3201-Opioid Conversion Calculator | eviQ

To see all protocols that comply with the WHO Essential Medicine List 

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• All calculations must be confirmed before use. Significant inter/intra patient variability exists in the response to different opioid drugs and the dose of these agents. After changing an opioid drug or its dose, patients should be closely assessed and the dose or drug altered as necessary.
• Calculations used for opioid switching should be documented in the patients record.
• All conversions are made by first calculating the daily oral morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. For conversion factors used in the calculator select here.
• It is the responsibility of the user to round up or down calculated results if required, to align with preparations available at individual workplaces.
• The eviQ opioid conversion calculator is only to be used for patients greater than 12 years old. For this reason the Date of Birth field is mandatory. For patients under this age consult with a pain or palliative care specialist

• Combination products: There is no conclusive evidence that combination analgesics containing lower doses of codeine with paracetamol, aspirin or ibuprofen have any benefits over these non-opioids alone.
• Buprenorphine transdermal patches: Calculator will only allow conversion FROM a buprenorphine patch and not TO a patch as there is limited evidence about, and experience of it’s use compared to other opioids.
• Methadone: Dose conversion to: from other opioids and methadone is complex; consultation with pain management specialists familiar with methadone use is recommended
• Fentanyl Lozenges: There is no dose equivalence between fentanyl lozenges and other opioid formulations. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. It should be individually titrated by starting at the lowest dose (200 micrograms)

Version 2

Disclaimer: The Cancer Institute NSW does not warrant or represent that the information is free from errors or omission. Furthermore, changes in circumstances after the time of publication of the information may impact on the accuracy of the information. The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from the opioid calculator. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user.

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https://www.eviq.org.au/p/3201

30 Jun 2023

Content

Dosage, Side Effects, and More

Written by Stephanie Watson

Medically Reviewed by Neha Pathak, MD on August 30, 2021

• How Do Opioids Work?
• Working With Your Doctor
• What Are the Side Effects of Opioids?
• Opioid Tolerance and Addiction
• Should You Take Opioid Pain Medications?

When you have a mild headache or muscle ache, an over-the-counter pain reliever is usually enough to make you feel better. But if your pain is more severe, your doctor might recommend something stronger: a prescription opioid.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don’t use them correctly. For people who have an opioid addiction, their problem often started with a prescription.

If you need to take opioids to control your pain, here are some ways to make sure you’re taking them as safely as possible.

Opioid drugs bind to opioid receptors in the brain, spinal cord, and other areas of the body. They tell your brain you’re not in pain.

They are used to treat moderate to severe pain that may not respond well to other pain medications.

Opioid drugs include:

• Codeine
• Fentanyl (Actiq, Abstral, Duragesic, Fentora)
• Hydrocodone (Hysingla, Zohydro ER)
• Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
• Hydromorphone (Dilaudid, Exalgo)
• Meperidine (Demerol)
• Methadone (Dolophine, Methadose)
• Morphine (Kadian, MS Contin, Morphabond)
• Oliceridine (Olynvik)
• Oxycodone (Oxaydo, OxyContin)
• Oxycodone and acetaminophen (Percocet, Roxicet)
• Oxycodone and naloxone

Your doctor can prescribe most of these drugs as a pill. Fentanyl is available in a patch. A patch allows the medication to be absorbed through the skin.

You’ll need a prescription from your doctor before you start taking opioids. The doctor can adjust the dose as needed to help control pain.

You may receive around-the-clock doses to manage pain throughout the day and night. And your doctor may prescribe opioids to be taken “as needed” in case you have “breakthrough” pain — a flare of pain that you get despite round-the-clock doses.

While you’re on opioid pain medications, check in with your doctor regularly. Your doctor will need to know:

• How your pain is responding to the drug
• Whether you’re having any side effects
• Whether you have any potential interactions or medical conditions that could make you more likely to have side effects, such as sleep apnea, alcohol use, or kidney problems
• Whether you’re taking the drug properly

Never change or stop taking any opioid medicine without first checking with your doctor. If a pain medication isn’t working as well as it should, your doctor may switch you to a different dose — or add on or try another drug.

