Narcotic

The term narcotic (ναρκωτικός) strictly refers to any psychoactive compound with
morphine-like effects.

It is believed to have been coined by the Greek physician Galen to refer to agents
that numb or deaden, causing loss of feeling or paralysis. It is based on the Greek
word ναρκωσις (narcosis), the term used by Hippocrates for the process of numbing
or the numbed state. Galen listed mandrake root, altercus (eclata)seeds, and poppy
juice (opium) as the chief examples.

A looser usage of the word "narcotic" to refer to any illegal or unlawfully possessed
drug including marijuana and cocaine is common worldwide, although these
substances are not considered narcotics in a medical context. The central drug
policy making body within the United Nations, for instance, is the Commission on
Narcotic Drugs, although the United Nations officially defines a narcotic drug to be
"any of the substances, natural or synthetic, in Schedules I and II of the Single
Convention on Narcotic Drugs, 1961, and that Convention as amended by the 1972
Protocol Amending the Single Convention on Narcotic Drugs, 1961" Used in this
manner the word "narcotic" is a useful if not wholly accurate label to denote any
drug that is subject to the U.S. Controlled Substances Act, or similar legislation
elsewhere.

In a U.S. legal context, the term "narcotic" specifically refers to opium, opium
derivatives, and their semi-synthetic or fully synthetic substitutes, as well as
cocaine and coca leaves.

Because the term is often used so broadly or pejoratively outside of medical

contexts, most medical professionals advocate the use of more precise terms such
as "opioids" and "opioid analgesics" to refer to the natural, semi-synthetic, and
synthetic substances that behave pharmacologically like morphine and are used
primarily for their pain-relieving qualities.

Hazards
Among the hazards of careless or excessive drug use are the increasing risks of
infection, disease and overdose. Medical complications are common among
recreational narcotic users and arise primarily from the non-sterile practices of
injecting. Skin, lung and brain abscesses, endocarditis, hepatitis and HIV/AIDS are
commonly found among persons with narcotic dependencies who share syringes or
inhale the drug. There has been much discussion about the dangers related to the
adulterants/dilutants found in street drugs, such as heroin, where rumors abound
about what is used to "cut" street drugs, e.g., ground glass, talcum powder, rat
poison, domestic cleaning powders, and other cutting agents. Recent evidence
shows that this kind of "dangerous adulteration" is largely mythical and that far less
cutting of drugs than is normally assumed actually takes place[citation needed].
However, since there is no simple way to determine the purity of a drug that is sold
on the street, the effects of using street narcotics are unpredictable. It remains the
case that the greatest risk presented by most illicit drugs relates to the drugs
themselves and how they are used, e.x., in conjunction with other drugs (alcohol is
a particularly risky drug to use whilst also using other street drugs), in excess (most
occasional, responsible and low-dose drug use does not result in harm), and how a
drug is administered[citation needed]. HIV and hepatitis infection rates drop among
opioid injectors who do not share injectors. Some agencies have attempted to
provide clean syringes in order to lessen injector sharing. b

Effects
Drug effects depends heavily on the dose, route of administration and previous
exposure to the drug. Aside from their clinical use in the treatment of pain, cough
and acute diarrhoea, narcotics elicit a general sense of well-being, anxiolysis, and
sometimes euphoria (it should be noted that any one of these may or may not be
experienced by a particular person: individual responses vary widely). These effects
are generally helpful in a therapeutic setting and contribute to the popularity of
narcotics as recreational drugs. They may also contribute to psychological
dependency, while long-term use leads to physical dependence because of various
adaptations of brain physiology to the continuous presence of the drug.

Narcotic use may also cause a variety of side effects, as detailed in the opioids
article.

Tolerance and dependence

With repeated use of narcotics, tolerance and dependence may develop. The
development of tolerance is characterized by a shortened duration and a decreased
intensity of all drug effects (positive as well as undesired), with the exception of
constipation (which never subsides). Tolerance creates the need to administer
progressively larger doses to attain the desired effect. Although the lethal dose is
increased significantly in tolerant users, overdosing is always possible, because
there always will be a dose high enough to cause death by respiratory depression.

Tolerance and dependence, both part of the conventional idea of addiction, are
insufficient to explain in totality what addiction is[citation needed]. Addiction is a
broader behavioural phenomenon that also encapsulates non-substance based
activity (such as excessive and compulsive gambling, excessive and compulsive
eating, and a range of other excessive and compulsive behaviors) that have many
of the same characteristics displayed by substance addiction.

Physical dependence refers to an alteration of normal bodily functions that

necessitates the continued presence of a drug in order to prevent withdrawal or
abstinence syndrome. The intensity and character of the physical symptoms
experienced during withdrawal are directly related to the particular drug in use, the
total daily dose, the interval between doses, the duration of use and the health and
personality of the user. In general, narcotics with shorter durations of action tend to
produce shorter, more intense withdrawal symptoms, while drugs that produce
longer narcotic effects have prolonged symptoms that tend to be less severe. This is
usually true of any addictive psychoactive drug, not just narcotics.

