Opioids Language of Substance Use Disorder

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Language of Substance Use Disorder

  • Opioids, Opiates, & Narcotics: The words narcotics, narcotic analgesics, opiates, opiate analgesics, and opioids are used interchangeably. Opiates are drugs derived from opium.   At one time opioids referred to synthetic opiates only (drugs created to emulate opium, however, different chemically).   Now the term opioid is used for the entire family of opiates including natural, synthetic, and semi-synthetic. The word narcotic is primarily used by law enforcement.   A preferred umbrella term is opioid.
  • Substance Abuse & Substance Use Disorder:   Framing addiction as “substance abuse” associates it with a crime; framing addiction as a “substance use disorder” associates it with a condition that requires treatment. There is clear evidence that the phrases “substance abuse” and “substance abuser” are harmful and disparaging to people with chemical health needs.   Abuse is associated with other forms of intentional harm such as child abuse, sexual abuse, physical abuse, emotional abuse, or domestic abuse.   A randomized controlled study in the International Journal of Drug Policy revealed that physicians favored a more punitive approach when a patient was labeled as a “substance abuser”, with more clinicians recommending jail and community service over treatment.   
  • Addict & Person with Addiction: There is a movement for person-first language. This started in the disability movement. Instead of labeling a person as their condition, diagnosis, or disability, the person comes first. In chemical health this plays out as “this patient has a substance use disorder.”
  • Pleasure & Pain: Pleasurable activities, such as laughing and sex, release natural endorphins, which activate opioid receptors, improving your mood.   Opioid receptors can also be activated by exogenous compounds, for example opioids.   Most opioids act on the µ-opioid receptor and are very effective at relieving pain. They also activate reward pathways, explaining why opioids have such a high risk potential. Opioids alter the body’s chemistry and cause the release of endorphins.
  • Clean & Dirty: When it comes to clinical care for substance use, it is common to hear the words clean and dirty, such as “He’s been clean for 2 days” or “Her U-tox came up dirty”.   Rather than talking about being “clean”, the preferred words are sober or abstinent, such as “He has abstained from opioids for 2 days”.   In the urine toxicology (U-tox) screen or urine analysis (UA) example, one could say “Her U-tox was positive for morphine.”   In general, it is recommended to listen to the how the patient describes themselves, and use those words when speaking with a patient. A patient’s chemical health goals may range from using more safely, reducing use, eliminating one drug, full abstinence, or maintaining sobriety.
  • MME: MME stands for morphine milligram equivalent. This is a standardized measure that makes two different types of opioids comparable in their potency. Equal milligrams may have different morphine equivalents. For example, 50 mg of hydrocodone (10 tablets of hydrocodone/acetaminophen 5/300) is 50 MME/day and 33 mg of oxycodone (2 tablets of oxycodone sustained-release 15mg) is 50 MME/day. The higher the potency, the stronger the opioid binds to the opioid receptor, the more pain relief, and increased risk of dependence, withdrawal, addiction, and overdose. 
  • Agonist: a drug that activates certain receptors and mimics natural chemical response in the brain.   Full agonist opioids activate the opioid receptors in the brain fully, resulting in the full opioid effect (e.g. heroin, oxycodone, hydrocodone, morphine, opium).   
  • Antagonist: a drug that blocks opioids by attaching to the opioid receptors without activating them.   Antagonists cause no opioid effect and block full agonist opioids (e.g. naltrexone, naloxone).
  • Partial agonist: a drug that activates the opioid receptors in the brain, but to a much lesser degree than a full agonist to prevent withdrawal and cravings (e.g. methadone).   
  • Mixed agonist/antagonist: a drug that acts as an antagonist, blocking some opioids, and also acts as an agonist, activating opioid receptors in the brain to a much lesser degree than a full agonist (e.g. suboxone).
  • Analgesics: a group of drugs used to achieve analgesia, or relief from pain.

Street Names for Opioids

The common opioids have many street names, including, but not limited to:

  • Heroin= Dope, Smack, H, Train, Thunder, Black Tar, China Whitehorse, Junk, Brother, Goods, Tecata, Direct, Dog Food, Hard Candy, Hero, Judas (a friend who betrays you)
  • Fentanyl=Apache, China Girl, White China, Dance Fever, Friend, Goodfella, Murder 8, TNT, Tango and Cash, Redrum (murder spelled backwards)
  • Morphine=M, Miss Emma, Monkey, White Stuff, Dreamer
  • Codeine=Schoolboy, Cough Syrup, T-3s, Captain Cody, Loads
  • Hydrocodone=Vikes, Viko, Norco, Hydro, Watson-387
  • Oxycodone=Oxy, Oxycotton, Percs, Hillbilly Heroin, Roxy, Kicker
  • Hydromorphone=Juice, Smack, D, Dillies, Footballs, Dust
  • Benzodiazepines=Downers, Sleeping Pills, Tranks, Chill Pills, Z-bar, Bricks, Benzos

Heroin mixed with other substances have additional street names:

  • Heroin & Ritalin=Pineapple
  • Heroin & Alprazolam=Bars
  • Heroin & Marijuana=Atom Bomb, Canade, Woola, Woolie
  • Heroin & Cold Medicine=Cheese
  • Heroin & Ecstasy=Chocolate Chip Cookies, H Bomb
  • Heroin & LSD=Beast, LBJ
  • Heroin & Cocaine=Belushi, Boy-Girl, Dynamite, Goofball, H & C, Primo, Snowball, Speedball, Whiz Bang
  • Heroin & Meth=Poor Man’s Speedball
  • Heroin & Crack=Back to Back, Chasing the Dragon
  • Talwin/Pentazocine & PBZ/Pvribenzamine (substitute for heroin)=Ts & Bs, Tease & Blues, Tops & Bottoms, Tricycles & Bicycles

Street language is complex and changing.  Below are some examples of street language:

  • Experimenting with heroin=Dip & Dab
  • Person dealing drugs=Paper Boy, Man
  • Picking up drugs=Score
  • Person who uses heroin=Channel Swimmer, Jolly Pop, Sleep Walker
  • Person who is under the influence of heroin or other opioids=Jammed, High, Floating, Smacked
  • A person who falls asleep after heroin use=Gouch, Gouching, Nodder (to nod off)
  • Being on heroin=Daytime
  • Onset of heroin withdrawal=Evening
  • Heroin withdrawal=Super Flu, Good Sick (nausea following heroin injection)
  • Hunger that follows injection=Chucks
  • Heating heroin for injection=Cook
  • Liquefying heroin for inhaling=Cook Down
  • Injecting heroin=Do Up (injecting), Firing (pressing syringe), shooting up
  • Abrupt withdrawal from heroin=A la canona, cold turkey

To understand the quantity of opioids, some of the street names are:

  • Bag=1 dose
  • Bundle=10 doses
  • G=Gram
  • Half G=1/2 Gram
  • Teener or T-Shirt=2 Grams
  • Ball or 8-Ball=3 Grams
  • Q or Quarter or Quad=Quarter Ounce or 7 grams
  • Nickle bag=$5 worth of drug
  • Deck=1 to 15 grams of heroin
  • Half Load=15 bags/decks of heroin
  • Load=25-30 bags/decks of heroin
  • Half Piece=1/2 ounce (or approximately 15 grams)
  • Piece=1 ounce (or approximately 28 grams)

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.