When you’re ready to stop taking opioids, your doctor may wean you off them slowly — if you have taken them for a long time — to give your body time to adjust. Otherwise, you may have withdrawal symptoms.

One of the reasons why your doctor needs to manage pain medications so closely is that they can cause side effects, such as:

Gastrointestinal problems. You may have nausea and vomiting when you start taking opioids. It often passes after a few days. Try lying down for an hour or so after taking a dose, or ask your doctor for an over-the-counter or prescription nausea remedy.

Constipation is a common problem when you take opioids. They cause food to move more slowly  through your system, which results in harder stools that don’t pass as easily. If you start having trouble:

• Don’t wait more than 2 days without a bowel movement before getting in touch with your doctor.
• Drink more water. This alone helps some people with mild constipation. But others may have to do more. Having a hot drink in the morning can get things moving through your GI tract. Avoid drinks with caffeine, like coffee and tea, and instead try hot water with lemon or herbal tea.
• Ask if other drugs may help. Your doctor may recommend either a stool softener or laxative that you can buy at the drugstore. Other drugs are available by prescription. Lubiprostone (Amitiza), methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol (Movantik) are approved to treat constipation due to opioid use in those with chronic pain.

Cognitive issues. Some people just don’t feel like themselves when they start taking opioids. You may have:

• Trouble staying focused
• Drowsiness
• “Foggy” feeling or trouble thinking clearly
• Slow reflexes

Don’t drive or operate heavy machinery while on opioids. It may take a week or more for you to start feeling normal again.

Opioids can be dangerous if you take them with alcohol or with certain drugs such as:

• Some antidepressants and anxiety medications (particularly benzodiazepines such as alprazolam, clonazepam, and lorazepam)
• Some antibiotics
• Sleeping pills

Make sure your doctor knows all of the other medicines you’re taking. That includes:

• Prescription drugs
• Over-the-counter drugs
• Herbal supplements

After taking opioid pain medication for a while, you might find that you need more and more of the drug to achieve the same effect in easing pain. This is called tolerance. It’s not the same as addiction, which involves a compulsive use of a drug.

When you use opioid medication over an extended period of time, you can have dependence. This can happen when your body becomes so used to the drug that if you abruptly stop taking it, you get withdrawal symptoms such as:

• Diarrhea, nausea, and vomiting
• Muscle pain
• Anxiety
• Irritability

You can also get a serious addiction to opioid pain medications. People who are addicted compulsively seek out the pain medications. Their behavior usually leads to negative consequences in their personal lives or workplace. They might take someone else’s pills or buy them off the street, which is especially dangerous since those drugs are often laced with lethal amounts of fentanyl. Learn more about what can happen when opioid addiction goes untreated.

If you are having a problem with addiction, you need to see your doctor or an addiction specialist.

Opioids can make a dramatic difference to people with moderate to severe pain, but they aren’t always the right choice. Discuss the necessity of using them with your doctor. If you take them, follow your doctor’s instructions carefully. If your pain isn’t related to cancer, talk with your doctor regularly about whether you need to keep taking opioids. If you need to continue taking them, lowering the dose or changing the type of opioid may help prevent problems.

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Important information for parents: modern types of drugs and their effects

Drugs are substances that adversely affect the human body. Regardless of whether they belong to the opioid or opiate group, they can cause strong dependence, which in most cases cannot be overcome on their own.

Contents:

• What are the types of drugs?
• Hallucinogens
• Opiates
• Amphetamines
• Cannabis preparations
• Cocaine
• Synthetic drugs
• Light drugs
• Types of drugs, comparison table

What types of drugs are there?

Today there are a large number of narcotic drugs, both heavy and light. Some believe that if you use ordinary weed, and not the “white powder”, as cocaine is called, then there is nothing wrong with that. In fact, each of these drugs is destructive, because it slowly but surely destroys the human body.