The withdrawal symptoms experienced from opioid addiction are usually first felt
shortly before the time of the next scheduled dose. Early symptoms include watery
eyes, runny nose, yawning and sweating. Restlessness, irritability, loss of appetite,
tremors and severe sneezing appear as the syndrome progresses. Severe
depression and vomiting are not uncommon. 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 and kicking movements, which may be the
source of the expression "kicking the habit." At any point during this process, a
suitable dose of any opioid 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 5 to 15 days, depending
on the opioid used. Opioid withdrawal is never life-threatening, even if it's
extremely unpleasant.

The psychological dependence that is 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. 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 dependence seen in the United States. One
involves individuals whose drug use was initiated within the context of medical
treatment who escalate their dose through "doctor shopping" or branch out to illicit
drugs.

The other common pattern of non-medical use is initiated outside the therapeutic
setting with experimental or recreational use of narcotics. The majority of
individuals in this category may use narcotics sporadically for months or even
years. These occasional users are called "chippers." Although they are neither
tolerant of nor dependent on narcotics, the social, medical and legal consequences
of their behavior can be very serious. Some experimental users will escalate their
narcotic use and will eventually become dependent, both physically and
psychologically.

Morphine (INN) (pronounced /ˈmɔrfiːn/) (MS Contin, MSIR, Avinza, Kadian,

Oramorph, Roxanol) is an extremely potent opiate analgesic psychoactive drug, is
the principal active ingredient in Papaver somniferum (opium poppy, or simply
opium), is considered to be the prototypical opioid. In clinical medicine, morphine is
regarded as the gold standard, or benchmark, of analgesics used to relieve severe
or agonizing pain and suffering. Like other opioids, e.g. oxycodone (OxyContin,
Percocet, Percodan), hydromorphone (Dilaudid, Palladone), and diacetylmorphine
(heroin), morphine acts directly on the central nervous system (CNS) to relieve pain.
Morphine has a high potential for addiction; tolerance and both physical and
psychological dependence develop rapidly.
Morphine can be used as an analgesic to relieve:
o pain in myocardial infarction
o pain in sickle cell crisis
o pain associated with surgical conditions, pre- and postoperatively
o pain associated with trauma
o severe chronic pain, e.g., cancer[14]
o pain from kidney stones (renal colic, ureterolithiasis)
o severe back pain

Morphine can also be used:

o as an adjunct to general anesthesia
o in epidural anesthesia or intrathecal analgesia
o for palliative care (i.e., to alleviate pain without curing the underlying
reason for it, usually because the latter is found impossible)
o as an antitussive for severe cough
o in nebulized form, for treatment of dyspnea, although the evidence for
efficacy is slim.[15] Evidence is better for other routes.[16]
o as an antidiarrheal in chronic conditions (e.g., for diarrhea associated with
AIDS, although loperamide (a non-absorbed opioid acting only on the gut) is the
most commonly used opioid for diarrhea).

Morphine has long been known to act on receptors expressed on cells of the central
nervous system resulting in pain relief and analgesia. In the 1970s and '80s,
evidence suggesting that opiate drug addicts show increased risk of infection (such
as increased pneumonia, tuberculosis, and HIV) led scientists to believe that
morphine may also affect the immune system. This possibility increased interest in
the effect of chronic morphine use on the immune system.

The first step of determining that morphine may affect the immune system was to
establish that the opiate receptors known to be expressed on cells of the central
nervous system are also expressed on cells of the immune system. One study
successfully showed that dendritic cells, part of the innate immune system, display
opiate receptors. Dendritic cells are responsible for producing cytokines, which are
the tools for communication in the immune system. This same study showed that
dendritic cells chronically treated with morphine during their differentiation produce
more interleukin-12 (IL-12), a cytokine responsible for promoting the proliferation,
growth, and differentiation of T-cells (another cell of the adaptive immune system)
and less interleukin-10 (IL-10), a cytokine responsible for promoting a B-cell
immune response (B cells produce antibodies to fight off infection).[37]

This regulation of cytokines appear to occur via the p38 MAPKs (mitogen activated
protein kinase) dependent pathway. Usually, the p38 within the dendritic cell
expresses TLR 4 (toll-like receptor 4), which is activated through the ligand LPS
(lipopolysaccharide). This causes the p38 MAPK to be phosphorylated. This
phosphorylation activates the p38 MAPK to begin producing IL-10 and IL-12. When
the dendritic cell is chronically exposed to morphine during their differentiation
process then treated with LPS, the production of cytokines is different. Once treated
with morphine, the p38 MAPK does not produce IL-10, instead favoring production of
IL-12. The exact mechanism through which the production of one cytokine is
increased in favor over another is not known. Most likely, the morphine causes
increased phosphorylation of the p38 MAPK. Transcriptional level interactions
between IL-10 and IL-12 may further increase the production of IL-12 once IL-10 is
not being produced. Future research may target the exact mechanism that
increases the production of IL-12 in morphine treated dendritic cells. This increased
production of IL-12 causes increased T-cell immune response. This response is due
to the ability of IL-12 to cause T helper cells to differentiate into the Th1 cell,
causing a T cell immune response.[citation needed]

