Opioids

What You Need to Know

Opioids are a type of drug used to treat moderate to severe pain. When used exactly as prescribed, they can help manage pain after surgery, injury, or certain medical conditions. However, taking higher doses, using someone else’s prescription, using opioids recreationally, or buying them illegally can lead to dependence, addiction, and overdose.

Common Opioids

  • Prescription opioids: Oxycodone, Hydrocodone, Morphine, Codeine
  • Illegal opioids: Heroin, illegally made Fentanyl (particularly dangerous because strength is unpredictable and often mixed with other substances)

Learn more about specific types of opioids below. All of those listed can be reversed if naloxone is administered within minutes of an overdose.

Common names/nicknames: Big O, black pill, chandu, dreams, hop, joy plant, midnight oil, O

What it is: It is a highly addictive non-synthetic narcotic extracted from the opium poppy plant. It is the raw source from which morphine, codeine, heroin, and many other opioids are derived. It has been used for thousands of years and was once widely available in patent medicines across the US. Today, it is rarely encountered in its pure form on the street.

How it works: It contains a mixture of naturally occurring alkaloids, primarily morphine and
codeine, which bind to opioid receptors in the brain and body. The experience is similar to a heroin high: a euphoric rush followed by relaxation and relief from physical pain.

Overdose risk: Potency can vary depending on source and preparation, making consistent
dosing difficult. Overdose effects include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, and possible death.

DEA Classification: Schedule II

Common names/nicknames: Miss Emma, M, morph, monkey, God’s drug

What it is: This is derived directly from the opium poppy and has been used medically for over 200 years. Many other opioids, including heroin, are chemically made from it. It is still used today in hospitals for severe pain, including end-of-life care.

How it works: It strongly activates opioid receptors throughout the brain and body, producing deep pain relief, sedation, and slowed breathing. It is the standard against which other opioids are measured for strength.

Overdose risk: It is slower-acting than some opioids, which can lead people to take more, thinking it isn’t working, then be hit by a dangerous, delayed effect. Respiratory depression is the primary cause of death.

DEA Classification: Schedule II

Common nicknames: H, smack, dope, junk, brown sugar, China white

What it is: It is an illegal drug made from morphine, which comes from the opium poppy plant. It can be injected, snorted, or smoked. It has no accepted medical use.

How it works: It hits opioid receptors in the brain fast and hard, producing a rush of intense euphoria followed by heavy drowsiness. Because it wears off quickly, people often take it repeatedly in a short window, stacking doses dangerously.

Overdose risk: The short high pushes people to redose before the previous dose has fully cleared. Street heroin is increasingly cut with fentanyl, meaning users often don’t know what they’re actually taking or how strong it is.

DEA Classification: Schedule I

Common names/nicknames: China white, dragon, M30s, fake Xanax, fake Percocet

What it is: It is a synthetic opioid originally developed for severe cancer pain and surgery. It is 50 to 100 times stronger than morphine, meaning a lethal dose is invisibly small. It is now a leading cause of overdose death in the United States.

How it works: It binds to opioid receptors almost instantly and shuts down breathing faster than almost any other opioid. Even a few micrograms, an amount you couldn’t see, can be fatal.

Overdose risk: It is now found mixed into heroin, cocaine, counterfeit pills, and even other drugs without the user knowing. An overdose can happen within minutes of exposure, leaving very little time to respond.

DEA Classification: Schedule I

Common names/nicknames: OxyContin, Percocet, Perc, Oxy, blues, 30s, roxy

What it is: It is a prescription opioid painkiller used for moderate to severe pain. It comes in immediate-release and extended-release forms. OxyContin in particular became a major driver of the opioid epidemic in the late 1990s and 2000s.

How it works: It activates opioid receptors in the brain and spinal cord to reduce pain and produce feelings of relaxation and euphoria. The extended-release version delivers a large dose over time, which becomes dangerous if the pill is crushed or chewed.

Overdose risk: It has a high risk, especially when combined with alcohol, benzodiazepines (Xanax, Valium), or other opioids. Many counterfeit pills sold as oxycodone on the street are actually fentanyl, making the real-world risk even higher than the drug itself would suggest.

DEA Classification: Schedule II

Common names/nicknames: Opana, Blue Heaven, blues, Mrs. O, pink, stop signs, The O Bomb

What it is: It is a powerful prescription opioid used for moderate to severe pain. The FDA approved it under the brand name Opana, but the extended-release version was pulled from the market in 2017 because its public health risks from misuse outweighed its medical benefits. It is now rarely prescribed and infrequently encountered on the street.

How it works: It is a strong opioid agonist that produces analgesia, euphoria, relaxation, and respiratory depression. Its effects are essentially similar to morphine and oxycodone, but it acts directly at the opioid receptor without converting through another compound first.

Overdose risk: Misuse by crushing, chewing, snorting, or injecting results in an uncontrolled release of the drug and dramatically raises the risk of overdose. Overdose can cause severe respiratory depression, loss of muscle tone, cold and clammy skin, constricted pupils, circulatory collapse, and death.

