK regulator – are sending customers emails urging them to order drugs by claiming stocks are running out or telling them their “limit” has been removed and they can now buy more codeine pills.

    Online pharmacies have a limit on the amount of prescription drugs that can be ordered within a certain timeframe. It comes amid international concern about the use of opioid drugs such as morphine, fentanyl, oxycodone, tramadol and codeine.

    One of these online pharmacies contacted one customer about buying codeine, which costs £84.99 for 200 tablets of 30g, writing: “What are you waiting for?…This item is going fast so grab them while you still can.”

    The president of the Royal Pharmaceutical Society said that he was astounded by the marketing. “That is, for me, something that should be firmly investigated by the regulators.”

    Both of these online pharmacies are approved by the Medicines and Healthcare products Regulatory Agency.

    The clinical director for addiction services at an NHS trust described the marketing as aggressive. He said: “When it comes to opioid medications there should not be any direct marketing towards the consumer, and if there is then there needs to be clear regulations and guidelines around that.”

    A spokesperson for one of the online pharmacies claimed the message was not a marketing email but said that when someone began making an order but then abandoned it before paying, the message was sent out.

    The other online pharmacy did not respond to the Guardian’s attempts to contact them for a comment.

    The Guardian was able to obtain 200 codeine tablets in two weeks by ordering 100 30g tablets form an online pharmacy under a false name but with a card registered under a different name. A further 100 tablets were obtained from another online pharmacy using the same false name and a card under another name. Random photographs were uploaded instead of proof of ID and proof of address. Both websites said customers should use their own name and card.

    A professor, who is chair of the Royal College of GP’s said the revelations were of great concern she added: “Codeine is an opioid and well known to be highly addictive and its use needs to be very carefully monitored. GP’s are experts in prescribing and will be extremely cautious about starting a patient on opioids, but will also make sure they are closely monitored and regularly reviewed.”

    It is clear that the system needs to be looked at and overhauled.

    Is it possible that this is not a mistake but a deliberate act from those in charge of the company?

    Why would anyone aggressively market the sale of a product that is knowingly harm-full and can cause people to become addicted?

    What makes one human being act in this way to another human being?

    Is it possible that this whole thing is motivated by money?

    If so, what is it in us that can make money more important than someone’s life?

  2. Evening Standard – 27th August 2019
    US drugs giant told to pay $572m over opioid deaths

    In the first trial of its kind, a huge US drugs company was found to have led “false, misleading and dangerous marketing campaigns” in Oklahoma which saw about 6,000 deaths from opioid overdoses since 2000.

    The figure of $572m is more than twice the amount another drug manufacturer has agreed to pay in a settlement. At present there are over 2,000 similar cases filed by state governments around the US.

    According to the Centers for Disease Control and Prevention, more than 70,000 Americans died from drug overdoses in 2017.

    Campaigners and opioid experts said it would serve as an “important warning” for drug companies.

    One of the UK’s most experienced opioid specialists told the Standard, “I think it will give companies pause for thought about the way they market any drug. It’s an important warning note if they over exaggerate the safety and effectiveness of their drugs, they won’t get away with that.”

    Because the UK’s opioid policy has tighter regulations in marketing, this ruling would have a limited impact on the UK.

    There are estimated to be about 250,000 opioid addicts in England, double the number previously thought with England and Wales seeing a 400 per cent rise in oxycodone and fentanyl deaths, with an average of three people killed each week in 2018.

    This ruling, the fact that another drugs company settled out of court and that there are over 2,000 similar cases waiting to be heard, indicates that this issue over the false and aggressive marketing of opioid’s is well known.

    Why does the US Government allow this practice to continue?

    Why can’t the US Government bring in tighter regulations on drug marketing like they have in the UK?

    Why is it that, a company that advocates helping us with our pain relief, goes to the lengths of false, misleading and dangerous marketing in order to sell their product?

    What could possibly be behind this type of marketing, knowing that the product they sell has the potential to get human beings addicted and the very possible potential of those same human beings being killed by that product?

    Is it possible that, in the case of the drugs company that settled out of court, there is no smoke without fire – surely you would want your day in court to say, No, these charges are not true?

    Is it possible that a monetary fine on a company that earns billions of dollars is just going to put a dent in their profit margin but not incur any true change?

    Why is it that ‘business’ is so cavalier when it comes to the welfare of their fellow human beings?

    1. CNN – 17th October 2019

      Drug Companies may Pay $50 billion for their Role in the Opioid Crisis.

      According to a source familiar with the negotiations, five of the many companies accused in thousands of federal and state lawsuits over the nations opioid epidemic may settle for over $50 billion.

      Three pharmaceutical distribution companies are in negotiations to settle with over 2,000 state, local and Native American tribal governments over their alleged roles in the nationwide opioid crisis.

      CNN has been told that the five companies will be contributing various amounts, totalling over $50 billion, that will be paid over 18 years.

      The timing of the negotiations is important, as jury selection in the multi-district litigation case began in the Northern District of Ohio and the trial is set for next week.

      $572 million referred to in the comment above, is a huge sum but nothing compared to $50 billion.

      If these companies are able to settle for this amount of money, how much is their annual incoming revenue?

      Is it possible that the old adage of, ‘there is no smoke without fire’, has some meaning here?

      It will be a travesty if they are allowed to settle out of court as I am sure it will be business as usual after the case and nothing will have changed.

      And nothing will change as long as money is made more important than human life.

  3. Independent – 4th November 2019

    MP’s Call for Decriminalization of Drug Use to Tackle Scotland’s Opioid Crisis.

    MP’s have called for personal drug use to be decriminalised to try and help stop an epidemic of drug-related deaths.

    The UK Parliament’s Scottish Affairs Committee has called for radical reforms to the UK’s approach to drug use, demanding new laws to allow for the creation of so-called “shooting galleries” for drug users to safely get high.

    The committee said that if the Westminster government was unwilling to do this, it should devolve the powers to Scotland. Their report also criticised the Scottish government for making the situation worse by cutting funding for some services and said it must do better if it is to demand more powers.

    MP’s said the current approach of treating drug use as a crime was “counter productive” and that decriminalizing drug use would help users to get treatment and mean the government could focus on suppliers and drug dealers.

    Drug related deaths north of the border reached an all time high last year of 1,187.

    The National Records of Scotland statistics show the majority of deaths involved more than one substance, with heroin and other opiates a factor in 86 per cent of fatalities.

    Yes, we can decriminalise drugs and it may give us more tax revenue, better control for the government, the police and courts are freed up, or there are safer environments for users. It may even reduce the negative consequences and stigma associated with drug use.

    But is it possible that it may also give us the appearance that society approves of drug use?

    But what about the ‘legal’ drugs we already have in the world – do they cause less deaths simply because they are legal?

    Alcohol – a scientific proven poison, is legal and it doesn’t stop people from dying.

    Tobacco, a known carcinogen is legal and it doesn’t stop people from dying.

    Is it possible, like alcohol and tobacco, decriminalising something will make it appear more attractive to more people?

    Where alcohol is concerned, we only have to look at the increase in alcohol consumption after prohibition in the US.

    Is it possible that people that have never tried these drugs, may now think to themselves that they must be OK because they are legal?

    Is it possible that those of us that are likely to become addicted to a substance, will be more inclined to experiment if we do not fear being legally prosecuted?