Further studies on the effects of morphine on the immune system have shown that
morphine influences the production of neutrophils and other cytokines. Since
cytokines are produced as part of the immediate immunological response
(inflammation), it has been suggested that they may also influence pain. In this
way, cytokines may be a logical target for analgesic development. Recently, one
study has used an animal model (hind-paw incision) to observe the effects of
morphine administration on the acute immunological response. Following hind-paw
incision, pain thresholds and cytokine production were measured. Normally,
cytokine production in and around the wounded area increases in order to fight
infection and control healing (and, possibly, to control pain), but pre-incisional
morphine administration (0.1-10.0 mg/kg) reduced the number of cytokines found
around the wound in a dose-dependent manner. The authors suggest that morphine
administration in the acute post-injury period may reduce resistance to infection
and may impair the healing of the wound.[38]

SIDE EFFECTS
• Constipation
• Addiction
• Tolerance
• Withdrawal
• Hepatitis C
• Overdose

Opium was commonly used as an analgesic until the development of

morphine. Morphine continues to be prescribed for relief of severe pain, but fears of
its addictive potential have limited its use. Laudanum was used in the 1800s to
promote sleep and alleviate pain; codeine suppresses coughing; paregoric stops
diarrhea.

Opium and its various constituents exert effects upon the body ranging from
analgesia, or insensitivity to pain, to narcosis, or depressed physiological activity
leading to stupor. Opium users describe experiencing a feeling of calm and well-
being. Opium addicts in otherwise good physical and mental health whose drug
needs are met are thought to experience no debilitating physiological effects from
their addiction, although there is some evidence that immune function is
compromised. However, their preoccupation with the drug and its acquisition can
lead to malnutrition and general poor self-care and an increased risk of disease.
Heroin, or diacetylmorphine (INN), also known as diamorphine (BAN), is a
semi-synthetic opioid drug synthesized from morphine, a derivative of the opium
poppy. It is the 3,6-diacetyl ester of morphine (di (two)-acetyl-morphine). The white
crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride,
though often adulterated thus dulling the sheen and consistency from that to a
matte white powder, which heroin freebase typically is.[2]

As with other opioids, heroin is used as both a pain-killer and a recreational drug
and has an extremely high potential for abuse. Frequent and regular administration
is associated with tolerance, moderate physical dependence, and severe
psychological dependence.

Internationally, heroin is controlled under Schedules I and IV of the Single

Convention on Narcotic Drugs.[3] It is illegal to manufacture, possess, or sell
diacetylmorphine without a licence in Belgium, Denmark, Germany, Iran, India, the
Netherlands, the United States, Australia, Canada, Ireland, Pakistan, the United
Kingdom and Swaziland.

Under the name diamorphine, it is a legally prescribed controlled drug in the United
Kingdom. It is available for prescription to long-term users in the Netherlands, the
United Kingdom, Switzerland, Germany and Denmark alongside psycho-social care,
[4][5] and a similar program is being campaigned for by liberal political parties in
Norway.

Under the name diamorphine, heroin is prescribed as a strong analgesic in the

United Kingdom, where it is given via subcutaneous, intramuscular, intrathecal or
intravenous route. Its use includes treatment for acute pain, such as in severe
physical trauma, myocardial infarction, post-surgical pain, and chronic pain,
including end-stage cancer and other terminal illnesses. In other countries it is more
common to use morphine or other strong opioids in these situations.

Adverse effects
Common effects other than analgesia associated with the use of codeine include
euphoria, itching, nausea, vomiting, drowsiness, dry mouth, miosis, orthostatic
hypotension, urinary retention, depression and constipation.[11] Another side effect
commonly noticed is the lack of sexual drive and increased complications in erectile
dysfunction.[12] Some people may also have an allergic reaction to codeine, such
as the swelling of skin and rashes.[12]

Tolerance to many of the effects of codeine develops with prolonged use, including
therapeutic effects. The rate at which this occurs develops at different rates for
different effects, with tolerance to the constipation-inducing effects developing
particularly slowly for instance.

A potentially serious adverse drug reaction, as with other opioids, is respiratory

depression. This depression is dose-related and is the mechanism for the potentially
fatal consequences of overdose. As codeine is metabolized to morphine, morphine
can be passed through breast milk in potentially lethal amounts, fatally depressing
the respiration of a breastfed baby.[13]

Withdrawal effects
As with other opiate-based pain killers, chronic use of codeine can cause physical
dependence. When physical dependence has developed, withdrawal symptoms may
occur if a person suddenly stops the medication. Withdrawal symptoms include:
drug craving, runny nose, yawning, sweating, insomnia, weakness, stomach
cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability, and pain. To
minimize withdrawal symptoms, long-term users should gradually reduce their
codeine medication under the supervision of a healthcare professional.[14] A
support group called Codeine Free exists to help people who have found themselves
dependent on codeine.