Hallucinogens

Hallucinogens are psychedelic drugs that can change emotions, sensations, thoughts and even perception of the surrounding world. The most common today are mushrooms and LSD.

The scientific name of the mushrooms is psilocybin and the psilocin found in toadstool mushrooms. For the long-awaited effect to come, it is enough to take only 2 grams of dried toadstools. The whole danger lies in the fact that getting such a drug is not difficult, and the harm from it is no less than it is the same heroin, for example.

As far as LSD is concerned, it is not only a hallucinogen, but also a synthetic drug created artificially. Some time ago, an odorless powder or colorless liquid was ingested in microscopic doses, but now paper or a small piece of cloth is impregnated with the substance, which is placed under the tongue. Addicts believe that this method makes the use of a drug invisible. Although, of course, this is not so, because the hallucinogenic effect occurs in half an hour and it is impossible not to notice it.

Signs of hallucinogenic intoxication are as follows:

• dilated pupils;
• tremor of limbs;
• dry skin;
• increased heart rate;
• high blood pressure;
• hallucinations, accompanied by loss of self-control, impaired coordination and overexcitation.

Sometimes drug addicts, in order to hide the true state of affairs, assure others that their not quite adequate behavior is a sign of poor health and nothing else. Indulging an addict is a thankless task, because addiction is a disease that needs to be treated.

If you have a problem, you can contact a specialized center where experienced narcologists work to help you cope with drug addiction. The Renaissance Clinic is always ready to receive people even in the most neglected and difficult cases.

Opiates

Opiates, unlike the same hallucinogens, lead to inhibitory effects. This group includes synthetic and natural compounds. As for the latter, they are made from poppy seeds. Using a narcotic substance, a person quickly gets used to it, becoming addicted. The opiate group is dangerous because it is difficult to get rid of its dependence.

Synthetic opiates include:

• acetylated opium;
• heroin;
• methadone;
• raw opium.

Each of them looks different and has certain effects on the body.

Acetylated opium

This is a dark brown ready solution that smells like vinegar. The drug is obtained during a series of chemical reactions.

Heroin

Heroin, also known as “gerych”, “relish”, “white” or “horse”, is the most popular synthetic opium drug. White powder is extremely toxic and dangerous; addicts quickly “sit down” on it, not imagining their life without a dose. Heroin is injected, snorted, or smoked.

Methadone

The drug is in the form of a white powder or solution. In some countries, methadone is used to eliminate opium addiction caused by other drugs.

Raw opium

The drug resembles plasticine and may be white to brown. “Piece”, “khanka”, “opiuha” – as it is also called, is a processed poppy juice, which is the raw material for the preparation of acetylated opium.

Regardless of the opiate group of drugs used, the symptoms of intoxication will be the same.

Namely:

1. Constant drowsiness.
2. Stretched speech.
3. Desire to be alone.
4. Compliance.
5. Very narrow pupils.
6. Pale skin.
7. Slow heartbeat.
8. Decreased appetite.
9. Decreased pain threshold.
10. Reduced reflexes.

Sometimes people who are nearby, understanding what problem the addict has, try to fix everything on their own. The problem is that initially it is very difficult to assess the situation and understand that opiate addiction is very strong, and in order to eliminate it, the help of qualified psychologists and narcologists is required. In our time, drug addiction treatment is not something shameful or unnatural. On the contrary, going to a clinic is a real opportunity to help an addict return to a normal life.

Amphetamines

Speaking about the classification of drugs, it is impossible not to mention the amphetamines that have gained popularity in the last two decades. These substances have a psychostimulating effect (encouraging). A synthetic drug is made from drugs that include ephedrine. In nature, this substance can be obtained from the plant “ephedra”. Not only do they quickly get hooked on the drug, but the addict also needs to increase the dose each time in order to feel the “high”.