    Is it possible that the resources we have at present to deal with drug addiction would become increasingly overburdened?

    Is it possible that due to decriminalisation, drug prices will fall and it may tempt more people to experiment with drugs?

    These drugs are illegal for a reason.

    Whether or not we agree with those reasons, at present, the authority has deemed these drugs to be harmful.
    So is it possible that decriminalising them will NOT reduce the efficacy of their harm or danger in using these drugs?

  4. CNN World – 20 May 2020


    Myanmar police have made Asia’s biggest drug bust in decades and seizing hundreds of millions of dollars worth of contraband including “unprecedented” amounts of methylfentanyl – a dangerously potent synthetic opioid.

    This happened after conducting a three month operation with the United Nations Office of Drugs and Crime (UNODC) saying the scale of the seizure was “truly off the charts”.

    There was more – 200 million methamphetamine tablets, 500 kg crystal meth, 35 metric tons and 163,000 liters of precursor chemicals used to manufacture illicit drugs.

    990 gallons of liquid methylfentanyl is the first time authorities have discovered such a massive amount and experts have warned that drug producers in Asia may eventually chose to supply those who use opiate drugs like heroin with synthetic opioids, which are made to mimic the chemical structure of poppy-based drugs.

    Their potency means it is easier to overdose on synthetic opioids, especially if the drug users do not know what they are consuming.

    UNODC regional coordinator, Jeremy Douglas has said that the amount of methylfentanyl precursor seized could have been used to produce a batch of synthetic opioids large enough to replace the region’s heroin production for a year.

    Douglas said “the operation provided further proof of the increasing size, scale and sophistication of Asia’s drug cartels.
    It is clear that a network of production facilities like those found would not be possible without the involvement and financial backing of serious transnational organized criminal groups”.

    We could say this is great news but we do not really have any idea of the mass scale under cover and under ground that continues to fuel the drug industry. What is true is that we as a world are not on the front foot, so to speak and that means we are not ahead of the game – the suppliers are.

    Before we go into any judgement or finger pointing, would it be a wise reminder to note that the criminal gangs who continue to find ways to supply their customers will never end because of the simple economics of Supply and Demand.

    In simple terms this means we the public or all those who take these drugs are the demand – the customer, client, punter so to speak. We want our drugs and they find us a way to have them, which means they supply our demand.

    Cut the demand and they have no one to supply.

    WHY have we not as a world united on this simple view to look at our global drug crisis.

    We need to cut the demand and the only way is by stopping the chain and that means real education, real role models and bringing understanding to all – every age about the harmfull effects of drugs on the human mind and body.

    This website would be a great start and teaching from school age could mean that we have new generations saying No to drugs and finally turning the tides, where suppliers would no longer be fed the need from those who currently demand. This means a dying trade and criminal gangs will not be in business. We could call that advancement or evolution for the human race.

    And finally, those caught in the need for drugs of this kind – can we support them by finding out and getting to the root cause of HOW and WHY they need this or that drug, so that they can heal and no longer be dependent on something that is toxic poison and not for human consumption?

  5. Drugabuse.gov – 27th May 2020

    Opioid Overdose Crisis

    The misuse of and addiction to opioids – including prescription pain relievers, heroin and synthetic opioids such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare.

    2018 data shows that every day, 128 people in the US die after overdosing on opioids.

    The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse in the US is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

    This has been allowed to happen because, in the late 1990’s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates.

    This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.

    Opioid overdose rates began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 1.7 million people in the US suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder.

    Some statistics known about the opioid crisis:

    • Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them
    • Between 8 and 12 percent develop an opioid use disorder
    • An estimated 4 to 6 percent who misuse prescription opioids transition to heroin
    • About 80 percent of people who use heroin first misused prescription opioids

    This issue has become a public health crisis with devastating consequences including increase in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid misuse and misuse during pregnancy.

    The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and Hepatitis C.

    It appears the pharmaceutical companies, who reassured the medical community that people would not become addicted with these opioid pain relievers, has a lot to answer for.

    With the medical system in the US, where everyone has to pay for their medical needs through insurance or even cash, does any responsibility lie with the healthcare insurance providers or individual doctors?

    Is it possible that the pharmaceutical companies are there to make money and the healthcare insurance providers are there to make sure they give back the least amount of money they can?

    Is it possible that a blind eye was turned to the efficacy and or the actual affects of these drugs?

    But, and a big but, is it possible that we, the patient, the user of these drugs, should be taking responsibility here?

    Is it possible we take the drugs in the first place because we need them to get through an injury or a medical procedure but we then get hooked on them because they make us feel good and we don’t want to let go of that feeling?

    Is it possible that, because of the way we live our lives, we allow ourselves to become dependent on these drugs because they distract us from our lives and give us permission to check out?

    Having undergone a total knee replacement recently, I had to take strong pain relief – opioids like morphine, dihydrocodeine – but although the pain relief these drugs gave me were very welcome and supplied a lot of relief, I never became addicted to them, or more correctly, I never became addicted to the pain relief.

    Is this because I have some strong immunity to drugs or is it that, to the best of my ability, I choose to live in a way where I don’t need to check out in my life, where I don’t need any distractions and where I live my life as full as I can?

    This is our life and however much we would like to say it is someone else’s fault, is it possible that it is not just a case of we SHOULD be taking responsibility for ourselves, but rather, we NEED to take responsibility for ourselves?



    Opioids cause the greatest harm to the health of users and the following is an extract from this report.

    Opioids, which include opiates (heroin and opium) and pharmaceutical and other synthetic opioids, are a major concern in many countries because of the severe health consequences associated with their use. For example in 2017 the use of opioids accounted for:

    80% of the 42 million years of “healthy” life lost as a result of disability and premature death


    66% of the estimated 167,000 deaths attributed to drug use disorders.

    57.8 million people globally were estimated to have used opioids in the past year.
    30.4 million of these people had used opiates and the others who had misused pharmaceutical opioids.

    Although global estimates are not available, the non medical use of pharmaceutical opioids is reported in many countries, in particular in countries in West and North Africa and the Near and Middle East (tramadol) and in North America (hydrocodone, oxycodone, codeine, tramadol and fentanyl).

    With the exception of Nigeria, where 4.6 million people were estimated to have used opioids – mainly tramadol in 2017, population-level prevalence estimates of the use of opioids are not available for countries in West, Central and North Africa.
    However, many countries in those sub-regions report high levels of non-medical use of tramadol.

    For example – in Egypt, female students aged 15 – 17 had misused tramadol in the pat year.
    Students in that country also reported the use, to a lesser degree of heroin or opium/morphine in 2016. Furthermore, data on the provision of treatment suggest that the prevalence of non-medical use of opioids is quite high in Egypt.

    Tramadol tablets available in some parts of Africa are reportedly intended for the illicit market and may be of a dosage higher than usually prescribed for medical purposes.

    The opioid crisis continues in North America, with a new record level in the number of opioid overdose deaths attributed to the use of fentanyl and its analogues. These substances are added to heroin and other drugs as adulterants and are also sold as counterfeit prescription opioids, such as oxycodone or hydrocodone and even as counterfeit benzodiazepines, to a large unsuspecting population of users of opioids and other drugs.

    10.3 million people age 12 and older in the United States had misused opioids in the past year.

