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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.
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