Chapter 9 Narcotics (Opioids)

What are Narcotics? Narcotics are illegal drugs that dulls the senses, relieves pain, and induces sleep. Stems from the Greek word (narkoticos), for benumbing or deadening.

History of Narcotics The term narcotics is used to refer to those naturally occurring substances derived from the opium poppy and their synthetic substitutes. These drugs are referred as opioid or opiate because of their association with opium. Pharmacological features include: Abuse potential Pain Relieving Effects: referring as analgesics, drugs that relieve pain without affecting consciousness Cough Suppressants Reduction of Intestinal Movement: often causing constipation but, useful in reducing severe diarrhea Jones and Bartlett Learning, LLC, 2012

History of Narcotics Continued The opium poppy use was used by many countries, these would include: Egyptians: a 6000-year-old Sumerian tablet had an ideograph for the poppy, labeled as a “joy plant”, these properties suggested to be an addictive substance. Greek God of sleep, Hypnos and Roman God of sleep, Somnus, were portrayed for carrying containers of opium pods and Minoan goddess of sleep wore a crown of opium pods. China: opium poppy were used for mainly medical purposes but later causing addiction (Karch, 1996). In 1690, however opium was being smoked and used for diversion and in 1729 the Chinese government outlawed the sale of opium. Penalty for disobedience was death by strangulation or decapitation. Jones and Bartlett learning, LLC, 2012

History of Narcotics Continued Other countries that were affected by opium use include: India: where most of the opium poppy was grown British Government encouraged cultivation of opium, they were the main principal shippers Over the next 120 years, opium smuggling routes developed in China with the help of local merchants, who received substantial profits, and local officials, who pocketed bribes to ignore the smugglers. In 1856, a second Opium war broke out occupying British and French troops, which compelled China in making any future concessions to Britain. America: By 1900, estimated 1 million Americans were dependent on opiates (Abel, 1980). Jones and Bartlett Learning, LLC, 2012

Examples of Narcotics Narcotic Drugs Common Names Most Common Uses Heroin Horse, Smack, Junk (Street Names) Abuse Morphine Several Analgesia Methadone Dolophine Treat Narcotic Dependence Meperidine Demerol Oxycodone Percodone, Oxycontin Propaxyphene Darvon Codeine Analgesia, Antitussive Loperamide Imodium A-D Anidiarrheal Diphenoxylate Lomotil Antidiarrheal Opium Tincture Paregoric Buprenorphine Suboxone

Pharmacological Effects of Narcotics The definition of Analgesics is drugs that relieve pain without affecting consciousness, in other words, drugs prescribed for pain relief. These drugs are effective against most varieties of pain, such as; Visceral: associated with internal organs of the body Somatic: associated skeletal muscles, bones, skin, and teeth (Gutstein and Akil, 2006) The definition of Antitussive is drugs that block the coughing reflex and or reduce diarrhea. Jones and Bartlett Learning, LLC, 2012

Pharmacological Effects of Narcotics Continued The opioid narcotics relieve pain by activating the same group of receptors that are controlled by the endogenous substances called endorphins. Endorphins are a family of peptides or small proteins that are released in the brain, spinal cord and from the adrenal glands in response to stress and painful experiences. Endorphins serve as transmitters to stimulate receptors designated as opioid types. Activation of opioid receptors by either the naturally released endorphins or administration of the narcotic analgesic drugs blocks the transmission of pain through the spinal cord or brain stem and alters the perception of pain in the pain center of the brain. Narcotics work at many levels of pain transmission and are potent analgesics against almost all types of pain. Jones and Bartlett Learning, LLC, 2012

Pharmacological Effects of Narcotics Continued Opioid narcotics are also use to treat other conditions that are not related to pain. Opioid narcotics are very effective, therapeutic tools if carefully monitored by a professional, but some guidelines must be followed to prevent unnecessary problems, for example (Rolfs, 2008) Opioid pain relievers should only be used for pain when severity warrants and after consideration of other nonopioid pain medications such as aspirin or ibuprofen. Doses and duration of use should be limited as much as possible while permitting adequate therapeutic care. The patient should be counseled to store the medications securely, not to share with others, and proper disposal when the pain has subsided and the medication is no longer needed. Jones and Bartlett Learning, LLC, 2012