If one fails to get pleasure, the person becomes embittered, becomes nervous and aggressive.

Signs of amphetamine use are as follows:

1. High blood pressure.
2. Increased heart rate.
3. Pupil dilation.
4. Indecent emancipation.
5. Hyperactivity.
6. Constant communication, and the addict can tell something off topic without maintaining a general conversation.
7. Violation of sleep and wakefulness.
8. Lack of appetite.

Treatment of addiction, if it has been discovered, should be started immediately, because, wanting to get another dose, a person can go to extreme measures, committing a crime. Today, drug addiction is being treated, and very successfully, so there is no need to delay contacting a specialized center.

Cannabis-based preparations

Cannabis-based preparations are called cannabinoids, fat-soluble substances that, when consumed in large quantities, accumulate in all organs. The most popular drugs in this group are hashish and marijuana. As for the first drug, it is made from the tops or pollen of hemp and a mixture of resin. Hashish can be found in the form of capsules or small dark-colored briquettes. This type of drug is often smoked, the effect of use begins in half an hour.

Marijuana is the herbaceous part of cannabis that is dried and also smoked. Sometimes the substance is ground and added to food. Some addicts just chew on the stem. Considering that in some countries this type of drug is allowed, dependence on it is not uncommon.

When using cannabis-based preparations, you may notice such abnormalities as:

• nausea and vomiting;
• dizziness;
• ringing in the ears;
• dry nose and mouth;
• labored breathing;
• anxious or vice versa depressed state;
• change in the perception of the surrounding world;
• feeling of warmth, lightness, joy.

The most terrible thing begins after the drug stops working. A person feels emptiness and longing, he may develop persecution mania, sometimes visual hallucinations appear. There have been cases when people seriously thought about suicide and even committed their plans.

If you have thoughts of suicide, you can get treatment for mental disorders. It is a mistake to believe that drug addiction is only a physical addiction. Most of the time it’s just psychic. Forgetting in nirvana after taking the next dose, the addict wants to return to it again and again. He is not interested in reality and all the interesting things that are happening around him, so he takes the drug again and again.

Cocaine

Cocaine is one of the hard drugs that become addictive after the first or second use. Despite the fact that some peoples smoked coca leaves, assuring that it can cure and prevent the occurrence of many diseases, taking cocaine is dangerous to health. The psychostimulant, which has many unofficial names: “snowflake”, “nose candy”, “coke”, “puffy”, “coca”, “inhale”, is a white crystalline powder that is inhaled through a small straw or rubbed on the gums.

During the use of the drug, the area from the eyes to the chest is frozen. Addicts do not understand that they instantly “get hooked” on “coke”, not imagining their life without it. Given the fact that the powder is extremely strong, a person may not notice how an overdose will occur.

The use of cocaine results in the following:

• euphoria;
• CNS stimulation;
• rapid pulse;
• improved mood;
• sweating;
• dilated pupils;
• excessive activity;
• insomnia;
• feeling of anxiety (when the effect of the drug comes to an end).

If you notice suspicious symptoms, you should definitely take a closer look at the person so as not to miss the situation. Getting into addiction treatment is just as easy as getting into alcoholism treatment, all you need to do is seek help.

Synthetic drugs

The list of types of drugs (synthetic) can be listed for a long time, because there are a great many of them. They are called synthetic because they are made artificially, and not extracted from plants, like some substances. This group includes several components at once, which have a strong effect on a person.

In contrast to the same opiates, “synthetics” are quickly perceived by the body, which leads to a strong dependence on the drug. Looking ahead, it is worth noting that the treatment of drug addiction in Israel is carried out taking into account the type of substance used, as well as the “experience” of use. In addition, an individual approach to each patient will allow the addict to quickly overcome his addiction.