DEA Classification: Schedule II

Common names/nicknames: Miss Emma, M, morph, monkey, God’s drug

What it is: This is derived directly from the opium poppy and has been used medically for over 200 years. Many other opioids, including heroin, are chemically made from it. It is still used today in hospitals for severe pain, including end-of-life care.

How it works: It strongly activates opioid receptors throughout the brain and body, producing deep pain relief, sedation, and slowed breathing. It is the standard against which other opioids are measured for strength.

Overdose risk: It is slower-acting than some opioids, which can lead people to take more, thinking it isn’t working, then be hit by a dangerous, delayed effect. Respiratory depression is the primary cause of death.

DEA Classification: Schedule II

Common nicknames: Vicodin, Norco, Lortab, Vike, hydro

What it is: It is one of the most commonly prescribed opioid painkillers in the US, typically combined with acetaminophen (Tylenol). It is used for moderate pain and is widely available, which contributes to how often it is misused. Long-term misuse can cause liver damage from the acetaminophen component in addition to opioid dependence.

How it works: It works the same way as other opioids: dulls pain signals and produces calm, relaxed feelings. At higher doses, the sedation and breathing suppression become dangerous.

Overdose risk: People often underestimate it because it’s “just a prescription,” but it carries the same overdose potential as other opioids. Mixing with alcohol is particularly dangerous.

DEA Classification: Schedules II & III

Common names/nicknames: Dilaudid, dillies, juice, hospital heroin

What it is: It is a powerful prescription opioid used for severe pain, typically in hospital settings. It is two to eight times stronger than morphine by weight, so a very small amount goes a very long way. It is not commonly found on the street but is sometimes diverted from medical settings.

How it works: It rapidly and powerfully binds to opioid receptors, producing intense pain relief and sedation. Its potency means dosing errors, even small ones, can quickly become fatal.

Overdose risk: People unfamiliar with how strong it is compared to other opioids are especially vulnerable. Even medical professionals treat it with extreme caution.

DEA Classification: Schedule II

Common names/nicknames: Cody, lean, purple drank, sizzurp, schoolboy

What it is: It is a weaker opioid found in some prescription cough syrups and combination pain pills. It is converted into morphine inside the body, which is how it produces its effects. “Lean,” a mixture of codeine cough syrup, soda, and sometimes candy.

How it works: The body metabolizes codeine into morphine, which then acts on opioid receptors. Some people metabolize it much faster than others, making the same dose far more dangerous for certain individuals.

Overdose risk: Drinking large amounts of lean, especially mixed with alcohol or other depressants, can suppress breathing and cause death. Children are extremely vulnerable to codeine overdose.

DEA Classification: Schedule II, III and V

Drug Schedules

The Drug Enforcement Administration (DEA) is a federal agency that enforces laws on controlled substances. It classifies drugs into “schedules” based on their medical use and potential for misuse and dependence.

Schedule I: No currently accepted medical use and a high potential for misuse
Schedule II: Accepted medical use, but a high potential for misuse and severe physical or psychological dependence.
Schedule III: Moderate to low potential for physical and psychological dependence; lower risk than Schedule I and II.
Schedule IV: Low potential for misuse and dependence.
Schedule V: Lowest potential for misuse; commonly used in small amounts to treat symptoms like cough, diarrhea, or mild pain.

Opiates vs. Opioids

The words “opiates” and “opioids” are often used interchangeably, but they are slightly different:

  • Opiates: Natural drugs from the opium poppy, such as Morphine and Codeine
  • Opioids: The broader group that includes opiates, lab-made prescription drugs like Oxycodone and Hydrocodone, and illegal drugs like Fentanyl and Heroin

In simple terms:

  • Opiates = natural drugs from the opium poppy
  • Opioids = natural, semi-synthetic, and synthetic drugs that work the same way in the body

Risks and Dangers of Opioids

In Marin County, about one person dies from drug overdose or poisoning each week, and Fentanyl is involved in roughly two-thirds of these deaths. Visit our Data Dashboard to learn more.

  • Addiction: Repeated opioid use can lead to dependence or a medical condition called Opioid Use Disorder, where it becomes hard to stop or control use.
  • Overdose: Opioids can slow or stop breathing, especially in high doses, when mixed with other substances, or when used without medical supervision. Overdose can be fatal.

Safety tips:

  • Only take opioids exactly as prescribed
  • Store medications securely
  • Never share medications with others
  • Learn how to recognize the signs of an overdose (link to training page or training video)
  • Carry Naloxone and never use opioids alone

Treatment Is Available

If someone develops a dependence on opioids, treatment can help people recover and stay healthy. Effective options include Medication Assisted Treatment:

  • Medications: Buprenorphine, Methadone, Naltrexone
  • Counseling and behavioral support services

If you or someone you know may be struggling with opioid misuse, contact your healthcare provider or visit our Treatment Locator to find confidential help and support.