Narcotic drugs

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Definition

Narcotics are addictive drugs that reduce the user's perception of pain and induce euphoria (a feeling of exaggerated and unrealistic well-being). The English word narcotic is derived from the Greek narkotikos , which means "numbing" or "deadening." Although the term can refer to any drug that deadens sensation or produces stupor, it is commonly applied to the opioids—that is, to all natural or synthetic drugs that act like morphine.

Description

Historical background

Narcotics are the oldest as well as the strongest analgesics , or pain-relieving drugs, known to humans. Ancient Sumerian and Egyptian medical texts dated as early as 4000 B.C. mention the opium poppy ( Papaver somniferum ) as the source of a milky fluid (opium latex) that could be given to relieve coughs and insomnia as well as ease pain. Traditional Chinese medicine recommended the opium poppy, known to Chinese physicians as ying su ke , for the treatment of asthma , severe diarrhea , and dysentery as well as chronic pain and insomnia. Opium latex contains between 10 and 20 percent morphine, which in its purified form is a white crystalline powder with a bitter taste.

Narcotics are central nervous system depressants that produce a stuporous state in the person who takes them. These drugs often induce a state of euphoria or feeling of extreme well-being, and they are powerfully addictive. The body quickly builds a tolerance to narcotics in as little as two to three days, so that greater doses are required to achieve the same effect. Because of the addictive qualities of these drugs, most countries in the twenty-first century have strict laws regarding the production and distribution of narcotics. These laws became necessary when opium addiction in the nineteenth century became a widespread social problem in the developed countries. Opium, which was the first of the opioids to be widely used, had been a common folk remedy for centuries that often led to addiction for the user; in fact, many popular Victorian patent medicines for "female complaints" actually contained opium. The invention of the hypodermic needle in the mid-nineteenth century, however, increased the number of addicts because it allowed opioids to be delivered directly into the bloodstream, thereby dramatically increasing their effect.

Classification of narcotics

As of the early 2000s, narcotics are commonly classified into three groups according to their origin:

Natural derivatives of opium: Narcotics in this group include morphine itself and codeine.
Partially synthetic drugs derived from morphine: These drugs include heroin, oxycodone (OxyContin), hydromorphone (Dilaudid), and oxymorphone (Numorphan).
Synthetic compounds that resemble morphine in their chemical structure: Narcotics in this group include fentanyl (Duragesic), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone, and propoxyphene (Darvon).

Narcotics are available in many different forms, ranging from oral, intramuscular, and intravenous preparations to patches that can be applied to the skin (fentanyl). Illegal street heroin can be taken by inhalation as well as by injection.

How narcotics work

The central nervous system in humans and other mammals contains five different types of opioid receptor proteins, located primarily in the brain, spinal cord, and digestive tract. When a person takes an opioid medication, the drug attaches to these opioid receptors in the brain and spinal cord and decreases the person's perception of pain. Narcotics do not, however, reduce or eliminate the cause of the pain.

Some of the opioid receptors (known as mu and sigma receptors) influence a person's perception of pleasure. When a narcotic medication stimulates these receptor proteins, the person typically experiences intense sensations of euphoria or well-being. The speed with which these drugs take effect depends on the method of administration; IV narcotics reach their peak effectiveness within ten minutes, while oral narcotics take about an hour and a half, and skin patches take between two and four hours.

Overdoses of narcotics can cause drowsiness, unconsciousness, and even death because these drugs suppress respiration.