    9.9 million of these people reported the non-medical use of prescription opioids while nearly 800,000 reported past-year use of Heroin.

    The number of overdose deaths in the United States reached its peak in 2017 of which 68% were attributed to opioids.

    67% of deaths were attributed to fentanyls.

    Similarly, opioid overdose deaths in Canada increased by 50% in two years.

    There are also signs of increasing non-medical use of pharmaceutical opioids in Western and Central Europe, as reflected in the increasing proportion of treatment admissions for the use of those substances in recent years.

    A major drug use survey carried out in India recently found that in 2018 a total of 23 million people aged 10 to 75 had used opioids in the past year. Among opioids, Heroin is the most prevalent substance. 7.7 million of these people suffer from opioid use disorders.

    Since 2004, opioid use in India has increased five fold.

  7. ABC News – 15 July 2020


    71,000 Americans died of drug overdoses last year, a new record that predates the pandemic.

    Experts and the White House believe the Covid crisis will drive such deaths even higher.

    The trend is driven by fentanyl and similar synthetic opioids, which accounted for 36,500 overdose deaths.

    Deaths involving cocaine and methamphetamine are also rising.

    Billions of dollars are devoted to ending the opioid epidemic and policymakers had hoped overdose deaths would continue to decline, but this latest report clearly states we are not on the front foot and things are getting worse.

    The Assistant Secretary for Health Administration called the news “a very disturbing trend”.

    Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health tells us that users migrated first to heroin and then to fentanyl – a cheaper, stronger drug that displaced heroin in many drug markets. With more than 30 states showing rising overdose deaths in the new data he is saying “I see a map of despair. People are feeling a lot more despair, anxiety and rootlessness and that leads to more problematic drug use and more risk of overdose”.

    With public efforts focused on the pandemic, we could say this is going to add to the already major opioids crisis.


    Are we on the front foot if we have medicines that help people stay in recovery?

    In other words, are we breaking the cycle or getting to the root issue of WHY any user is dependent on opioids?

    Has the pandemic really disrupted the supply of illicit fentanyl from China or have our suppliers out there found another way that will one day come to light?

    Do we need to view this situation as a global 911, as experts tell us the pandemic is likely to be creating more demand among users?

    If we examine what the addiction researcher Saloner is saying – are users feeling ‘rootlessness’ because they are de-based and by that we could say it means not having any roots – no foundation in life to speak of, because they are un-settled inside their body and this comes from not dealing with the root of the issue?

    So how does one get to the root cause of any issue and the more pertinent question is – are we ready and if so, what are the movements needed to take action and have such a paradigm shift?

    Dear World,

    With the utmost respect to those who are genuinely doing their best in this crisis to bring about real change or go up against the tides when it comes to government legislation and policy making procedures et cetera.

    Simple Living Global is presenting that time has run out and we need swift action to turn the tides. Waiting for the next research study or another scientific evidence backed paper for the government to then meet and pass through to policy making bigwigs is not helping the 911 that our drug users are facing in every moment.

    We all matter and we all have a say and we all count. It is us as individuals that make up this entire world, who thus far are not doing great in the way we are living human life.

    Each of us is a contributor to what goes on in our world. We can sit and accept the news and all the harm that continues or we can make changes by doing something instead of doing nothing.
    A side note but relevant – read our blog called Do Nothing, Do Something on this website –

    How have we gotten ourselves into such situations that we feel more despair and anxiety because of a pandemic that has forced us to restrict our movements outside our home?

    Have we gone with the masses and got caught up in the media frenzy about a virus, instead of putting our attention and focus onto real life everyday routine and a basic way of living?

    Are we so pre-occupied and busy in our own lives that we forget we have a world of opioid users who are, as this news story tells us, ending their lives from overdose?

    How do they get to the point where they take an overdose and it ends their life?

    What on earth is coming through them at that moment for such an act to take place?

  8. CNN Health News – 7 December 2020


    Non-fatal drug overdoses in children under age 15 on the rise, according to a new study published in the journal Pediatrics.

    The rise appears to be driven by stimulants such as cocaine and amphetamines like methamphetamine and ecstasy.

    This study is for the period between 2016 and 2019 and if the trend continued into 2020, it could be a wake up call for parents, as drug overdoses appear to be on the rise during the pandemic we are currently in.

    “More than 40 states in the U.S. have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder” said the American Medical Association in a recent issue brief.

    90 million emergency room visits for youth up to the age of 24 between April 2016 and September 2019.

    Stimulant associated overdoses were on the rise among all 3 age groups –
    Children from birth to age 10
    Youth aged 11 to 14
    Young adults aged 15 to 24

    There was a parallel rise in stimulant use in the adult population.

    Dear World

    How and Why have we got to this point where our kids are overdosing on medication for pain?

    Why are they abusing their bodies with substances?

    What has gotten into them and how come adults are showing parallel statistics when it comes to drug overdose?

    Are we anywhere on the front foot when it comes to the mis-use of substances?
    If not, then it is time to question absolutely everything with a big dose of honesty.

    This is not going away and this is happening on our watch. We each have a responsibility to wake up and take this seriously. Our children and youth of today are the adults of the future.

    Our world and its systems are not designed or equipped to deal with this type of ill behaviour that we are now observing in our children and young adults.

  9. NBC 7 San Diego – 16 June 2021


    200% rise in Fentanyl overdose deaths in San Diego during the pandemic.

    Federal agents have said that it was a problem before but during the pandemic, it has ballooned and is getting worse.

    The news link has a video, which shows us a real life story about a man called Manning. He started drinking Alcohol age 10, marijuana, age 11, cocaine first year at high school and heroin before his senior year.

    He said he “put on a good show. I was able to make it look like I was drinking socially, when really I was drinking to blackout every weekend and then mixing in different pharmaceuticals.”

    The show ended when his addiction to heroin left him homeless and in and out of jail.

    Next –

    50% of the clients to a recovery center come with opioid use disorder diagnoses.

    Another real life story – Addiction from age 15. Basketball player suffered an injury and then was hooked on painkillers for 8-10 years. They said that what made them so addicting was they were easy to hide.

    Hiding an addiction gets a lot easier with self isolation during the 2020 pandemic lockdown.

    Last year’s increased isolation conflated an already alarming problem – a prevalence of a very lucrative and very dangerous drug – Fentanyl.

    DEA Special Agent (in reference to the meteoric rise in fentanyl related deaths) says “Something has to hit home enough to where people have to notice.”

    Manning said he found purpose in life and direction and was not giving up.

    On that note – would it be wise for us ALL to consider real life stories, as they seem to give us a clear indication about what is really going on.

    What if we collated more of this type of ‘evidence’ and then got the researchers all together from around the world and asked them to join the dots?

    What happens to a person if they commit to life and not give up on life?
    On that note – it is important to read our blogs on this website called Commit to Life and Giving Up on Life.

    What if the very act of making the steps to commit to life and not give up offers us a new track on the life road where opportunities unfold, things happen and life is no longer a misery and full of agony?

    What if we find purpose and direction when we stop giving up on life and commit, both feet in, so to speak and just get on with it?

    We as a world have for a very long time subscribed to a certain way of receiving un-comfortable news like this story. That way has been, accepting what we are told and leave it at that. Let the so-called academics and those who supposedly know more than us, inform us and we say nothing, do nothing and that is how it is.

