Narcotic drugs

Definition

Narcotics are addictive drugs that reduce the user's perception of pain and induce euphoria (a feeling of exaggerated and unrealistic well-being). The English word narcotic is derived from the Greek narkotikos, which means "numbing" or "deadening." Although the term can refer to any drug that deadens sensation or produces stupor, it is commonly applied to the opioids—that is, to all natural or synthetic drugs that act like morphine.

Description

Historical background

Narcotics are the oldest as well as the strongest analgesics , or pain-relieving drugs, known to humans. Ancient Sumerian and Egyptian medical texts dated as early as 4000 B.C. mention the opium poppy (Papaver somniferum ) as the source of a milky fluid (opium latex) that could be given to relieve coughs and insomnia as well as ease pain. Traditional Chinese medicine recommended the opium poppy, known to Chinese physicians as ying su ke, for the treatment of asthma , severe diarrhea , and dysentery as well as chronic pain and insomnia. Opium latex contains between 10 and 20 percent morphine, which in its purified form is a white crystalline powder with a bitter taste.

Narcotics are central nervous system depressants that produce a stuporous state in the person who takes them. These drugs often induce a state of euphoria or feeling of extreme well-being, and they are powerfully addictive. The body quickly builds a tolerance to narcotics in as little as two to three days, so that greater doses are required to achieve the same effect. Because of the addictive qualities of these drugs, most countries in the twenty-first century have strict laws regarding the production and distribution of narcotics. These laws became necessary when opium addiction in the nineteenth century became a widespread social problem in the developed countries. Opium, which was the first of the opioids to be widely used, had been a common folk remedy for centuries that often led to addiction for the user; in fact, many popular Victorian patent medicines for "female complaints" actually contained opium. The invention of the hypodermic needle in the mid-nineteenth century, however, increased the number of addicts because it allowed opioids to be delivered directly into the bloodstream, thereby dramatically increasing their effect.

Classification of narcotics

As of the early 2000s, narcotics are commonly classified into three groups according to their origin:

• Natural derivatives of opium: Narcotics in this group include morphine itself and codeine.
• Partially synthetic drugs derived from morphine: These drugs include heroin, oxycodone (OxyContin), hydromorphone (Dilaudid), and oxymorphone (Numorphan).
• Synthetic compounds that resemble morphine in their chemical structure: Narcotics in this group include fentanyl (Duragesic), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone, and propoxyphene (Darvon).

Narcotics are available in many different forms, ranging from oral, intramuscular, and intravenous preparations to patches that can be applied to the skin (fentanyl). Illegal street heroin can be taken by inhalation as well as by injection.

How narcotics work

The central nervous system in humans and other mammals contains five different types of opioid receptor proteins, located primarily in the brain, spinal cord, and digestive tract. When a person takes an opioid medication, the drug attaches to these opioid receptors in the brain and spinal cord and decreases the person's perception of pain. Narcotics do not, however, reduce or eliminate the cause of the pain.

Some of the opioid receptors (known as mu and sigma receptors) influence a person's perception of pleasure. When a narcotic medication stimulates these receptor proteins, the person typically experiences intense sensations of euphoria or well-being. The speed with which these drugs take effect depends on the method of administration; IV narcotics reach their peak effectiveness within ten minutes, while oral narcotics take about an hour and a half, and skin patches take between two and four hours.

Overdoses of narcotics can cause drowsiness, unconsciousness, and even death because these drugs suppress respiration.

General use

Narcotics have several legitimate uses:

• Analgesic: Doctors frequently prescribe oral codeine and propoxyphene (alone or in combination with aspirin) for pain control after oral surgery, for severe menstrual cramps, and for temporary pain relief after other outpatient surgical procedures. Intravenous narcotics may be given for several days after major surgery to relieve the patient's discomfort. Subsequent methods of administering opioids following surgery include a sustained-release injected form of morphine sulfate (DepoMorphine) and a patient-controlled transdermal system (E-TRANS) that releases doses of fentanyl when the patient pushes a button attached to the arm or upper chest. Intravenous narcotics may also be used for palliative care, to relieve the pain of patients diagnosed with terminal cancer .
• Antitussive: Antitussives are medications given to control coughing. Codeine is often effective in relieving severe coughs and is a common ingredient in prescription cough mixtures. Antidiarrheal: Paregoric, a liquid preparation containing powdered opium, anise oil, and glycerin, is sometimes prescribed for severe diarrhea. The opium in paregoric works to control diarrhea because it slows down the rhythmic contractions of the intestines that ordinarily move food through the digestive tract. Lomotil, another antidiarrheal medication, contains a synthetic opioid known as diphenoxylate; it is often recommended for treating cancer patients with diarrhea caused by radiation therapy.

