delphic analysis regarding 20 popular recreational drugs. Street<unk>  was ranked 4th in dependence, 5th in physical harm, and 5th in social harm. Adverse effects of<unk>  include: * Sedation * Constipation * Flushing * Perspiration * Heat intolerance * Dizziness or fainting * Weakness * Chronic fatigue, sleepiness and exhaustion * Sleep problems such as drowsiness, *Insomnia * Constricted pupils * Dry mouth * Nausea and vomiting * Low blood pressure * Headache * Heart problems such as chest pain or fast/pounding heartbeat * Abnormal heart rhythms * Respiratory problems such as trouble breathing, slow or shallow breathing (hypoventilation), light-headedness, or fainting *weight gain * Memory loss * Itching * Difficulty urinating * Swelling of the hands, arms, feet, and legs * Mood changes, euphoria, disorientation * Blurred vision * Decreased libido, difficulty in reaching orgasm, or impotence * Missed menstrual periods, * Skin rash * Central sleep apnea Withdrawal symptoms Physical symptoms * Lightheadedness * Tearing of the eyes * Mydriasis (dilated pupils) * Photophobia (sensitivity to light) * Hyperventilation syndrome (breathing that is too fast/deep) * Runny nose * Yawning * Sneezing * Nausea, vomiting, and diarrhea * Fever * Sweating * Chills * Tremors * Akathisia (restlessness) * Tachycardia (fast heartbeat) * Aches and pains, often in the joints or legs * Elevated pain sensitivity * Blood pressure that is too high (hypertension, may cause a stroke) Cognitive symptoms * Suicidal ideation * Susceptibility to cravings * Depression * Spontaneous orgasm * Prolonged insomnia * Delirium * Auditory hallucinations * Visual hallucinations * Increased perception of odors (olfaction), real or imagined * Marked increase in sex drive * Agitation * Anxiety * Panic disorder * Nervousness * Paranoia * Delusions * Apathy * Anorexia (symptom)<unk>  withdrawal symptoms are reported as being significantly more protracted than withdrawal from opioids with shorter half-lives. When used for opioid maintenance therapy,<unk>  is generally administered as an oral liquid.<unk>  has been implicated in contributing to significant tooth decay.<unk>  causes dry mouth, reducing the protective role of saliva in preventing decay. Other putative mechanisms of<unk> -related tooth decay include craving for carbohydrates related to opioids, poor dental care, and general decrease in personal hygiene. These factors, combined with sedation, have been linked to the causation of extensive dental damage. Black box warning<unk>  has the following US FDA black box warning: * Risk of addiction and abuse * Potentially fatal respiratory depression * Lethal overdose in accidental ingestion * QT prolongation * Neonatal opioid withdrawal syndrome in children of pregnant women * CYP450 drug interactions * Risks when used with benzodiazepines and other CNS depressants, including alcohol. * A certified opioid treatment program is required under federal law (42 CFR 8.12) when dispensing<unk>  for the treatment of opioid addiction or detoxification. Overdose Most people who have overdosed on<unk>  may show some of the following symptoms: * Miosis (constricted pupils) * Vomiting *Spasms of the stomach and intestines * Hypoventilation (breathing that is too slow/shallow) * Drowsiness, sleepiness, disorientation, sedation, unresponsiveness * Skin that is cool, clammy (damp), and pale *Blue fingernails and lips * Limp muscles, trouble staying awake, nausea * Unconsciousness and coma The respiratory depression of an overdose can be treated with naloxone. Naloxone is preferred to the newer, longer-acting antagonist naltrexone. Despite<unk> 's much longer duration of action compared to either heroin and other shorter-acting agonists and the need for repeat doses of the antagonist naloxone, it is still used for overdose therapy. As naltrexone has a longer half-life, it is more difficult to titrate. If too large a dose of the opioid antagonist is given to a dependent person, it will result in withdrawal symptoms (possibly severe). When using naloxone, the naloxone will be quickly eliminated and the withdrawal will be short-lived. Doses of naltrexone take longer to be eliminated from the person's system. A common problem in treating<unk>  overdoses is that, given the short action of naloxone (versus the extremely longer-acting<unk> , a dosage of naloxone given to a<unk> -overdosed person will initially work to bring the person out of overdose, but once the naloxone wears off, if no further naloxone is administered, the person can go right back into overdose (based upon time and dosage of the<unk>  ingested). Tolerance and dependence As with other opioid medications, tolerance and dependence usually develop with repeated doses. There is some clinical evidence that tolerance to analgesia is less with<unk>  compared to other opioids; this may be due to its activity at the NMDA receptor. Tolerance to the different physiological effects of<unk>  varies; tolerance to analgesic properties may or may not develop quickly, but tolerance to euphoria usually develops rapidly, whereas tolerance to constipation, sedation, and respiratory depression develops slowly (if ever).<unk>  fills the same opioid receptors in the brain as heroin and other prescription pain killers making it a suitable substitute. Driving<unk>  treatment may impair driving ability. Drug abusers had significantly more involvement in serious crashes than non-abusers in a study by the University of Queensland. In the study of a group of 220 drug abusers, most of them poly-drug abusers, 17 were involved in crashes killing people, compared with a control group of other people randomly selected having no involvement in fatal crashes. However, there have been multiple studies verifying the ability of<unk>  maintenance patients to drive. In the UK, persons who are prescribed oral<unk>  can continue to drive after they have satisfactorily completed an independent medical examination which will include a urine screen for drugs. The license will be issued for 12 months at a time and even then, only following a favourable assessment from their own doctor. Individuals who are prescribed<unk>  for either IV or IM administration cannot drive in the UK, mainly due to the increased sedation effects that this route of use can cause. Mortality In the United States, deaths linked to<unk>  more than quadrupled in the five-year period between 1999 and 2004. According to the U.S. National Center for Health Statistics, as well as a 2006 series in the Charleston Gazette (West Virginia), medical examiners listed<unk>  as contributing to 3,849 deaths in 2004. That number was up from 790 in 1999. Approximately 82 percent of those deaths were listed as accidental, and most deaths involved combinations of<unk>  with other drugs (especially benzodiazepines). Although deaths from<unk>  are on the rise,<unk> -associated deaths are not being caused primarily by<unk>  intended for<unk>  treatment programs, according to a panel of experts convened by the Substance Abuse and Mental Health Services Administration, which released a report titled<unk> -Associated Mortality, Report of a National Assessment". The consensus report concludes that "although the data remains incomplete, National Assessment meeting participants concurred that<unk>  tablets or Diskets® distributed through channels other than opioid treatment programs most likely are the central factors in<unk> -associated mortality." In 2006, the U.S. Food and Drug Administration issued a caution about<unk> , titled<unk>  Use for Pain Control May Result in Death." The FDA also revised the drug's package insert. The change deleted previous information about the usual adult dosage. The Charleston Gazette reported, "The old language about the 'usual adult dose' was potentially deadly, according to pain specialists."
Methadone
Isomethadone
Normethadone
Levomethadone
Morphine
Buprenorphine
Codeine
Naltrexone