Narcotics abuse

• ALSO KNOWN AS: Opioid abuse

DEFINITION: Narcotics include a variety of natural and synthetic substances, including opium, morphine, heroin, oxycodone, fentanyl, Demerol, and methadone, which are used to reduce pain. Some are used medicinally to suppress cough, treat diarrhea, ease pain, and induce sleep or stupor. Narcotics bind to opioid receptors in the central nervous system. Narcotics can be abused at higher dosages to achieve intoxication, but even at prescribed levels, there is a risk of dependence, particularly in patients who require long-term use.

Causes

Narcotics produce their effect by binding to opioid receptors in the central nervous system. The human body contains opioid receptors to respond to naturally occurring opioids in the body known as endorphins. Endorphins serve to block or suppress the feeling of pain, having an analgesic and sedative effect. Narcotics lead to euphoria and sedation, produced by stimulation of the opioid receptors.

Risk Factors

The type of narcotic abuse can be a factor in addiction potential. Dependence on heroin can develop very quickly; second in potency is morphine. Other highly addictive drugs include alcohol, nicotine, and methamphetamines. Even prescribed medications may form addictions, and the longer drugs like oxycodone (OxyContin) and hydrocodone (Vicodin) are taken, the more likely a person is to become addicted. Other risk factors for narcotics abuse include psychological mindsets such as antisocial attitudes and sensation-seeking during adolescence. Many psychological conditions commonly coexist with narcotics abuse, like anxiety, depression, obsessive-compulsive disorder, or post-traumatic stress disorder. Environmental risk factors, including a lack of social support or positive family relationships, poverty, unemployment, gang membership, unstable housing, a family history of substance abuse, a history of physical or sexual abuse, and low self-esteem, can increase vulnerability.

Symptoms

Narcotic intoxication may include sensations such as euphoria, a rush of pleasure, relaxation, and drowsiness, followed by sedation or sleep. Users report feeling free from cares and worries, a lessening of anxiety and tension, and a sense of escapism from life. The feeling is so pleasurable that the user often develops an irresistible urge to use again, an urge that may eventually develop into an addiction.

Some of the negative effects of narcotics abuse are sleep disturbances, sexual dysfunctions, anxiety, drowsiness, inability to concentrate, apathy, lethargy, flushing of the face and neck, constipation, nausea, and vomiting. A person prescribed a narcotic may develop some withdrawal symptoms over time if use is suddenly interrupted. Generally, if narcotics are prescribed for a longer time for pain relief, the dosage is progressively lowered over several weeks to prevent withdrawal symptoms.

Withdrawal symptoms from narcotics are some of the worst exhibited for any abused substance. Early symptoms of withdrawal may appear within a few hours, but typically appear within six to thirty-six hours of the last dose. Symptoms of withdrawal are typically the reverse of the pleasurable effects produced by the narcotic and include anxiety, irritability, loss of appetite, tremors, salivation, yawning, flu-like symptoms, and sweating. More serious withdrawal symptoms include abdominal cramping, fever, gooseflesh, gastrointestinal upset, confusion, and convulsions. Less acute withdrawal symptoms, which may persist for months after the last dose, include anhedonia, insomnia, and drug craving. The severity of symptoms is proportionate to dosage and duration of abuse.

Screening and Diagnosis

Persons suspected of a narcotics overdose require immediate emergency medical attention. With an unconscious person suspected of a narcotics overdose, doctors will look for physical signs of overdose, such as shallow breathing and small pupils. Patients may then be administered naloxone (Narcan) or another opioid overdose reversal medication (OORMs), which are opioid antagonists that reverse an opioid overdose and reduce the possibility of coma (which can occur in as little as one minute). In the 2020s, Narcan became available over the counter.

To diagnose abuse, a doctor will question a person about their history of drug use, including use under dangerous conditions, and will ask about failures to meet obligations, legal problems, and impairments of social or occupational functioning caused by narcotics use. A psychological inventory, such as the Drug Abuse Screen Test (DAST-10) or the Opioid Risk Tool (ORT-OUD), may be used.

Treatment and Therapy

Treating people who are addicted to narcotics is difficult, mainly because of denial and the severity of withdrawal symptoms. Detoxification is the first step, and the most common long-term treatment is to substitute methadone (a synthetic narcotic with less addictive potential) for the abused drug, followed by gradual tapering off methadone. Buprenorphine is another medicine that can be used in the same manner for detoxification. The drug clonidine is also sometimes used to help alleviate some of the symptoms of withdrawal, particularly salivation, a runny nose, sweating, abdominal cramping, and muscle aches. Naltrexone (Vivitrol), an extended-release injection or oral medication that treats opioid and alcohol use disorders, is also used as part of many comprehensive treatment plans.

Also, recovery groups such as Narcotics Anonymous provide an important source of community support for persons who are overcoming narcotics addiction.

Prevention

To prevent possible addiction and dependence, it is important to use opioid medications only at the prescribed dosages or to avoid narcotics altogether. An individual recovering from addiction must deal with the intense, long-term psychological dependence on narcotics. Counseling, self-help groups, halfway houses (also called residential reentry centers and recovery residences), and group therapy may help recovering individuals maintain abstinence.

If a patient has opioid medication left after they no longer require it for pain relief, they should locate a public controlled substance disposal location or a Drug Enforcement Administration-maintained program to properly and safely dispose of the extra medication. Additionally, patient education concerning non-opioid pain management alternatives and prescription monitoring programs is an important preventive tool.

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