General use

Narcotics have several legitimate uses:

Analgesic: Doctors frequently prescribe oral codeine and propoxyphene (alone or in combination with aspirin) for pain control after oral surgery, for severe menstrual cramps, and for temporary pain relief after other outpatient surgical procedures. Intravenous narcotics may be given for several days after major surgery to relieve the patient's discomfort. Subsequent methods of administering opioids following surgery include a sustained-release injected form of morphine sulfate (DepoMorphine) and a patient-controlled transdermal system (E-TRANS) that releases doses of fentanyl when the patient pushes a button attached to the arm or upper chest. Intravenous narcotics may also be used for palliative care, to relieve the pain of patients diagnosed with terminal cancer .
Antitussive: Antitussives are medications given to control coughing. Codeine is often effective in relieving severe coughs and is a common ingredient in prescription cough mixtures. Antidiarrheal: Paregoric, a liquid preparation containing powdered opium, anise oil, and glycerin, is sometimes prescribed for severe diarrhea. The opium in paregoric works to control diarrhea because it slows down the rhythmic contractions of the intestines that ordinarily move food through the digestive tract. Lomotil, another antidiarrheal medication, contains a synthetic opioid known as diphenoxylate; it is often recommended for treating cancer patients with diarrhea caused by radiation therapy.

Precautions

In the United States, opioids are as of 2004 classified as Schedule II drugs under the Controlled Substances Act of 1970. Drugs in this category are described by the government as having a high potential for abuse and a liability for dependence and yet an approved medical use in pain management . The corresponding Canadian legislation, the Controlled Drugs and Substances Act of 1997, classifies medications containing any narcotic under the heading (N) but specifies varying levels of regulation ranging from strict controls for highly addictive single-drug products to lesser controls on drugs combining a narcotic with non-narcotic substances. As both countries' legal controls indicate, narcotics should be used cautiously, for as short a period of time as possible, and only under a doctor's supervision. In particular, they should never be used together with certain other categories of prescription drugs or herbal preparations.

Side effects

In addition to the risk of dependency or addiction, narcotics have a number of physical side effects, including the following:

constipation
drowsiness
withdrawal symptoms after extended use (tearing, sweating, diarrhea, vomiting , gooseflesh, muscle twitching, runny nose, loss of appetite, and hot or cold flashes)

Interactions

Narcotics can be dangerous because of their potential for deadly interactions with other medications as well as their potential for dependence and addiction. Narcotics should never be combined with other types of drugs that depress the central nervous system. These categories of drugs include the following:

alcohol
benzodiazepine tranquilizers, including such drugs as diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium)
barbiturates, used to treat insomnia and anxiety , including such medications as pentobarbital (Nembutal) and mephobarbital (Mebaral)
antihistamines, even over-the-counter cold or allergy medications, which can interact with narcotics to intensify drowsiness and repress breathing

Narcotics can also interact with certain herbal preparations to cause central nervous system depression. Anyone taking narcotics for pain relief should avoid using herbal preparations containing kava kava ( Piper methysticum ), valerian ( Valeriana officinalis ), chamomile ( Matricaria recutita ), or lemon balm ( Melissa officinalis ), as these herbs intensify the tendency of opioids to cause drowsiness and slow down breathing. Ginseng ( Panax ginseng ) should also be avoided because it interferes with the pain-relieving qualities of opioid medications.

Prevention

Scientists have attempted to develop ways to use the pain-killing properties of narcotics while counteracting their addictive qualities. Substances known as narcotic or opioid antagonists are drugs that block the actions of narcotics and are used to reverse the side effects of narcotic abuse or an overdose. A class of drugs, a mixture of opioids and opioid antagonists, has been developed so that patients can be relieved of pain without the addictive or other unpleasant side effects associated with narcotics.

Parental concerns

One minor concern that parents may have if the doctor prescribes narcotic medications for their child is that such side effects as constipation or sleepiness are more common and more severe in children younger than 18 years of age.

Far more seriously, narcotic drugs are among those substances used illegally or abused by adolescents. Some researchers estimate that as many as 90 percent of adult drug addicts began a pattern of substance abuse during adolescence . Teenagers are particularly likely to begin experimenting with narcotics in the form of prescription cough syrup and such pain relievers as Darvon or Oxy-Contin and to combine narcotics with alcohol or other drugs of abuse. Moreover, although opioid medications account for fewer cases of drug abuse than cocaine, alcohol, or several other drugs, they still account for 4 to 5 percent of emergency room visits. In addition, the death rate of opioid abusers is proportionately significantly higher than the mortality of people who abuse PCP or cocaine.