Precautions

In the United States, opioids are as of 2004 classified as Schedule II drugs under the Controlled Substances Act of 1970. Drugs in this category are described by the government as having a high potential for abuse and a liability for dependence and yet an approved medical use in pain management . The corresponding Canadian legislation, the Controlled Drugs and Substances Act of 1997, classifies medications containing any narcotic under the heading (N) but specifies varying levels of regulation ranging from strict controls for highly addictive single-drug products to lesser controls on drugs combining a narcotic with non-narcotic substances. As both countries' legal controls indicate, narcotics should be used cautiously, for as short a period of time as possible, and only under a doctor's supervision. In particular, they should never be used together with certain other categories of prescription drugs or herbal preparations.

Side effects

In addition to the risk of dependency or addiction, narcotics have a number of physical side effects, including the following:

• constipation
• drowsiness
• withdrawal symptoms after extended use (tearing, sweating, diarrhea, vomiting , gooseflesh, muscle twitching, runny nose, loss of appetite, and hot or cold flashes)

Interactions

Narcotics can be dangerous because of their potential for deadly interactions with other medications as well as their potential for dependence and addiction. Narcotics should never be combined with other types of drugs that depress the central nervous system. These categories of drugs include the following:

• alcohol
• benzodiazepine tranquilizers, including such drugs as diazepam (Valium), alprazolam (Xanax), and chlordiazepoxide (Librium)
• barbiturates, used to treat insomnia and anxiety , including such medications as pentobarbital (Nembutal) and mephobarbital (Mebaral)
• antihistamines, even over-the-counter cold or allergy medications, which can interact with narcotics to intensify drowsiness and repress breathing

Narcotics can also interact with certain herbal preparations to cause central nervous system depression. Anyone taking narcotics for pain relief should avoid using herbal preparations containing kava kava (Piper methysticum ), valerian (Valeriana officinalis ), chamomile (Matricaria recutita ), or lemon balm (Melissa officinalis ), as these herbs intensify the tendency of opioids to cause drowsiness and slow down breathing. Ginseng (Panax ginseng ) should also be avoided because it interferes with the pain-relieving qualities of opioid medications.

Prevention

Scientists have attempted to develop ways to use the pain-killing properties of narcotics while counteracting their addictive qualities. Substances known as narcotic or opioid antagonists are drugs that block the actions of narcotics and are used to reverse the side effects of narcotic abuse or an overdose. A class of drugs, a mixture of opioids and opioid antagonists, has been developed so that patients can be relieved of pain without the addictive or other unpleasant side effects associated with narcotics.

Parental concerns

One minor concern that parents may have if the doctor prescribes narcotic medications for their child is that such side effects as constipation or sleepiness are more common and more severe in children younger than 18 years of age.

Far more seriously, narcotic drugs are among those substances used illegally or abused by adolescents. Some researchers estimate that as many as 90 percent of adult drug addicts began a pattern of substance abuse during adolescence . Teenagers are particularly likely to begin experimenting with narcotics in the form of prescription cough syrup and such pain relievers as Darvon or Oxy-Contin and to combine narcotics with alcohol or other drugs of abuse. Moreover, although opioid medications account for fewer cases of drug abuse than cocaine, alcohol, or several other drugs, they still account for 4 to 5 percent of emergency room visits. In addition, the death rate of opioid abusers is proportionately significantly higher than the mortality of people who abuse PCP or cocaine.

The American Academy of Child and Adolescent Psychiatry (AACAP) lists opiates as common drugs of abuse among teenagers and notes that children as young as 12 may be using narcotics. In many cases, children can obtain these drugs at home in the form of medications prescribed for other family members. Children who are abusing opioid medications may show the following signs:

• euphoria or "feeling no pain"
• constipation
• slurred speech
• shallow breathing
• itching or flushing of the skin
• mental confusion and poor judgment
• bloodshot eyes with small pupils
• nausea and vomiting
• unusual drowsiness

Parents who suspect that their children are abusing opioids, either alone or in combination with other drugs, should get help as soon as possible.

