Narcotics


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Narcotics

 

Definition

Narcotics are natural opioid drugs derived from the Asian poppy Palaver somniferous or semi-synthetic or synthetic substitutes for these drugs.

Purpose

Narcotics are drugs that dull the sense of pain and cause drowsiness or sleep. They are the most effective tool a physician has to relieve severe pain. Narcotics are also given pre-operatively to relieve anxiety and induce anesthesia. Other common uses are to suppress cough and to control very severe diarrhea. In large doses, they can suppress the ability to breathe and cause coma and death. Narcotics are also taken illegally for recreational use.

Precautions

Narcotics should only be taken under the direction of a physician. These drugs depress the central nervous system and should not be taken with other drugs, such as alcohol, barbiturates, antihistamines, and benzodiazepines that also depress the central nervous system.
Opioids are broken down by the liver. Individuals with liver damage may not detoxify these substances as rapidly as healthy individuals, leading to potential accidental overdose. Street narcotics are of uncertain strength and may be contaminated with toxic chemicals or contain a mixture of drugs that can cause life-threatening reactions.

Description

Natural narcotics are derived directly from the sap of the unripe seed pods of the opium poppy. Morphine and codeine are the most familiar natural narcotics and are the narcotics most frequently used in medical settings. Often they are prescribed in combination with other non-narcotic drugs. Heroin is a semi-synthetic narcotic. It has no medical or legal uses. Other completely synthetic narcotics are made in the laboratory. These include drugs with medical uses such as fentanyl and oxycodone and illegal "designer drugs" synthesized for recreational use. Some man-made narcotics are hundreds of times more potent than natural narcotics.
Narcotics depress the central nervous system. They work by binding chemically with receptors in a way that blocks the transmission of nerve impulses. These drugs do not cure the source of the pain; they simply block the individual's perception of pain. When used to treat cough or diarrhea, they slow or block muscle contractions.
Morphine (Roxanol, Dura morphine, morphine sulfate, morphine hydrochloride) is the most commonly used medical narcotic for managing moderate to severe pain. It can be also be used to control extreme diarrhea caused by cholera or similar diseases. Morphine sulfate is a white powder that dissolves in water. It is usually given by injection into a muscle or intravenously by injection into a vein. When given intravenously, its effect occurs almost immediately. Individuals given morphine regularly have a high potential for developing dependence on the drug. Morphine can cause withdrawal symptoms if stopped abruptly. It is not a common street drug.
More codeine is prescribed medically than any other narcotic. Concentrations of codeine in the sap of the opium poppy are low, so most codeine is manufactured by chemical alteration of morphine. For pain control, codeine is combined with other non-narcotic painkillers such as aspirin (Empirin with Codeine,) acetaminophen (Tylenol with Codeine) or non-steroid anti-inflammatory drugs. These combination painkillers are manufactured as tablets (most common) or liquids and come in a variety of strengths based on the amount of codeine they contain. Codeine is also found in some cough syrups (Robitussin A-C, for example) and is used to control dry cough. Occasionally codeine is used to control severe diarrhea, although diphenoxylate (Lomotil) is used more often.
In Canada, certain low-dose codeine pain relievers are sold without prescription. In the United States pain medication with codeine requires a prescription. The likelihood of physical or psychological dependence on codeine is much lower than with morphine.
Hydromorphone (Dilaudid) is a narcotic synthetically produced from morphine. It is available in tablets or as an injectable solution and used for pain relief. It is one of the most common pain relievers prescribed for patients who are terminally ill, because it combines high effectiveness with low side effects.
Mederidine (Demerol) was originally developed to treat muscle spasms but is as of 2005 used mainly for pain relief. It is manufactured as tablets of varying strengths. Another synthetic pain relief narcotic whose use parallels mederidine is propoxyphene. When combined with aspirin this narcotic is known under the brand name Darvon.
Oxycodone (Oxycontin), a synthetic narcotic used for pain relief, is manufactured both alone and with aspirin (Percodan) or acetaminophen (Percoset) in tablets of various strengths. OxyContin is a controlled release formula of oxycodone that controls pain continuously for 12 hours at a time. Oxycodone has a high potential for prescription drug and street abuse. Hydrocodone with acetaminophen (Vicodin) is another synthetic narcotic whose use and potential abuse parallels oxycodone.
Fentanyl (Sublimaze, Actiq, Duragesic) is used as a surgical anesthetic. It is available as an injectable solution and as a skin patch.
Methadone is a synthetic narcotic used mainly as a substitute for heroin in heroin withdrawal treatment, although it does have pain-killing properties. Methadone, when taken by mouth (liquid, wafers, tablets) provides little of the euphoria of heroin, but it blocks heroin cravings and withdrawal symptoms.
The first international attempts to control narcotic drugs were made in 1909 with the formation of the Opium Commission Forum, which developed the first international drug control treaty in 1912. In the early 2000s narcotics are regulated internationally by the International Narcotics Control Board (INCB), established in 1961. The INCB regulates the cultivation of raw materials to make narcotics and natural and man-made drugs. Cocaine and marijuana also fall under the board's control, although they are not technically narcotics. Narcotic drugs are also regulated by federal and state governments. In law enforcement, the term narcotics is extended to include other, mainly illicit drugs such as cocaine that have little medical use.

