Drug Abuse - Narcotics (opiates)
Narcotics are drugs that relieve pain and induce sleep by depressing the central nervous system. Under U.S. law, narcotics are addictive drugs that produce rapid and severe physical and psychological dependence; that category includes opium and such opium derivatives as heroin, morphine, and codeine. The narcotics, or opioids , also include the so-called synthetic opiates, among them meperidine and methadone .
The seedpods of the opium poppy, Papaver somniferum , produce a gummy resin that has narcotic effects when eaten or smoked. Opium has been used in many lands and many cultures since prehistoric times. It was used medicinally in ancient Egypt. But not until recently did its addictive properties become known.
Of the more than two dozen active compounds, or alkaloids , that can be isolated from opium, the two most important are morphine and codeine.
Morphine, named after Morpheus, the Roman god of dreams, is the chemical substance in opium that gives it sedative and analgesic properties. Isolated initially in the early 1800s, morphine was later synthesized in pure form. On the illicit drug market it appears usually as a white powder.
Morphine can relieve almost any kind of pain, particularly dull, continuous pain. It may also relieve the fear and anxiety that go with such suffering. In addition to drowsiness, euphoria, and impairment of mental and physical performance, morphine may have adverse effects including nausea, vomiting, and sweating. Intravenous injections of the drug may produce an orgasmic high sensation beginning in the upper abdomen and spreading throughout the body. Taken in overdose, morphine can lead to respiratory depression that is sometimes severe enough to cause coma and death. Morphine is highly addictive and is used only short-term in hospitals because longer exposure easily leads to problems. Naloxone (Narcan) may be administered intravenously as an antidote for morphine overdose.
Taking its name from the Greek word kodeia , meaning poppyhead, codeine is a mild pain-reliever that can be produced from gum opium or through conversion from morphine. The effects of codeine peak in 30 to 60 minutes; they disappear in three to four hours. Codeine is milder than either morphine or heroin in analgesic effect, and is an ingredient in some popular nonprescription cough syrups. All forms can induce addiction problems with regular use.
Originally thought to be nonaddictive, heroin was for a time used as a cure for opium and morphine addiction. It was then found to be more addictive than either of those drugs. It was prohibited in the United States in 1924 and became a staple on the drug black market. Heroin is several times as powerful as morphine.
All of the opiates, including heroin, produce feelings of well-being or euphoria. They also lead to dulled senses and to reduction or elimination of normal fears, tensions, and anxiety. The drug also produces sleepiness and lethargy; nodding is one of the characteristic symptoms of abuse. Possible side effects include nausea, flushing, constipation, slowed respiration rates, retention of urine, and, eventually, malnutrition resulting from loss of appetite. When first injecting heroin, nausea and vomiting can occur almost immediately.
The heroin abuser rapidly develops tolerance to the drug. Continually larger doses are then required to produce the same degree of euphoria. Used chronically, heroin leads to both psychological and physical dependence. The former is far more important, and is more difficult to break.
Caught in a cycle involving desperate efforts to obtain enough money, often by criminal means, and getting high, the heroin abuser is not necessarily driven by the search for escape. He or she may want, equally, to avoid withdrawal symptoms. For the chronic abuser these symptoms can be difficult and painful, and may include anxiety, sweating, muscle aches, vomiting, and diarrhea.
Heroin sold on the streets is cut with quinine, milk sugar, or baking soda. It may be cut several times before reaching the abuser. A bag may contain only 1 to 5 percent heroin. If the addict unknowingly buys a dose containing 30 percent or more pure heroin, the higher concentration can spell grave illness or death.
Because heroin can be taken in different ways, the drug's narcotic effects are variable. Sniffing is the mildest form of abuse, followed by skin-popping or subcutaneous injection anywhere on the body, and mainlining, injection directly into a vein, usually the large vein inside the elbow. Abscesses at the preferred site of injection are common, and the vein may become inflamed.
Heroin use does not necessarily lead to dependence. Many persons have experimented with the drug without becoming addicted. Others “joy-pop”—use the drug on weekends, usually for recreational purposes or “kicks.”
Little agreement exists regarding treatments for heroin abuse. A promising yet controversial method is the substitution of controlled doses of methadone for heroin. Methadone is a synthetic opiate that does not produce the euphoria of heroin. The substitution can help the abuser to lead a normal life, but he or she may still be addicted—to methadone.
Other forms of treatment utilize group psychotherapy, often in live-in communities modeled after the West Coast's Synanon . Some experts believe that only multiple-approach treatment formats, combining chemical treatment, psychiatry, user communities, and rehabilitation, can be effective. But the five-year cure rate for heroin abusers is low—only about one-third of that for alcoholics.
Prescription pain-relievers such as Demerol, Dilaudid, Pantopon, and other synthetic opiates can become addicting if used indiscriminately. They occasionally appear on the illicit drug market. With the increased availability of methadone in treatment clinics, methadone itself is used illicitly, often in combination with alcohol or other drugs, and especially when heroin is in short supply.