    What if we took on board and valued real life stories and got digging and found more real life on the street, so to speak stories and joined the dots?

    What if we could learn more from talking and observing those that are in the cycle of addiction?

    What if we take note of those that are raising the alarm and not being heard, like the staff at rehab centers?

    What if those that can do something, actually have a responsibility to not hold back but take some form of action?

  10. Harvard T.H. Chan School of Public Health – November 2021

    100,306 overdose deaths May 2020 – April 2021
    Highest ever recorded in a single year, according to the Centers for Disease Control and Prevention.

    In the previous year, the number of drug overdose deaths was 78,000 – up almost 30%.
    This is 3 times that of traffic accident deaths and twice that of gun deaths during the same period.

    Most deaths were due to Opioids fuelled by the powerful drug known as Fentanyl which is often added to illegal drugs to increase their potency.

    According to Professor Michael Barnett the pandemic was likely to have accelerated drug addiction. He estimated that “hundreds of billions” of dollars will be needed to stem the overdose crisis in the coming years.

    Furthermore, Barnett states that lifesaving treatments like naloxone or buprenorphine, which are used to save lives in addiction are not widely available for people that need them.

    Dear World,

    How serious is this and are we all paying attention?

    Decades ago we had not even heard of Opioids and the medics started prescribing because they were assured by the pharmaceutical industry that these drugs were not coming with the side affect of serious addiction. So we were sold it and we bought it.
    That is just a simple well known fact.

    Before we go jumping on the bandwagon of blame, we need to turn the focus on to individuals that are taking the Opioids. Should we be asking some serious questions so that we can stop the fight against Opioids and get to the root cause?

    This means we need to learn from those that are addicted. What happened, when and what on earth was going on at the time that was not dealt with that led to pain?
    We take Opioids to relieve our pain – correct?

    If we never deal with the pain we have chosen to bury then we will need more of the same to keep it pushed down. Is this making sense?
    This means more drugs to get the same result and we call this addiction.

    This simplified explanation above may be refuted and thrown out by all the bigwigs and kingpins that are academically trained and have an intelligence that cannot support anything that is common sense or simple.

    What this author does is asking all of us to at least consider another way.

    We are told by a Professor at Harvard that we are going to need hundreds of billions of dollars to deal with the Opioid crisis in the coming years and there is no guarantee if we just look at how fast it is accelerating out of control.

    What if we could save those billions by way of education which would then turn the tides for those future adults who are currently children?

    Presenters like the author of this blog and website are experts at giving a simple communication across to any age group and those that are ready and willing to listen will take on board what makes total sense.

    We need to start somewhere and this website offers a library not just about drugs, but how to live human life and get us back on track.

    Our world is in such a mess and yet we seem to resist all the FREE websites like this one that works for the people and reports about the people and that means ALL of us – humanity, leaving no one out.

  11. The Guardian – 30 November 2021

    Two supervised injection sites will open in a bid to curb overdose deaths in the U.S.

    2020 had the highest overdose year on record in the United States.
    93,000 people died and this is a 30% rise from the previous year, according to the Centers for Disease Control and Prevention.

    The plan is to offer clean needles to drug users, administer naloxone, (the opioid reversal medication), medical assistance and treatment options for drug dependency.

    Why is there debate and scrutiny being reported about safe injection sites?

    Is this the answer or a step in the right direction for drug users and are we on the front foot with the opioid epidemic?

    Will our harm reduction measures work or do we need to consider WHY we all are not in agreement with this solution?

    Historically, attempts at a local level to implement injection sites have been met with pushback at the federal level. A mandate known as the “crack house statute” prohibits operating, owning or renting a location for the purpose of using illegal substances.

    In addition, the current government whilst speaking positively about harm reduction methods have not publicly endorsed safe injection sites.

    The question we all need to be asking is will providing a safe place to use clean needles change anything in the long term.

    This forensic article is well worth another read and consider ALL the questions that have been presented.

    What we need to be reminded of are the side effects and offering another drug, which also comes with its own side effects, may not be the actual true answer, if we are to ever get to the root cause of Why and How opioids become an addiction.

  12. CBC News – 2 January 2022


    Benzodiazepines are now a major problem in the illicit drug supply.

    A call to regulate drug supply has been made as Benzodiazepines begin appearing in street drugs across Canada.

    According to Health Canada, Benzodiazepine, which is typically prescribed as a sedative, is very dangerous when paired with an opioid like fentanyl because the sedation increases the risk of an overdose.

    Withdrawal symptoms can include extreme anxiety, sweats and dangerous seizures.

    It is worth noting that the so-called lifesaving medication which brings someone out of an opioid overdose does not work on Benzodiazepines.

    Sarah Blyth, the Executive Director of the Overdose Prevention Society says “Like fentanyl when it was first introduced, benzos started popping up randomly in drug checking and now it is everywhere. People completely black out and they don’t know who they are sometimes or where they are. It is leaving people with long term damage, if they don’t die”.

    According to the BC Coroner Services Illicit Drug Toxicity report in December 2021 – during the pandemic lockdown, between July 2020 and October 2021, the detection rate of Benzodiazepines in British Columbia went from 15% to 53%.

    Blyth puts it down to the unregulated supply, which continues to allow more unpredictability and volatility in the drugs. She says Benzodiazepines in the supply are making it harder to bring people back from overdoses.

    Benzodiazepines exist in some of the most commonly prescribed medications. They are often used as sedatives because of their ability to calm the brain and are used to treat people with sleep, seizure or anxiety disorders.

    Common names we can recognise that are types of Benzodiazepines are Valium and Xanax.

    There are 13 different types of Benzodiazepines in Ontario and some are not even prescribed in Canada. Karen McDonald, the lead for Toronto’s drug checking service operating from St. Michael’s Hospital said “we cannot keep up with how many new drugs are coming in and out”.

    The lifesaving medication that is used to bring someone out of an opioid overdose does not work on benzodiazepines.
    How serious is that when we know what is being presented here?

    Have we joined the dots Dear World that this pandemic and the restrictions have created even greater problems for individuals and society as a whole?

    To know that the rise in lockdown was from 15% – 53% is not a small hike. This is huge and we are talking about ingesting drugs and harming the human frame.

    We are being told that the combination of drugs is now becoming a ‘major problem’.

    Are we going to come up with more solutions to fix the problem or can we admit we are failing as the whole thing is getting worse and we are nowhere on the front foot, so to speak.

    Users totally knocked out on the streets all day and the potential of being robbed or sexually assaulted whilst unconscious.

    Harm reduction sites and safe spaces cannot deal with the meteoric rise that we now face.

    The fact we have long term damage if they do not die is such a serious statement and yet most of us will just read this as another news story or even skip it as it’s the same stuff just with a bit more ‘wow’ factor. It is this reductionism response that ensures things will never change.

    The whole world and its brothers need to wake up and get talking about our Opioid crisis. If we bring it into our everyday conversations and that means our daily consciousness, chances are it gets out there and more of us will have something to say. Sitting around, doing notHing and not saying something is perpetuating this call for help and each of us has a responsibility.

    If we spent less time scrolling social media and keeping up with our influencers or uploading fake images of ourselves and all the other nonsense we do on our screens and swapped it for reporting news stories like this, our world would have change. This is a fact and we do all know this.