Preparation

No special preparation is required before being treated with narcotics, although, as with all medications, individuals should tell their physician about all prescription and non-prescription drugs, supplements, and herbal remedies that they are taking, as certain medications may enhance the effects of narcotics.

Aftercare

When an individual is prescribed narcotics regularly for an extended period, tolerance may develop. With tolerance, the individual must take higher and higher doses to achieve the same level of pain control. In some cases, when narcotics are stopped abruptly, withdrawal symptoms may develop. These include:
  • anxiety
  • irritability
  • rapid breathing
  • runny nose
  • sweating
  • vomiting and diarrhea
  • confusion
  • shaking
  • lack of appetite
In order to prevent withdrawal symptoms, the dose of narcotics can be gradually diminished, a process known as tapering, until they can be discontinued completely without unpleasant effects. Individuals may also be treated with the drug cloindine (Catapres) to relieve some withdrawal symptoms.

Risks

All narcotics have the potential to become physically and psychologically addictive. When used regularly, tolerance can develop. Abuse and dependence on narcotic prescription drugs in an increasing problem among the elderly particularly and among members of the middle class generally.
Overdose and withdrawal symptoms and reactions caused by contamination with other drugs or toxic chemicals are common reasons for drug-related visits to the emergency room by individuals using street narcotics recreationally. Overdose is treated with the drug naloxone (ReVia). Naloxone blocks and reverses the effects of narcotics. When given intravenously it is effective within one to two minutes.

Key terms

Tapering — Gradually reducing the amount of a drug when stopping it abruptly would cause unpleasant withdrawal symptoms.

Normal results

When used as prescribed, narcotics are a generally safe and effective way to relieve pain and control cough and severe diarrhea. Individuals should not be afraid they will develop an addiction after a short-term course of narcotics following a dental or medical procedure, provided that they follow their physician's instructions for taking the drugs.

Resources

Organization

National Institute on Drug Abuse/National Institutes of Health. 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561. (301) 443-1124. http://www.nida.nih.gov.
United States Drug Enforcement Administration. Dr Mailstop: AXS, 2401 Jefferson Davis Highway, Alexandria, VA 22301. (202) 307-1000. http://www.dea.gov.

Other

"Narcotics." United States Drug Enforcement Administration (undated) [cited March 25, 2005] http://www.usdoj.gov/dea/concern/narcotics.html.
National Institute on Drug Abuse. February 4, 2005 [cited March 25, 2005]. 〈http://www.nida.nih.giv/ResearchReport/Prescription/Prescription.html〉
Stephens, Everett. Toxicity, Narcotics January 7, 2005 [cited March 25, 2005]. http://www.emedicine.com/emerg/topic330.htm.
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