The American Academy of Child and Adolescent Psychiatry (AACAP) lists opiates as common drugs of abuse among teenagers and notes that children as young as 12 may be using narcotics. In many cases, children can obtain these drugs at home in the form of medications prescribed for other family members. Children who are abusing opioid medications may show the following signs:

euphoria or "feeling no pain"
constipation
slurred speech
shallow breathing
itching or flushing of the skin
mental confusion and poor judgment
bloodshot eyes with small pupils
nausea and vomiting
unusual drowsiness

Parents who suspect that their children are abusing opioids, either alone or in combination with other drugs, should get help as soon as possible.

KEY TERMS

Analgesics —A class of pain-relieving medicines, including aspirin and Tylenol.

Antitussive —A drug used to suppress coughing.

Euphoria —A feeling or state of well-being or elation.

Morphine —The principal alkaloid derived from the opium poppy for use as a pain reliever and sedative. In its purified form, it is a white, bitter-tasting crystalline powder.

Narcotic —A drug derived from opium or compounds similar to opium. Such drugs are potent pain relievers and can affect mood and behavior. Long-term use of narcotics can lead to dependence and tolerance. Also known as a narcotic analgesic.

Opium latex —The milky juice or sap of the opium poppy, used to produce morphine.

Palliative —Referring to a drug or a form of care that relieves pain without providing a cure. Persons in severe pain from terminal cancer are often prescribed narcotics as palliative care.

Stupor —A trance-like state that causes a person to appear numb to their environment.

Resources

BOOKS

"Opioid Dependence." Section 15, Chapter 195 in The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, and Robert Berkow. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Pelletier, Kenneth R. The Best Alternative Medicine , Part II, "CAM Therapies for Specific Conditions: Pain." New York: Simon & Schuster, 2002.

PERIODICALS

Abebe, W. "Herbal Medication: Potential for Adverse Interactions with Analgesic Drugs." Journal of Clinical Pharmacy and Therapeutics 27 (December 2002): 391–401.

Cone, E. J., et al. "Oxycodone Involvement in Drug Abuse Deaths. II: Evidence for Toxic Multiple Drug-Drug Interactions." Journal of Analytical Toxicology 28 (May-June 2004): 217–25.

Elwood, W. N. "Sticky Business: Patterns of Procurement and Misuse of Prescription Cough Syrup in Houston." Journal of Psychoactive Drugs 33 (April-June 2001): 121–33.

Nevin, J. "Drug Update: Fentanyl Patch Abuse." Emergency Medical Services 33 (July 2004): 24–5.

Stern, J., and C. Ippoliti. "Management of Acute Cancer Treatment-Induced Diarrhea." Seminars in Oncology Nursing 19 (November 2003): 11–6.

Viscusi, E. R. "Emerging Techniques for Postoperative Analgesia in Orthopedic Surgery." American Journal of Orthopedics 33 (May 2004): 13–16.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016–3007. Web site: http://www.aacap.org..

National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892–9561. Web site: http://www.drugabuse.gov.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857–0001. Web site: http://www.fda.gov.

WEB SITES

Rehman, Ziaur, Suzan Khoromi, and James E. Douglas. "Opioid Abuse." eMedicine , August 15, 2004. Available online at http://www.emedicine.com/med/topic1673.htm (accessed November 30, 2004).

Stephens, Everett. "Toxicity, Narcotics." eMedicine , September 20, 2004. Available online at http://www.emedicine.com/emerg/topic330.htm (accessed November 30, 2004).

OTHER

American Academy of Child and Adolescent Psychiatry (AACAP). Teens: Alcohol and Other Drugs . AACAP Facts for Families #3. Washington, DC: AACAP, 2004.

National Institute on Drug Abuse (NIDA). NIDA InfoFacts: Prescription Pain and Other Medications . Bethesda, MD: NIAMS, 2004.

Rebecca Frey, PhD