Albia Dugger • Miami Dade College

Chapter 8 Narcotics

History

• Opium-based drugs such as morphine and heroin are referred to as narcotics

• Throughout history, opium has figured prominently in wars between nations, the economies of some countries, in medicine, and in the work of lyricists and authors

• Laudanum, a mixture of opium and alcohol, was developed in the 1500s by Paracelsus

Opium Poppies in Afghanistan

History

• By 1906, opium and its derivatives were found in more than 50,000 medicines

• The hypodermic needle hastened the effects of morphine

• By the late 1800s, an estimated 4.59 per 1,000 people were dependent on opiates

• Ironically, the drug promoted to help people overcome morphine dependency was heroin

History

• The Harrison Act of 1914 made narcotic use without a prescription illegal

• The typical opiate addict shifted from a middle-class woman to a young, lower-class man

• Perceptions of the opiate addict went from unfortunate victim to a deviant criminal who was a threat to society

Perceptions of Narcotics

• Narcotics were advertised as a cure for addiction to tobacco

Illicit Opium Production

Extent of Narcotic Use

• During the 1930s, morphine abuse exceeded heroin abuse – by the 1940s, heroin addiction was greater

• Heroin use increased greatly beginning in the late 1960s and early 1970s.

• In 2010, about 200,000 Americans had used heroin in the previous month

• In the US, more than 800,000 people are addicted to heroin and other narcotics

Students Reporting Heroin Use

Extent of Narcotic Use

• Controlled users (chippers) fit the following pattern:• Seldom used the drug more than once a day• Could keep opiates around without using them• Avoided opiates when addicts were present• Did not use opiates to alleviate depression• Seldom binged on opiates• Knew the opiate source or dealer• Took opiates for recreation or relaxation• Did not take opiates to escape life’s daily hassles

Extent of Narcotic Use

• 68% of heroin addicts admitted into treatment are male, 59% are White, and ¾ have been in treatment previously

• Increase in abuse is significantly higher in rural areas than in metropolitan areas

• During the Vietnam War, 10-15% of US troops were addicted to heroin

Worldwide Comparison

• More than 15 million people worldwide illegally use opium, morphine, and heroin

• Afghanistan is the largest heroin producer worldwide

• China is believed to have the largest number of narcotic addicts

• An estimated 24 million to 34 million people throughout the world use opium

Characteristics of Narcotics

• Opium poppy• Plant from which narcotics are derived

• Narcotic • An opium-based central nervous system depressant used

to relieve pain and diarrhea

• Opiate • A class of drugs derived from opium

• Opioid• Drugs with characteristics similar to those of opium

Opium

• The opium poppy, Papaver somniferum, is cultivated throughout Asia and the Middle East

• When the seedpod is cut open, it exudes a white, milky sap which dries to a brown, thick, gummy resin (opium)

• There is only a ten-day window in which opium can be made from the resin of the opium poppy

Papaver somniferum

Morphine

• In 1803, Friedrich Serturner of Germany synthesized morphine from opium and called it morphium

• Morphine is about ten times more potent than opium, although physicians thought it was safer and purer

• Codeine was isolated from opium 30 years later

• How morphine is administered and its dosage has a bearing on its effectiveness

Heroin

• Heroin (diacetylmorphine) was first synthesized from morphine in 1874

• When heroin was introduced, it was believed not to be addicting

• When smoked, its effects are rapid – it is ineffective when ingested

• Heroin is three to ten times more powerful than morphine because it is more lipid-soluble

Synthetic Opiates

• Fentanyl (Sublimaze)• Synthetic narcotic 1,000 times more potent than heroin• Greater risk of a fatal overdose than heroin

• China white • Synthetic analgesic drug derived from fentanyl that mimics

heroin but is considerably more potent

• Meperidine • Synthetic derivative of morphine widely used as an

analgesic – less potent than morphine

Synthetic Opiates

• Propoxyphene hydrochloride (Darvon)• Mild narcotic that has the potential to cause dependence

• Methadone • Drug given to heroin addicts to block withdrawal effects

and euphoria

• Oxycodone (Percodan)

Common Narcotics

Synthetic narcotics come in many forms

OxyContin

• OxyContin is a particularly strong painkiller that blocks the pain signals from nerves

• Thousands have become addicted to it – the number of addicted babies has doubled or tripled over the past decade

