What is covered in this topic?
This topic describes the management of harms from:
- illicit opioid use, such as heroin
- nonmedical use of prescription opioids, such as oxycodone, codeine, fentanyl, tramadol, morphine and hydromorphone.
Nonmedical use of opioids describes use of prescription drugs in ways that do not align with the directed use; for example, use in order to become intoxicated or to treat a symptom other than the clinician intendedAustralian Institute of Health and Welfare (AIHW), 2018McNeely, 2014.
Toxicity (overdose) from opioids is covered in the Toxicology and Toxinology Guidelines; see:
- Opioid poisoning: advice for first responders in the community or primary healthcare setting
- Opioid poisoning: general management
- Buprenorphine poisoning
- Tapentadol poisoning
- Tramadol poisoning
- Novel psychoactive substance poisoning, including novel synthetic opioids (eg fentanyl analogues), which are associated with an increased risk of overdose because of their high potency.
Heroin was once a leading source of opioid harm but has been supplanted by prescription opioids. Prescription opioids can be used by injection, orally or transdermally. Illicit opioids may be used by a range of routes; heroin is used intravenously, intranasally (‘snorted’) or by vapour inhalation (‘chasing the dragon’).
Prescription opioid use has increased over 10-fold in the last 2 decades in Australia; currently over one million Australians are prescribed repeat opioid prescriptions annually. In 2016, deaths and hospitalisations from prescription opioids exceeded those from illegal opioids in AustraliaAustralian Institute of Health and Welfare (AIHW), 2018. Some of these events are the result of nonmedical use (the focus of this topic), but harms, including dependence, can also arise from use as prescribed, particularly if doses are high or prolonged (eg in some patients with chronic pain).