    What is ‘trending’ currently would be off the radar, like celebrity news and what the next innovation is because we have people all over the world suffering in pain and taking opioids and illicit drugs to deal with it.

  13. Science Daily – 11 January 2022


    Older adult opioid overdose death rates on the rise according to a new study that analysed 20 years of fatal opioid overdose data in adults over the age of 55 between 1999 and 2019.

    Researchers say that opioid related deaths increased exponentially in U.S. adults ages 55 and older.

    Senior author of this study – Lori Post the Buehler Professor of Geriatric Medicine and Professor of Emergency Medicine and Medical Social Sciences said many are Baby Boomers who, in their youth, were using recreational drugs and continued to use in older age and it is a growing problem.

    Doctors do not often screen for drug misuse during appointments with older people because it does not fit the stereotype of the older population – supposedly doing other things, not drug misuse.

    Post said “They are invisible. We are talking grandmas and grandpas doing drugs, to the point of overdosing. We don’t think of them seriously. Not potential victims of domestic abuse, physical or sexual assault or drug addiction. That needs to change.

    Maryann Mason – Associate Professor of Emergency Medicine at Northwestern University Feinberg School of Medicine in Chicago says the study is suggestive of the beginning of the 3rd wave of the opioid epidemic, when Fentanyl began making its presence in the normal drug supply. Older black men are more involved in illicit drug use, while other populations are more involved in prescription drug use.

    Mason also noted that black men are also more likely to have experienced trauma, lack of access to health insurance and health care, don’t trust health care providers and are under treated for pain compared to other sub-populations of older adults.

    Other contributing factors according to the study include: depression; social isolation; exposure to medically prescribed opioids for chronic conditions such as arthritis and cancer, which increases with age; declining cognitive function that may interfere with taking opioids as prescribed.

    How many of us are aware that the body’s ability to metabolize opioids decreases with age, meaning people are more vulnerable to overdose?

    Mason pointed out the dis-proportionate rates among black men require addressing the social determinants of health that drive drug mis-use in the first place.

    On that note Dear World – is Mason telling us we need to get to the root cause?
    This is not the time or space for blame as that will not help those trapped in this cycle of drug abuse.

    Have we considered the younger generations in the black population? If the older, let’s call them role models are taking illicit drugs, then what are we to expect? Kids are influenced by those that supposedly are older – not just in family but beyond in the community.

    Have we asked enough questions about the trauma experienced that creates pain and without proper awareness and understanding they are left in the agony and misery to then go and find solutions, in the form of drugs?

    We all know that over time, if no real changes are made, then more drugs are needed to keep things buried. We call that addiction. But if there is already a lack – not just trust but funding, resources and whatever tools needed to break the cycle, then let us not be surprised at research studies of this kind.

    Opioids are big business and what would happen if the big pharmaceuticals were told by those that they profit from, that it is time to give back the fat surpluses made to bring in real education about the harmfull effects of drugs to the people?

    Are we ready to put people before profits or do we continue living like we are separate from other humans – our own kind because they live over there and we live here, away from that so somehow we are ok?

    A reminder – we are all part of the one human family and no colour, country, culture or age can divide us. Let us not forget that next time we make a choice that is about I, me, myself, my family, friends and my close group only.

  14. American Association for the Advancement of Science – 2 February 2022


    Experts are warning us now that over 1.2 million additional Opioid overdose deaths are expected in North America by 2029, with the epidemic set to expand globally. This was reported in The Lancet.

    How serious is this?

    Do we really need more information and more text to read or can we go between the lines and apply our common sense and innate wisdom?

    If we start with just a few words to wake us up and receive what has been said above –


    The pandemic has added to the Opioid crisis that we know
    37% increase in overdose deaths in USA
    67% increase experienced in Canada

    For those that have been asleep, this news story reminds us again –

    The Opioid crisis began in the 1990s when policymakers and health care systems failed to stop the pharmaceutical industry’s aggressive push to increase Opioid prescribing. The crisis became worse in the past decade when illegal drugs like Heroin and Fentanyl became widely available.

    600,000 lives lost from the Opioid epidemic over 25 years and 2020 was the worst year ever in North America with more than 76,000 deaths.

    While we wait for new evidence based strategies to respond through public policy, industry reform, innovations in pain management and prescribing methods, can we ask a few simple questions –

    WHY does anyone use drugs and not question why and how they got the pain in the first place? Where did it come from?

    What triggered it?

    When did it start?

    When did we start taking more drugs to keep the pain at bay because our usual dosage was not cutting it?

    Dear World,

    What goes on in someone’s life that leads them to take pain remedies that we call Opioids?

    WHY have we not worked out that overdosing can and in all the above cases did lead to death?

    Are we not bothered about our life because the pain is so great?

    Have we simply got addicted to the point where we just need the pain to go away?

    Why are the opioid deaths disproportionally affecting certain populations?

    Are the clues there and can we start observational studies and take on board anecdotal evidence? This means we listen to the people and learn from what they have to say as they are going through or been through it.

    If the “Commission authors attribute the onslaught of the Opioid epidemic to the profit motives of those within the pharmaceutical and health care industry and the disastrous regulatory failures from the Food and Drug Administration of the U.S.” why stop at that?

    Why not hold them accountable and get them to fund and pay for real rehabilitation programs that do not have victims but those genuinely taking responsibility to seek real change and learn from their ill ways of living to avoid pain?

    It may be a long way off before we see effective regulation and a real change in the profit motive created by the Opioid epidemic, so why not read this in depth article and then every post thereafter, which is a comment from Simple Living Global that confirms we have a serious 911 with Opioids globally.

    “..we must end the pharmaceutical and health care industry’s undue influence on the government and its unregulated push for Opioid use. This includes insulating the medical community from pharmaceutical company influence and closing the constantly revolving door between regulators and the industry.
    Commission Author Professor Howard Koh of Harvard’s T.H. Chan School of Public Health.

    Worth pondering on the revolving door mentioned as that tells us clearly why we are in this crisis today and why there is absolutely no change except that it is on the rise.

    To truly evolve we need real change and treating addiction as a chronic condition would be a start in admitting how serious it is instead of how it currently is viewed – ‘a moral failing that needs punishment.’

    Then the next step is to send all our researchers out there and they are not to come back until they find the root cause of why any human being uses Opioids.

    Working together and collating anecdotal evidence needs to happen as our current model is failing us and we have not evolved out of this global epidemic that is destroying lives.

  15. The Guardian – 19 March 2022


    San Francisco health officials have issued a public health alert about fentanyl laced cocaine after fatal and non-fatal fentanyl overdoses among individuals who reportedly intended to only use cocaine.

    Fentanyl is an opioid with a strength that can be up to 50 times stronger than heroin. It can impact the user’s ability to breathe because it has respiratory depressant characteristics.

    In San Francisco, the drug is sold typically as a white or lavender powder and it is not usually mixed with heroin.

    The similar appearance of fentanyl and stimulants may lead to unintentional use of fentanyl among people who use stimulants and have little or no tolerance to opioids.

    Since 2015, fentanyl related deaths in San Francisco have increased significantly, with the city reporting 474 deaths in 2021.
    70% of deaths in the last 2 years have involved fentanyl.