• The manufacturer, Purdue Pharma, admits that dozens to hundreds of people have died from it

Physical and Psychological Effects

• Opiates mimic endorphins in the brain

• Physical problems frequently result from using narcotics in unclean, unsafe environments

• Narcotics often are contaminated with other drugs, sugar, starch, powdered milk, quinine, or strychnine

• Sharing needles is a major risk for HIV infection

Physical Effects

• Narcotics cause drowsiness, vomiting, nausea, and difficulty concentrating

• Euphoria is followed by gradually anesthetizing sensations, then sleep and lethargy

• Opiates impede the ability to urinate, and can cause potentially serious constipation

• Male addicts have difficulty achieving an erection

Emotional and Social Effects

• Narcotics relieve psychic distress arising from anxiety, hostility, feelings of inadequacy, and aggression

• Heroin addicts have difficulty regulating inhibitions and frequently make risky decisions

• Users sometimes ignore or become alienated and hostile toward friends and family members

• Heroin use has been associated with criminal behavior, unemployment, and violence

Needle-Exchange Programs

• The second most common HIV risk is injection drug use

• Many health care personnel favor needle-exchange programs (NEPs) or giving hypodermic needles to addicts at no cost

• One study reported a 5.9% decrease in HIV infection rates in cities with NEPs

• Congress banned federal funding for NEPs in 1988 and has since renewed the ban numerous times

NEPs retard the spread of HIV/AIDS

Dependency

• Physical dependence, psychological dependence, and tolerance develop quickly

• Withdrawal symptoms include:• Diarrhea and runny nose• Insomnia• Muscle aches and pains• Dysphoria• Fatigue• Anxiety and irritability• Stomach cramps

Dependency

• Factors affecting the difficulty of withdrawal:• Availability of a social support network• Addict’s desire to stop• Physical environment during withdrawal• Convenience and practicality of alternative opiates

• About half of narcotic abusers become dependent:• People can become drug-dependent in less than two

weeks if they take increasing amounts of narcotics• Average addiction is six to eight years

Toxicity

• Narcotics are capable of depressing the respiratory system to the point of death

• According to the CDC, painkillers kill twice as many people as cocaine and five times more people than heroin

• Synergistic effect of narcotics and other drugs can be fatal

• Death from an overdose of heroin is slow – people who die quickly are likely to die from anaphylactic shock

Medical Benefits

• Analgesics• Patients receiving morphine are aware of pain, but their

perception and response are altered in positive ways

• Gastrointestinal difficulties• In less-developed countries, narcotics treat diarrhea that is

a major cause of death among the young and elderly

• Cough suppressant (antitussive)• Narcotics slow activity of the cough control center• Nonopiate dextromethorphan is chemically similar

Treatment and Support Groups

• The recidivism (relapse) rate for narcotic addiction is high, but success improves the longer one is off drugs

• Most addicts are withdrawn from narcotics gradually, although rapid detoxification can be just as effective

• Addicts in withdrawal receive drugs such as clonidine, buprenorphine, naltrexone, naloxone, or methadone

• Typically, detoxification is completed in 10 to 14 days on an inpatient basis

Narcotic Antagonists

• Drugs that block narcotics from producing their reinforcing effects are called antagonists

• They remove the physical need for opiates, but not the psychic need

• Examples are naltrexone, buprenorphine, nalorphine, naloxone, and cyclazocine

Methadone

• Since 1960, methadone has been the drug used most frequently to treat heroin addiction

• Methadone is highly specific to opiate addiction

• Methadone use leads to addiction, though many people consider it preferable to heroin addiction

• Methadone has to be administered daily to avert withdrawal symptoms

Levo-alpha-acetylmethadol (LAAM)

• In 1993 the FDA approved an alternative to methadone called levo-alpha-acetylmethadol (LAAM)

• Can block the withdrawal symptoms for up to 3 days

• LAAM produces fewer withdrawal symptoms than methadone, and could help patients who do not benefit from methadone

• Individuals taking LAAM are more likely to stay in treatment

Narcotics Anonymous

• Modeled on Alcoholics Anonymous, Narcotics Anonymous (NA) is a self-help group designed to help people who are addicted to heroin and medically prescribed narcotics

• More than 58,000 group meetings in 2010

• NA addresses all drugs including alcohol