As for synthetic drugs, the most popular are:

1. LSD.
2. Ecstasy.
3. Spice.

LSD was discussed above, so you can immediately go to ecstasy. This type of drug is very popular among young people, because after its use, fear and anxiety completely disappear. People want to communicate, make new acquaintances. Many begin to sing, dance, and it does not matter where they are at this moment. From the outside, it may seem that the addict is “not in himself.” In fact – it is so. At this moment, the addict does not control himself, he thinks that he is able to do absolutely everything, the world belongs to him, and he is his king.

Speaking about the types of smoking drugs that belong to the synthetic group, one cannot fail to note the spices that appeared not so long ago. Some call this drug weed, although this is far from being the case. Spice is a herb (it can be a herbal collection bought at a pharmacy), which after the manufacturer processes it with a special chemical composition – it has the same intoxicating effect. The worst thing is that the effect of spice is very different. It even happens that the manufacturer cannot guarantee what you can count on.

Sometimes drug addiction treatment for “synthetics” takes even longer than for stronger drugs.

Soft drugs

Although some addicts believe in soft drugs, they don’t actually exist. The narcotic substance, whatever it may be, slowly destroys the body. Of course, marijuana or hashish can be added to the

“light” group, but dependence on them develops as quickly as on opiates or hallucinogens.

Types of drugs, comparison table

Article 53.

Rights and obligations of officials of bodies authorized to exercise control over the fulfillment of the requirements of this Federal Law \ ConsultantPlus exercise control over the fulfillment of the requirements of this Federal Law

1. If there is sufficient data indicating a violation of the procedure for activities related to the circulation of narcotic drugs, psychotropic substances and their precursors, as well as the cultivation of drug-containing plants, officials of the prosecutor’s office, the Investigative Committee of the Russian Federation, internal affairs bodies, customs authorities , bodies of the federal security service, within their competence, have the right:

.12.2022 N 640-FZ)

(see the text in the previous edition)

inspect land plots where the cultivation of drug-containing plants is possible, places of development, production, manufacture, processing, storage, release, sale, distribution, acquisition, use and destruction of narcotic drugs, psychotropic substances and their precursors;

(as amended by Federal Law No. 87-FZ of May 19, 2010)

(see the text in the previous edition)

check the compliance of the processes of production and manufacture of narcotic drugs, psychotropic substances and their precursors with the established rules, if necessary, withdraw samples for comparative research;

seal premises in order to prevent access to narcotic drugs, psychotropic substances and their precursors;

require the submission of explanations and documents necessary for the performance of control functions;

give to legal entities – holders of licenses engaged in activities related to the circulation of narcotic drugs, psychotropic substances and their precursors included in Schedule I, with the cultivation of narcotic plants, legal entities and individual entrepreneurs – holders of licenses engaged in activities related to the circulation of precursors listed in Table I of List IV, as well as legal entities and individual entrepreneurs engaged in activities related to the circulation of precursors included in Table II and Table III of List IV, mandatory orders to eliminate the identified violations;

(as amended by Federal Law No. 640-FZ of December 29, 2022)

(see the text in the previous edition)

to carry out other control measures.

2. Officials of bodies of inquiry, investigators or prosecutors may enter any premises and inspect places where activities related to the circulation of narcotic drugs, psychotropic substances and their precursors are carried out.

3. In case of detection of violations of the procedure for activities related to the circulation of narcotic drugs, psychotropic substances and their precursors, as well as the cultivation of narcotic plants, legal entities and individual entrepreneurs engaged in this activity are obliged to take appropriate measures within their competence to elimination, and if there are signs of administrative offenses or crimes, report this to the internal affairs bodies and provide the necessary materials.

(as amended by Federal Laws No. 86-FZ of 30.06.2003, No. 305-FZ of 03.07.2016, No. 640-FZ of 29.12.2022)

(see the text in the previous version)

the persons specified in paragraph 1 of this article are obliged to take measures to suppress the administrative offenses or crimes identified by them related to the circulation of narcotic drugs, psychotropic substances and their precursors, new potentially dangerous psychoactive substances, the cultivation of narcotic plants, as well as to bring to justice guilty persons.