Narcotics
The term "narcotic," derived from the Greek word for stupor,
originally referred to a variety of substances that dulled the
senses and relieved pain. Today, the term is used in a number of
ways. Some individuals define narcotics as those substances that
bind at opiate receptors (cellular membrane proteins activated
by substances like heroin or morphine) while others refer to any
illicit substance as a narcotic. In a legal context, narcotic
refers to opium, opium derivitives, and their semi-synthetic
substitutes. Cocaine and coca leaves, which are also classified
as "narcotics" in the Controlled Substances Act (CSA), neither
bind opiate receptors nor produce morphine-like effects, and are
discussed in the section on stimulants. For the purposes of this
discussion, the term narcotic refers to drugs that produce
morphine-like effects.
Narcotics are used therapeutically to treat pain, suppress
cough, alleviate diarrhea, and induce anesthesia. Narcotics are
administered in a variety of ways. Some are taken orally,
transdermally (skin patches), or injected. They are also
available in suppositories. As drugs of abuse, they are often
smoked, sniffed, or injected. Drug effects depend heavily on the
dose, route of administration, and previous exposure to the
drug. Aside from their medical use, narcotics produce a general
sense of well-being by reducing tension, anxiety, and
aggression. These effects are helpful in a therapeutic setting
but con tribute to their abuse.
Narcotic use is associated with a variety of unwanted effects
including drowsiness, inability to concentrate, apathy, lessened
physical activity, constriction of the pupils, dilation of the
subcutaneous blood vessels causing flushing of the face and
neck, constipation, nausea and vomiting, and most significantly,
respiratory depression. As the dose is increased, the
subjective, analgesic (pain relief), and toxic effect become
more pronounced. Except in cases of acute intoxication, there is
no loss of motor coordination or slurred speech as occurs with
many depressants.
Among the hazards of illicit drug use is the ever-increasing
risk of infection, disease, and overdose. While pharmaceutical
products have a known concentration and purity, clandestinely
produced street drugs have unknown compositions. Medical
complications common among narcotic abusers arise primarily from
adulterants found in street drugs and in the non-sterile
practices of injecting. Skin, lung, and brain abscesses,
endocarditis (inflammation (the fining of the heart), hepatitis,
and AIDS are commonly found among narcotic abusers. Since there
is no simple way to determine the purity of a drug that is sold
on the street, the effects of illicit narcotic use are
unpredictable and can be fatal. Physical signs of narcotic
overdose include constricted (pinpoint) pupils, cold clammy
skin, confusion, convulsions, severe drowsiness, and respiratory
depression (slow or troubled breathing).
With repeated use of narcotics, tolerance and dependence
develop. The development of tolerance is characterized by a
shortened duration and a decreased intensity of analgesia,
euphoria, and sedation, which creates the need to consume
progressively larger doses to attain the desired effect.
Tolerance does not develop uniformly for all actions of these
drugs, giving rise to a number of toxic effects. Although
tolerant users can consume doses far in excess of the dose they
took, physical dependence refers to an alteration of normal body
functions that necessitates the continued presence of a drug in
order to prevent a withdrawal or abstinence syndrome. The
intensity and character of the physical symptoms experienced
during withdrawal are directly related to the particular drug of
abuse, the total daily dose, the interval between doses, the
duration of use, and the health and personality of the user. In
general, shorter acting narcotics tend to produce shorter; more
intense withdrawal symptoms, while longer acting narcotics
produce a withdrawal syndrome that is protracted but tends to be
less severe. Although unpleasant, withdrawal from narcotics is
rarely life threatening.
The withdrawal symptoms associated with heroin/morphine
addiction are usually experienced shortly before the time of the
next scheduled dose. Early symptoms include watery eyes, runny
nose, yawning, and sweating. Restlessness, irritability, loss of
appetite, nausea, tremors, and drug craving appear as the
syndrome progresses. Severe depression and vomiting are common.
The heart rate and blood pressure are elevated. Chills
alternating with flushing and excessive sweating are also
characteristic symptoms. Pains in the bones and muscles of the
back and extremities occur, as do muscle spasms. At any point
during this process, a suitable narcotic can be administered
that will dramatically reverse the withdrawal symptoms. Without
intervention, the syndrome will run its course, and most of the
overt physical symptoms will disappear within 7 to 10 days.
The psychological dependence associated with narcotic addiction
is complex and protracted. Long after the physical need for the
drug has passed, the addict may continue to think and talk about
the use of drugs and feel strange or overwhelmed coping with
daily activities without being under the influence of drugs.
There is a high probability that relapse will occur after
narcotic withdrawal when neither the physical environment nor
the behavioral motivators that contributed to the abuse have
been altered.
There are two major patterns of narcotic abuse or dependence
seen in the United States. One involves individuals whose drug
use was initiated within the context of medical treatment who
escalate their dose by obtaining the drug through fraudulent
prescriptions and "doctor shopping" or branching out to illicit
drugs. The other; more common, pattern of abuse is initiated
outside the therapeutic setting with experimental or
recreational use of narcotics. The majority of individuals in
this category may abuse narcotics sporadically for months or
even years. Although they may not become addicts, the social,
medical, and legal consequences of their behavior is very
serious. Some experimental users will escalate their narcotic
use and will eventually become dependent, both physically and
psychologically. The younger an individual is when drug use is
initiated, the more likely the drug use will progress to
dependence and addiction.
Narcotics of Natural Origin
The poppy Papaver somniferum is the source for non-synthetic
narcotics. It was grown in the Mediterranean region as early as
5000 B.C., and has since been cultivated in a number of
countries throughout the world. The milky fluid that seeps from
incisions in the unripe seedpod of this poppy has, since ancient
times, been scraped by hand and air-dried to produce what is
known as opium. A more modern method of harvesting is by the
industrial poppy straw process of extracting alkaloids from the
mature dried plant. The extract may be in liquid, solid, or
powder form, although most poppy straw concentrate available
commercially is a fine brownish powder. More than 500 tons of
opium or its equivalent in poppy straw concentrate are legally
imported into the United States annually for legitimate medical
use.
Synthetic Narcotics
In contrast to the pharmaceutical products derived from opium,
synthetic narcotics are produced entirely within the laboratory.
The continuing search for products that retain the analgesic
properties of morphine without the consequent dangers of
tolerance and dependence has yet to yield a product that is not
susceptible to abuse. A number of clandestinely produced drugs,
as well as drugs that have accepted medical uses, fall within
this category.
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