Painkillers, Narcotic Misuse, and Addiction

What Is Narcotic Misuse?

One of the most frequent reasons people go to the doctor is for pain relief. There are a number of different drugs that can ease pain.

Opioids -- also called opiates or narcotics -- are pain relievers made from opium, which comes from the poppy plant. Morphine and codeine are the two natural products of opium. Synthetic modifications or imitations of morphine produce the other opioids:

Fentanyl (Duragesic)

Heroin (street drug)

Hydrocodone with acetaminophen (Lorcet, Lortab, Vicodin)

Hydrocodone (Zohydro ER, Hysingla ER)

Hydromorphone (Dilaudid)

Methadone

Oxycodone (OxyContin)

Oxycodone with acetaminophen (Percocet)

Oxycodone with aspirin (Percodan)

Meperidine(Demerol)

When people with no history of drug addiction appropriately use narcotics at prescribed doses to control pain, they are relatively unlikely to become addicted to the drugs. However, opioids provide an intoxicating high when injected or taken orally in high doses. Opioids are also powerful anxiety relievers. Additionally, in people with no history of addiction who take opiates for chronic pain, studies have not found clear-cut predictors of who is more or less likely to eventually abuse their pain killers. For these reasons, narcotic abuse is one of the most common forms of drug abuse in the U.S.

Terms like opioid abuse, drug abuse, drug dependence, and drug addiction are often used interchangeably. However, modern diagnostic classification systems technically no longer use the terms "abuse" or "dependence" but instead refer to "substance use disorders" with accompanying levels of mild, moderate or severe intensity.

Drug misuse occurs when someone uses a medicine beyond a doctor's prescription, usually with the intention to get high, or relieve anxiety or distress. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), opiate use disorder involves:

  • strong desire to use opioids
  • inability to control or reduce use
  • trouble meeting social or work obligations
  • having legal problems due to drug use
  • spending large amounts of time to obtain opiates
  • development of tolerance (meaning the need to use larger amounts over time)
  • having withdrawal symptoms after stopping or reducing use (such as depressed mood, stomach upset, insomnia, and muscle aches)

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Symptoms of Narcotic Misuse

Signs and symptoms of opioid misuse include:

Symptoms of Opioid Drug Withdrawal

If a person uses opioids for a long time, they often can develop physical dependence and tolerance. Usually, opioid abusers will then take more of the drug, to continue to get high. If a person stops using opioids after they become physically dependent on the drug, they will experience drug withdrawal symptoms.

Symptoms of drug withdrawal from opioids include:

  • Anxiety
  • Irritability
  • Craving for the drug
  • Rapid breathing
  • Yawning
  • Runny nose
  • Salivation
  • Goosebumps
  • Nasal stuffiness
  • Muscle aches
  • Vomiting
  • Abdominal cramping
  • Diarrhea
  • Sweating
  • Confusion
  • Enlarged pupils
  • Tremors
  • Loss of appetite

The symptoms of opioid drug withdrawal aren't medically dangerous. But they can be agonizing and intolerable, contributing to continued drug abuse. In general, how severe opioid drug withdrawal symptoms are, and how long they last, depends on how long the person has been abusing opioids and how much they have been taking.

There are medicines that can be taken in various forms and used to prevent withdrawal symptoms after a person stops using, a process called detoxification (detox). Methadone is widely used to ease the symptoms of opiate withdrawal and is also sometimes used long-term (known as methadone maintenance) to prevent relapse. Buprenorphine (Subutex) is an alternative to methadone for acute detoxification from opiates. It is sometimes combined with naloxone (a combination called Suboxone) for acute treatment of opiate withdrawal. Other medication options to treat acute opiate withdrawal include the blood pressure medicine clonidine. "Rapid detox" using naltrexone (a medicine that blocks opiate receptors) is sometimes done under general anesthesia in specialized treatment centers, although that approach has not been shown to have better outcomes than more traditional detox methods.

After drug withdrawal is complete, the person is no longer physically dependent on the drug. But psychological dependence can continue. Some people with drug addiction may relapse in response to stress or other powerful triggers.

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A new form of buprenorphine (Probuphine) can be implanted under the skin and prescribed for maintenance treatment of opiate dependence in people who have remained stable on oral buprenorphine and are no longer being treated for acute withdrawal. It provides a constant dose of buprenorphine for six months.

The drug naltrexone blocks the effects of opiates and is another treatment option for preventing opiate relapse. It can be administered orally (Revia) or as a monthly injection (Vivitrol).

Dependence vs. Addiction

Controlling pain is the goal when opioids are used medically. Patients or health care professionals should not let fear of addiction prevent them from appropriately using opioids for effective pain relief. Knowing the difference between dependence and addiction is important.

  • People who take opioids for pain relief for extended periods of time may need higher doses to ease their pain. They may develop tolerance to the drug and experience withdrawal symptoms if the medication is abruptly stopped. They become physically dependent on the drug.
  • Addiction occurs when narcotic abuse becomes compulsive and self-destructive, especially concerning an opioid user's need to use the drug for reasons other than pain relief.
  • To prevent withdrawal symptoms in people who have become physically dependent on opioids for pain relief, the dose may be slowly lowered over a few weeks. People with no previous history of addiction who are weaned off opioids and are pain free usually don't start taking the drug again or become abusers of narcotics. Opioids used for short-term medical conditions rarely require weaning. In those cases, stopping the medication after a brief period usually doesn't cause withdrawal symptoms.

Other Abused Drugs

Most drugs referred to informally as narcotics really aren't. Technically, narcotics refer to opiate drugs, or synthetic or semi-synthetic opiates. Two drug classes have some similar effects to opioids, when abused:

  • Benzodiazepines include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Benzodiazepine abuse results in sedation and calm, but tolerance develops rapidly. Withdrawal can result in seizures, unlike opioid withdrawal.
  • Barbiturates include amobarbital (Amytal), pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal). Barbiturates are also sedating and calming. Withdrawal after continued barbiturate abuse, like benzodiazepine abuse, is medically serious.

Benzodiazepines and barbiturates are considered sedative-hypnotics and do not have meaningful pain-relieving effects. Benzodiazepines, barbiturates and opiates all are sedating and can produce feelings of emotional well-being that can be attractive to people who are vulnerable to addiction. Long-term use of all three of these types of drugs can lead to tolerance and physical dependence over time, and withdrawal symptoms if you suddenly stop taking them.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on July 16, 2016

Sources

SOURCES:

Bateson, A.N. Current Pharmaceutical Design, January 2002.

eMedicine.com: "Toxicity, Barbiturate."

FDA. "FDA approves first buprenorphine implant for treatment of opioid dependence."

Van den Brink, W. Canadian Journal of Psychiatry, 2006.

WebMD Medical Reference: "Narcotic Abuse."

 

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