The Narcotic Drugs

1
The Narcotic Drugs

• considered by many to be the most powerful and
  the most dangerous of the drug categories

2
Why isnt everyone who uses an addict?

• The drugs are biochemically compatible and
  produce
• an intense high
• a significant rebound effect
• The body is often
• genetically predisposed
• sensitive to the drugs actions
• intolerant of pain

3
Why isnt everyone who uses an addict?

• The mind often
• lacks self control and self discipline
• experiences low self esteem and depression
• struggles with inconsistent values
• The environment often provides
• availability and access to the drugs
• few alternative activities and social guidelines
• little social and medical support
• triggering events

4
-- Class Responses --

• A start medical use (i.e., for pain relief)
  leads to better functioning and less social
  isolation addict use leads to poorer functioning
  and increasing social isolation.

5
General Characteristics

• natural, semisynthetic, synthetic, or endogenous
  by formulation
• uses pain relief (analgesia), fear / anxiety
  relief, withdrawal relief, constipation
• persistent use leads to opioid dependence
• side effects pupil constriction, mental
  distress, constipation, respiratory
  irregularities

6
Blocking the Effects of Prostaglandins
No Pain!!
7
The Natural Narcotics

• Opium the mother drug
• Morphine medical sedative and analgesic pre- or
  post-operative spinal block
• Codeine exempt status analgesic, cough
  suppressant, anti-diarrhea agent

useful drug when traveling outside of the United
States
8
The Semisynthetic Narcotics

• Hydromorphone (Dilaudid)
• Oxycodone (Percodan)
• Etorphine
• Heroin (90 of all narcotic abuse)
• black tar / China White
• skin popping, mainlining, snorting
• tolerance, then psychological physiological
  dependence
• continued use to regain high or avoid pain

9
The Synthetic Narcotics

• Meperidine (Demoral)
• Propoxphene (Darvon)
• Fetanyl (80 times more potent than morphine)

Designer drugs
Analogue drugs
Look-alike drugs
10
The Endogenous Opioids

• enkephalins and endorphins
• morphine within
• influences drug dependency
• enhances the withdrawal effects
• related to
• tolerance of severe pain
• placebo relief of pain
• effectiveness of acupuncture
• natural high of exercise

11
Palliative Treatment

• Chronic pain management
• sustained-release morphine
• co-analgesics
• Issues
• medical malpractice
• opiate medications
• physician assisted suicide right to die

12
Treatment for Narcotic Dependence

• Detoxification (controlled withdrawal)
• Therapeutic Communities
• Psychotherapy
• Narcotics Anonymous
• Acupuncture
• Maintenance Therapy

Note. Multimodal Approach
13
A Closer Look at Maintenance

• Methadone Maintenance
• synthetic narcotic used for maintenance or
  detoxification
• up to 24-36 hours of drug action
• prevents the high and withdrawal symptoms
• LAAM Maintenance (levo-alpha-acetylmethadol)
• synthetic narcotic used as a narcotic antagonist
• blocks or reverses narcotic effects

14
Goals of Narcotic Maintenance

• Gaining control over the addiction (daily use vs.
  every few hours)
• Oral administration, not injection
• Prevention
• IV drug use
• crimes related to drug use (theft, prostitution,
  etc.)
• Addiction ? Detoxification
• naltrexone (Trexan) when narcotics-free

15
Problems with NarcoticMaintenance

• Short-term vs. long term users
• Cycling
• Multi-drug use
• Dealing of methadone / other drugs around clinics
• Limited medical supervision counseling
• Dependency continues
• Dangers to newborn

Note. Multimodal Approach
16
Side Effects of Methadone

• weight gain
• loss of sexual desire
• nausea
• constipation
• swelling / aching of joints
• nodding