Pharmacological Effects of Narcotics Continued Long-duration opioid drugs should not be used to treat acute pain, except in situations where adequate monitoring can be conducted. The use of opioids should be reevaluated if pain persists beyond the anticipated time period for acute pain management. A comprehensive evaluation should be conducted before initiating opioid treatment. The provider should consider conducting a screen for risk of abuse or addiction before initiating opioid treatment. A treatment plan should be established between the doctor and patient that includes measureable goals for reduction of pain and improvement of function. Jones and Bartlett Learning, LLC, 2012

Pharmacological Effects of Narcotics Continued The patient, and if appropriate, family members, should be informed of the risks and benefits of the opioid treatment. Sometimes a written contract identifying these elements should be prepared and signed. Opioid treatment should be discontinued if the terms of the contract are not being met by the patient. If significant abuse is suspected, the clinician should discuss the concerns with the patient and help the patient find appropriate treatment. Jones and Bartlett Learning, LLC, 2012

Side Effects of Narcotics Signs and symptoms of narcotics: Jones and Bartlett Learning, LLC, 2012 Possible Signs of Use Possible Signs of overdose Euphoria Low and shallow breathing Drowsiness Clammy skin Respiratory depression Convulsions Constricted pupils Coma Nausea Possible death

Abuse, Tolerance, Dependence and Withdrawal All opioid narcotic agents that activate opioid receptors have abuse potential and are classified as scheduled drugs because of the abuse patterns and their abilities to cause tolerance, dependence, withdrawal effects, and addiction. Tolerance literally begins with the first dose, but does not become clinically evident until 2 to 3 weeks of frequent use. Tolerance occurs more rapidly with higher doses in short intervals. Physical dependence invariably accompanies severe tolerance (Reisine and Pasternak, 1995). Psychological dependence can also develop with continual use of narcotics and lead to compulsive use (Gutstein and Akil, 2006; O’Brien, 2006). Jones and Bartlett Learning, LLC, 2012

Abuse, Tolerance, Dependence, and Withdrawal Continued Narcotics have similar actions; however there is a difference in their potencies, severity of side effects, likelihood of being abused, and clinical usefulness. (Jones and Bartlett Learning, LLC, 2012) Development of psychological and physical dependence makes stopping the drug uncomfortable due to unpleasant withdrawals. Severe withdrawal effects include: Exaggerated pain responses Agitation Anxiety Stomach cramps and vomiting Joint and muscle aches Runny nose An overall flu-like feeling (McEvoy, 2003)

Natural Narcotic Substances Many herbal preparations can cause drowsiness and have analgesic properties but a few contain only opioid narcotic drugs, such as; morphine, codeine, heroin, papaverine and thebaine, only found in the opium poppy (Papaver somniferum). This plant is typically a winter crop, located in the Southern Hemisphere, but do best in climates that have warm days and cool nights. Most of the drugs are found in the seepage from the seed heads, located beneath the flower petals of the poppy flowers. Although this is the main part, the stem and leaves show life of opium. This species of plant can survive in the United States if the environment is rigidly controlled, the vast majority of the supplies of the naturally occurring narcotic drugs brought into the country, either legally and sold as legitimate pharmaceuticals or smuggled across borders and sold as illicit narcotics. Jones and Bartlett Learning, LLC, 2012

References 1)PowerPoint presentation to Chapter 9, "Narcotics," in the textbook. 2) PowerPoint presentation on Narcotic Analgesics Part 2 3) HBO Video, "Opiate Addiction: A New Medication 4) HBO Fact Sheet on Replacement Therapy in Opiate Addiction 5) View the documentary on, Oxycotin 6) Chapter 9 in textbook 7) podcast from NPR on Oxycotin addiction. 8) podcast from NPR on "Black-Tar Heroin Lures New Users"