KEY TERMS

Analgesics —A class of pain-relieving medicines, including aspirin and Tylenol.

Antitussive —A drug used to suppress coughing.

Euphoria —A feeling or state of well-being or elation.

Morphine —The principal alkaloid derived from the opium poppy for use as a pain reliever and sedative. In its purified form, it is a white, bitter-tasting crystalline powder.

Narcotic —A drug derived from opium or compounds similar to opium. Such drugs are potent pain relievers and can affect mood and behavior. Long-term use of narcotics can lead to dependence and tolerance. Also known as a narcotic analgesic.

Opium latex —The milky juice or sap of the opium poppy, used to produce morphine.

Palliative —Referring to a drug or a form of care that relieves pain without providing a cure. Persons in severe pain from terminal cancer are often prescribed narcotics as palliative care.

Stupor —A trance-like state that causes a person to appear numb to their environment.

Resources

BOOKS

"Opioid Dependence." Section 15, Chapter 195 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, and Robert Berkow. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Pelletier, Kenneth R. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Pain." New York: Simon & Schuster, 2002.

PERIODICALS

Abebe, W. "Herbal Medication: Potential for Adverse Interactions with Analgesic Drugs." Journal of Clinical Pharmacy and Therapeutics 27 (December 2002): 391–401.

Cone, E. J., et al. "Oxycodone Involvement in Drug Abuse Deaths. II: Evidence for Toxic Multiple Drug-Drug Interactions." Journal of Analytical Toxicology 28 (May-June 2004): 217–25.

Elwood, W. N. "Sticky Business: Patterns of Procurement and Misuse of Prescription Cough Syrup in Houston." Journal of Psychoactive Drugs 33 (April-June 2001): 121–33.

Nevin, J. "Drug Update: Fentanyl Patch Abuse." Emergency Medical Services 33 (July 2004): 24–5.

Stern, J., and C. Ippoliti. "Management of Acute Cancer Treatment-Induced Diarrhea." Seminars in Oncology Nursing 19 (November 2003): 11–6.

Viscusi, E. R. "Emerging Techniques for Postoperative Analgesia in Orthopedic Surgery." American Journal of Orthopedics 33 (May 2004): 13–16.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016–3007. Web site: <www.aacap.org.>.

National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892–9561. Web site: <www.drugabuse.gov>.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857–0001. Web site: <www.fda.gov>.

WEB SITES

Rehman, Ziaur, Suzan Khoromi, and James E. Douglas. "Opioid Abuse." eMedicine, August 15, 2004. Available online at <www.emedicine.com/med/topic1673.htm> (accessed November 30, 2004).

Stephens, Everett. "Toxicity, Narcotics." eMedicine, September 20, 2004. Available online at <www.emedicine.com/emerg/topic330.htm> (accessed November 30, 2004).

OTHER

American Academy of Child and Adolescent Psychiatry (AACAP). Teens: Alcohol and Other Drugs. AACAP Facts for Families #3. Washington, DC: AACAP, 2004.

National Institute on Drug Abuse (NIDA). NIDA InfoFacts: Prescription Pain and Other Medications. Bethesda, MD: NIAMS, 2004.

Rebecca Frey, PhD

Narcotics

Definition

Narcotics are natural opioid drugs derived from the Asian poppy Palaver somniferous or semi-synthetic or synthetic substitutes for these drugs.

Purpose

Narcotics are drugs that dull the sense of pain and cause drowsiness or sleep. They are the most effective tool a physician has to relieve severe pain. Narcotics are also given pre-operatively to relieve anxiety and induce anesthesia. Other common uses are to suppress cough and to control very severe diarrhea. In large doses, they can suppress the ability to breathe and cause coma and death. Narcotics are also taken illegally for recreational use.

Precautions

Narcotics should only be taken under the direction of a physician. These drugs depress the central nervous system and should not be taken with other drugs, such as alcohol, barbiturates, antihistamines, and benzodiazepines that also depress the central nervous system.

Opioids are broken down by the liver. Individuals with liver damage may not detoxify these substances as rapidly as healthy individuals, leading to potential accidental overdose. Street narcotics are of uncertain strength and may be contaminated with toxic chemicals or contain a mixture of drugs that can cause life-threatening reactions.

