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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. |