    According to the San Francisco Department of Public Health (SFDPH), fentanyl overdose deaths typically involved cocaine, methamphetamine or both.

    The director of SFDPH, Dr. Phillip Coffin says “90% of opioid deaths in San Francisco are now due to fentanyl, so it is the most common street drug.”

    Dear World

    How do we get on the front foot with our current opioid epidemic which is escalating at speed like never before?

    San Francisco is one city, so we can do our own maths and work out how big a problem we now have that is worldwide.

    We know that fentanyl is used to completely anaesthetise a patient from pain in combination with other prescribed medication. So how is it that we are seeking this kind of numbing and total altered state which is not for surgery but because we have some kind of pain that is not going away?

    We know that addiction comes after as the first thing is taking the drugs, then we want more of the same as the dose doesn’t cut it, so we need more to have the same effect.

    WHY are we relying on fentanyl and how scary is it knowing how potent the strength is and the harm it does to the human body?

    We need education, real education and we need it now. Throughout all schools and then add in all teachers, educators, parents, siblings and the whole adult and child population be it in study, at work or out and off the radar. We all need to be reined in now and given some basic lessons about drugs, what they are, what they do and how on earth we have gotten to this point in modern 21st century.

    Articles like this one and others on the website about cocaine and amphetamines need to be on the school agenda. Authors like the one that writes this whole website need to be presenting and sharing this with wider audiences, so we get the message across.


    We will never stop the harm and the devastation that drugs are doing with a war.
    We will if we stop long enough for one moment and ask – Is There Another Way?
    Yes, there is and blog number 1 on this website has this title – Is There Another Way.

    Take a seat, have a read and keep on reading until the end of all the articles and then go back and read the 6,000 comments which add another dimension. Make that a bedtime reading and there will be no doubt that we as humans are in trouble and we created all of this and we are the ones that need to sort it out and our time is up. We can no longer continue ignoring the signs and that is we have a serious fentanyl crisis and there is a responsibility to act now – not with solutions but changing our lifestyles, so we are not in the pain that then seeks drugs to not feel it.

  16. The Guardian – 31 March 2022


    The number of Fentanyl filled pills seized by U.S. law enforcement is up by 4,850%.

    A study has found that more than 2 million counterfeit pills were confiscated in the last quarter of 2021. This is up from 42,000 in the first quarter of 2018.
    Researchers also found that the number of individual seizures involving Fentanyl pills increased by 834%.

    This study, led by New York University has underscored the alarming surge in counterfeit pills containing Fentanyl.

    The authors say this reflects the vast supply which criminal drug networks manufacture to look like legitimate pharmaceutical tablets such as Xanax, Adderall and Percocet being imported into the U.S. and sold on the streets.

    “One pill that contains Fentanyl can literally kill you” says the study’s lead author – Joseph Palamar, Professor of Population Health at NYU Grossman School of Medicine.

    In a 2 month period in 2021, the U.S. Drug Enforcement Agency announced it had arrested 810 drug traffickers across the United States and seized Fentanyl pills enough to kill over 700,000 Americans.

    The number of drug seizures is a reflection of how much Fentanyl is on the streets and researchers warned of the dangers it can pose to unknowing members of the public, particularly young people who may buy Fentanyl tainted pills online or from friends.

    A college student trying to stay up all night to study may be given a fake pill by a buddy or a kid who goes to a club and thinks it is more fun if he takes a party drug and instead gets Fentanyl.

    The problem is, the street pill is now much more dangerous than it was for earlier generations said Dr. Daniel Ciccarone, a Professor specialising in addiction medicine at the University of California, San Francisco.

    “An increase in illicit pills containing Fentanyl points to a new and increasingly dangerous period in the United States. Pills are often taken or snorted by people who are more naïve to drug use and who have lower tolerances. When a pill is contaminated with Fentanyl, as is now often the case, poisoning can easily occur.” Said Dr. Nora Volkow – Director of the National Institute on Drug Abuse.

    Youth under age 24 account for the fastest rise in drug deaths, with 7,337 youth dying in 2020.

    Fentanyl deaths were rare in California 5 years ago, and now a young person is dying every 12 hours. This is a 1000% increase over 2018.

  17. The Guardian – US News 13 April 2022


    Drug overdose deaths among high school age teenagers in the United States have more than doubled since 2019, driven by a rise in the deadly opioid fentanyl, according to a new study from the University of California, Los Angeles.

    Researchers attribute this to a flood of counterfeit pills, which look exactly like real oxycodone or Xanax tablets but actually contain fentanyl, a synthetic opioid so potent that one counterfeit pill can prove fatal.
    Vast quantities of these fake pills are smuggled into the U.S. and are circulating in the illicit drug market and this could mean teenagers are often ingesting the drug unknowingly.

    The study found the rates of drug deaths were highest among Indigenous and Hispanic teens and young people of all races.

    Joseph Friedman, the study lead says that the illicit drug supply has become extremely toxic and we are seeing young kids start to die. He also added that teenagers are continuing to experiment with pills and these pills are getting much more deadly, which they buy online or from friends.

    2 million fentanyl filled fake pills were seized by law enforcement agencies in the last quarter of 2021.

    834% increase in individual seizures involving fentanyl pills. This reflects the huge supply of these pills according to the authors. Criminal drug networks manufacture to look like legitimate pharmaceutical tablets being imported into the U.S and sold on the streets.

    In a 2 month period in 2021, the U.S Drug Enforcement Agency announced it had arrested 810 drug traffickers across the United States and seized fentanyl pills to kill more than 700,000 Americans. See link

    In California, where fentanyl deaths were rare just 5 years ago, a young person under 24 is now dying every 12 hours – 1000% increase 2018 to June 2021.

    Some of the tragic cases involve teenagers experimenting with pills obtained from social media or friends, which they think are pharmaceutical-grade painkillers or anti-anxiety medications but are actually deadly doses of fentanyl.

    Pills are taken by college students who want to stay up all night and study for an exam and are unsure if their buddy sold them Adderall or fake Adderall OR kids going to a club and thinks they will have more fun if he takes the party drug MDMA and instead gets fentanyl, says Dr. Daniel Ciccarone, study co-author.

  18. University of Toronto News – 21 April 2022


    Researchers at the University of Toronto have found that opioid related deaths are increasing and affecting more younger adults.

    From 2003 to 2020, opioid related mortality in Ontario increased 5-fold and the age distribution shifted – with rates peaking for people in their mid-30s.

    72% of opioid related deaths were male.
    82% accounted for accidental deaths.

    Due to the emergence of highly potent non-pharmaceutical opioid drugs like fentanyl, deaths from synthetic opioids have continued to rise.

    “Despite changes in opioid prescribing practices, rates of deaths continue to worsen across North America, largely because of the current highly toxic unregulated drug supply” says Tara Gomes, epidemiologist and Assistant Professor in Pharmacy at University of Toronto.

    Based on the study’s modelling, researchers estimate that opioid related mortality among the younger population will continue to grow and increase along the current trajectory.

    Note – as mentioned by Associate Professor Patrick Brown, the pandemic overshadowed the opioid problem and that means it did not go away and is still growing at its previous rate.

  19. United Press International – 2 May 2022


    American Indians and Alaska Native communities have seen higher rates of deaths caused by drug overdoses than other populations, according to a new study published by BMJ Open.

    The opioid overdose death toll has increased more that 5-fold over the past 2 decades.

    800 opioid overdose deaths among American Indian and Alaska Natives in the United States occurred in 2019. This was less than 100 in 1999.

    Men from this origin were 50% more likely to die from an opioid overdose compared to women.

    Over 100,000 across the U.S. died of drug overdoses in 2020 and that number is expected to rise over the next decade.

  20. UPI News – 11 May 2022


    Drug overdose deaths in the United States have hit a record high in 2021, according to the Centers for Disease Control and Prevention.

    107,622 people died as a result of drug overdoses last year.
    This is the highest number recorded in a calendar year and a 15% rise from the previous year – 2020.

    The total now since 2001 is over 1 million.

    Deaths are due to overdose from opioids and synthetic or manufactured opioids, such as fentanyl. There are also deaths from psychostimulants such as methamphetamine.

    The ongoing rise in the “Opioid Epidemic” in the United States from the mis-use and use of these drugs has been going on since the late 1990s.

    Much of this increase is fuelled by fentanyl, which was developed initially as a strong prescription painkiller but now sold often illegally.

  21. Government UK News – 15 June 2022


    The Home Secretary has commissioned the Advisory Council on the Misuse of Drugs (ACMD) to advise on tightening controls on brorphine and metonitazene, ahead of them being banned in the UK, the Home Office has announced today.

    Brophine, known as “purple heroin” and similar to fentanyl can cause life-threatening respiratory depression and arrest. It has been detected in fake pain medication tablets, such as oxycodone and in blood samples of at least 60 fatal and non-fatal overdoses abroad involving users of multiple substances.

    Metonitazene is another synthetic opioid, indicated a potency of between 30 and 200 times that of morphine and it has been linked to at least 20 deaths in the U.S.

    Currently, these 2 substances are in the Psychoactive Substances Act 2016, which means that whilst supply is unlawful, possession is not.

    If we have a drug that is ‘unlawful’ to supply but to have the same drug in our possession is not – then HOW does the drug come to our possession?

    In other words, without a supplier providing the drug, where would we get it from in the first instance?

    Is this where the illegal trafficking of drugs takes place because our laws are confusing and not simple to understand?

    In other words, is the hole that we are doing our best to seal but it is not happening because we created the hole in the first place?

    In this example – we say it is OK to have a synthetic opioid, similar to fentanyl, but it is not ok to supply it as that goes against the country’s law.

  22. Massachusetts General Hospital – 30 August 2022


    EEG tests (Electroencephalogram) revealed fentanyl’s effects on the brain and indicated that the drug stops people’s breathing before other noticeable changes and before they lose consciousness.

    Fentanyl begins to impair breathing about 4 minutes before there is any change in alertness and at 1,700 times lower drug concentrations than those that cause sedation.

    “This explains why fentanyl has been so deadly because it stops people’s breathing before they even realise it.”
    Patrick L. Purdon, PhD – the Nathaniel M. Sims Endowed Chair in Anaesthesia Innovation and Bioengineering at Massachusetts General Hospital.

    Fentanyl produces a specific EEG signature, which could allow clinicians to monitor its effects to enable safer, more personalized administration during and after surgery.


  23. Science Direct – 1 September 2022


    Prevalence of mental disorders among people with Opioid Use Disorder:
    A systematic review and meta-analysis

    Prevalence of mental disorders among people with Opioid Use Disorder, the following were common –

    36% – Depression
    29% – Anxiety
    18% – PTSD

    34% – Anti-Social
    18% – Borderline Personality Disorder

    21% – ADHD
    9% – Biopolar Disorder

    7% – Dysthymia
    7% – OCD

    Depression, anxiety and PTSD were more common among women.

  24. SKY News – 7 October 2022


    There is a North-South divide in the UK over the prescription of high dose opioids and other painkillers.

    The findings are described as a “time bomb” of potential addiction problems.

    In the North East, the amounts prescribed are 3 times more per head than in London.
    For example – a practice in Durham with 18,000 patients prescribes around 42,000 strong tablets.

    An average UK practice of the same size would prescribe about 16,000 strong tablets.
    Opioids are also prescribed to people in the most deprived parts of the country, almost twice as much as those in the most well-off areas.

    Social workers and other professionals say that GPs are creating the clientele for a growing black market in prescription drugs and there is a lack of services to help people with their addictions.

    Patients said they struggled to beat their addiction and often turned to illegal dealers to top up their medication.

    Pregabalin has increased as a prescription for pain.
    It works on nerve pain and produces feelings of euphoria, relaxation and calmness; and can heighten the effects of other drugs.

    Pregabalin and opioids taken together can cause people to stop breathing. The NHS recommends that it is not stopped suddenly as withdrawal could cause anxiety, insomnia, nausea, pain and sweating.

    It is a Class C drug and GPs have been warned to look out for signs of dependency and abuse.

    Advice published by NHS England 8 years ago warns doctors that this type of drug “can lead to dependence and may be mis-used or diverted”. It also says that the drug is used as a “commodity for trade” in prisons.

    A support worker from Positive Directions who help accommodate vulnerable people said “For the last year, there has been a lot of suicides through drugs and people not getting help. People really depressed, can’t get any help from anywhere, getting told there is no one that can come out and see them because there’s not enough staff.”

    The Director said “Being on the frontline, what we are encountering is an explosion in prescribed drugs from the GPs and certainly on the black market.
    A lot of people has been accessing drugs from the dark web and buying prescription drugs that way, at a real big discount and selling them on the streets. They are extremely addictive and quite often the problem is they are prescribed by medical professionals and so the people who are taking the prescriptions don’t realise how addictive these substances are.”

    Ewan Maule, a lead Pharmacist for the North East says there is a link between poverty, especially in declining industrial regions such as the North East and chronic pain and this in turn leads to greater use of opioids in certain groups.

    He said “The conversation is changing and we are starting to talk about non-drug treatments, non-medicines for treatment of chronic pain. We all need to re-educate ourselves. People like me who were educated 20 years ago, need to change the way we think about things.”

    Next –

    Addicts told reporters finding help to get off the drugs is a struggle. The main rehab centre in Durham often has dealers outside and sometimes inside. One recovering addict said it was a great place to “go for a hit” rather than rehab.

    A social worker with the Sky News team visiting was offered Heroin by a client coming out of the premises.

  25. Science Magazine – 8 December 2022


    People who take medical opioid drugs without a doctor’s prescription are 37% more likely than non-users to plan suicide.

    People with disabilities who mis-use opioid drugs are 73% more likely to attempt suicide, according to a new national study in the U.S. This remained true even when other factors such as using other substances, self-rated health, mental health and health access were taken into account.

    The study is from over 38,000 adults.

    10.1 million people in the United States misused opioid drugs and there were 48,000 deaths from overdosing on medical opioids in 2019.

    Consistent with past research, those mis-using drugs were more likely to have serious thoughts of suicide, a plan for suicide and to have made an attempt on their own life over the past year. They were also more likely to be young, male, unmarried and living on a low income.

    Medicare beneficiaries with a disability are one of the fastest growing groups of people to be hospitalised for opioid or heroin poisoning and 23% are chronic users of the drugs. Mis-using opioids to help deal with difficult feelings or emotions is also more common among those with disabilities.

  26. U.S. News – 28 December 2022


    Babies are in danger from ingesting Opioids laced with animal tranquilizer.

    According to a new research study published, pediatric poisonings from a lethal combination of a potent synthetic opioid known as Fentanyl and a powerful veterinary sedative called Xylazine.

    “Infants or toddlers exposed to Fentanyl are at risk of death, even without the added threat of Xylazine” said the lead author Dr. Stephanie Deutsch – Medical Director of the Nemours CARE Program at Nemours Children’s Health in Wilmington, Delaware.

    In both children and adults, Fentanyl quickly slows both breathing and heart rate while also triggering an altered mental state. That risk is increasingly common – the study authors pointed out.

    Fentanyl exposure accounted for 14% of overdose deaths in the United States.

    60% of overdose deaths in the U.S. accounted from Fentanyl exposure.

    Xylazine is not an opioid and there is no known antidote or medication to reverse its effects.

    On the street, the xylazine-opioid combi is commonly sold as “anastesia de caballo” (horse tranquilizer), “tranq” or “sleep cut”.

    This combo is increasingly sought after by recreational drug users seeking a prolonged and euphoric high, in spite of the risks.

    A database of fatal drug overdoses in 38 states and Washington D.C. shows that quest has been gaining traction.

    Since 2019, adult overdose deaths involving opioids laced with Xylazine – a drug that has been around since 1962 but never approved for human use, have been on the rise.

  27. CNN Health News – 29 August 2023


    Emerging group of synthetic opioids may be more potent than Fentanyl, a new study warns.

    These opioids are emerging in illicit drugs in the United States and maybe 1,000 times more potent than morphine and may even require more doses of the medication naloxone to reverse an overdose.

    Over 150 people a day die from overdoses related to synthetic opioids.
    Fentanyl has been involved in nearly 2/3rds of all overdose deaths in the U.S. and is up to 50 times stronger than Heroin and 100 times stronger than Morphine.

    Nitazenes, a subclass of synthetic opioids appear to be even more potent and this new study suggests they may be associated with an increased rate of cardiac arrest when people overdose.

    Synthetic opioids, including Fentanyl and Nitazenes are “among the fastest growing types of opioids” being detected in people who are overdosing and who have been admitted to hospital emergency departments, according to the study.

    Nitazene and analogues entered the drug supply within the past few years because distributors and suppliers cut opioid drugs with them. One reason why this new class of drugs has entered the Fentanyl supply is because we have passed harsher Fentany and Fentanyl analogue penalties at the state and federal level.
    Sheila Vakharia – Deputy Director of the Department of Research and Academic Engagement – Drug Policy Alliance.

    1. The Conversation – 25th September 2023


      Nitazenes: synthetic opioids more deadly than Fentanyl are starting to turn up in overdose cases

      Nitazenes have recently been the subject of a national patient safety alert in the UK as a result of a spike in opioid-related deaths over the last two months, with several cases involving nitazenes.

      The recent study, published in JAMA Network Open, reported that people who overdosed on Nitazenes typically needed two or more doses of the overdose-related drug Naxolone, whereas those who overdosed on Fentanyl typically only needed one dose.

      Nitazenes were first developed in the 1950’s as a new type of potent painkiller (analgesic) but the drugs never made it to market.

      It appears that chemists in clandestine labs have poured over old research papers looking for new synthetic opioids to make and stumbled across this class of deadly drugs.

      These new synthetic opioids are illegal in the UK as they are covered under the Psychoactive Substances Act 2016, which bans all chemicals capable of producing a psychoactive effect in people.

      Opioids act at sites in the brain, and elsewhere in the body, called mu-opioid receptors. These brain receptors, when activated, can relieve pain, and at high doses evoke feelings of euphoria followed by drowsiness.

      Morphine, Heroin and Fentanyl all activate these mu-opioid receptors. However, Fentanyl can do so at much lower doses than Morphine or Heroin – and some Nitazenes can relieve pain at even lower doses than Fentanyl.

      For example, a study in rats found that a Nitazene called N-desethyl isotonitazene provide pain relief at a dose nearly ten times smaller than that needed for Fentanyl, and around 1,400 times less than that for Morphine, to see the same effect.

      Not only do these drugs relieve pain and cause euphoria, they also suppress the respiratory system. That is, they reduce breathing, and this is the cause of death in Opioid overdose.

      N-desethyl isotonitazene causes apnea (where breathing stops) at about a third of the dose of Fentanyl. It also takes much longer to recover normal breathing after N-desethyl isotonitazene (208 minutes) compared with Fentanyl (67 minutes).

      There are issues with Nitazenes being used as adulterants in other illicit drugs, such as Cocaine, Benzodiazepines and Synthetic Cannabinoids (“Spice”). Illicit drug users may be unwittingly taking opioids and need to be aware of the risk of respiratory depression.

      Several Nitazenes have been found in overdose cases recently, and the number of drugs in this class (called analogs) emerging on the street appears to be growing. However, the true extent of this drug’s penetration into the illicit market is not known as many testing facilities are not set up to test for Nitazenes.

      There are also new non-nitazene synthetic opioids, such as the brorphine-like-compounds, as with Nitazenes, these drugs have been found to be slightly more potent than Fentanyl, and much more potent than Morphine, in lab tests.

      Is it possible that our bodies are now at the point that taking drugs like Heroin, Fentanyl and other Opioids doesn’t have the same effect it used to have?

      Is it possible that we are searching for newer and stronger drugs that will ‘check us out and numb us’ for even longer?

      Although the risk of death, by stopping breathing, is so much greater with this new drug, will it truly stop those that seek relief from using it?

      Is it possible the chance of a greater high will be worth the risk?

      If the supply of a product is created by the demand for a product, then is it possible that we are the ones asking for these stronger, more dangerous drugs?

      The question we need to ask is – WHY?

  28. SKY News – 23 November 2023


    UK’s LARGEST-EVER stash of synthetic Opioids seized in a “sophisticated” factory in North London.

    Metropolitan Police seized 150,000 nitazene tablets – a highly dangerous synthetic Opioid, which is more potent than Fentanyl.

    Nitazene is a super strength Class A drug.

    £60,000 cash, a firearm and a pill-pressing machine together with a “Substantial” amount of other Class A and B drugs were also seized.

    Hard drives storing cryptocurrency, mobile phones and laptops seized.

  29. RAND News – 4 December 2023


    The RISE in Child Suicide in the United States since 2010 was fuelled in part by the nation’s Opioid Crisis.

    Previous studies found INCREASED RATES of child neglect and altered household living arrangements, according to a new RAND Corporation study.

    The analysis links the rise in child suicides to the reformulation of prescription Opioids to discourage mis-use, which led to a steep rise in the use of illicit Opioids, such as Heroin and may have contributed to the growth of illicit Opioid markets.

    2011 – 2018
    Suicide rates among children aged 10 to 17 accelerated at an unprecedented level and over an unprecedented duration.

    Among this age group – suicide was the 2nd leading cause of death.

    The American Academy of Paediatrics declared a national state of emergency in Children’s Mental Health.

    The Opioid crisis itself is considered a national emergency.

    2011 – 2020
    An extrapolation analysis suggested that the reformulation of OxyContin can explain 49% of the rise in child suicides.

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