Description

Natural narcotics are derived directly from the sap of the unripe seed pods of the opium poppy. Morphine and codeine are the most familiar natural narcotics and are the narcotics most frequently used in medical settings. Often they are prescribed in combination with other non-narcotic drugs. Heroin is a semi-synthetic narcotic. It has no medical or legal uses. Other completely synthetic narcotics are made in the laboratory. These include drugs with medical uses such as fentanyl and oxycodone and illegal "designer drugs" synthesized for recreational use. Some man-made narcotics are hundreds of times more potent than natural narcotics.

Narcotics depress the central nervous system. They work by binding chemically with receptors in a way that blocks the transmission of nerve impulses. These drugs do not cure the source of the pain; they simply block the individual's perception of pain. When used to treat cough or diarrhea, they slow or block muscle contractions.

Morphine (Roxanol, Dura morphine, morphine sulfate, morphine hydrochloride) is the most commonly used medical narcotic for managing moderate to severe pain. It can be also be used to control extreme diarrhea caused by cholera or similar diseases. Morphine sulfate is a white powder that dissolves in water. It is usually given by injection into a muscle or intravenously by injection into a vein. When given intravenously, its effect occurs almost immediately. Individuals given morphine regularly have a high potential for developing dependence on the drug. Morphine can cause withdrawal symptoms if stopped abruptly. It is not a common street drug.

More codeine is prescribed medically than any other narcotic. Concentrations of codeine in the sap of the opium poppy are low, so most codeine is manufactured by chemical alteration of morphine. For pain control, codeine is combined with other non-narcotic painkillers such as aspirin (Empirin with Codeine,) acetaminophen (Tylenol with Codeine) or non-steroid anti-inflammatory drugs. These combination painkillers are manufactured as tablets (most common) or liquids and come in a variety of strengths based on the amount of codeine they contain. Codeine is also found in some cough syrups (Robitussin A-C, for example) and is used to control dry cough. Occasionally codeine is used to control severe diarrhea, although diphenoxylate (Lomotil) is used more often.

In Canada, certain low-dose codeine pain relievers are sold without prescription. In the United States pain medication with codeine requires a prescription. The likelihood of physical or psychological dependence on codeine is much lower than with morphine.

Hydromorphone (Dilaudid) is a narcotic synthetically produced from morphine. It is available in tablets or as an injectable solution and used for pain relief. It is one of the most common pain relievers prescribed for patients who are terminally ill, because it combines high effectiveness with low side effects.

Mederidine (Demerol) was originally developed to treat muscle spasms but is as of 2005 used mainly for pain relief. It is manufactured as tablets of varying strengths. Another synthetic pain relief narcotic whose use parallels mederidine is propoxyphene. When combined with aspirin this narcotic is known under the brand name Darvon.

Oxycodone (Oxycontin), a synthetic narcotic used for pain relief, is manufactured both alone and with aspirin (Percodan) or acetaminophen (Percoset) in tablets of various strengths. OxyContin is a controlled release formula of oxycodone that controls pain continuously for 12 hours at a time. Oxycodone has a high potential for prescription drug and street abuse. Hydrocodone with acetaminophen (Vicodin) is another synthetic narcotic whose use and potential abuse parallels oxycodone.

Fentanyl (Sublimaze, Actiq, Duragesic) is used as a surgical anesthetic. It is available as an injectable solution and as a skin patch.

Methadone is a synthetic narcotic used mainly as a substitute for heroin in heroin withdrawal treatment, although it does have pain-killing properties. Methadone, when taken by mouth (liquid, wafers, tablets) provides little of the euphoria of heroin, but it blocks heroin cravings and withdrawal symptoms.

The first international attempts to control narcotic drugs were made in 1909 with the formation of the Opium Commission Forum, which developed the first international drug control treaty in 1912. In the early 2000s narcotics are regulated internationally by the International Narcotics Control Board (INCB), established in 1961. The INCB regulates the cultivation of raw materials to make narcotics and natural and man-made drugs. Cocaine and marijuana also fall under the board's control, although they are not technically narcotics. Narcotic drugs are also regulated by federal and state governments. In law enforcement, the term narcotics is extended to include other, mainly illicit drugs such as cocaine that have little medical use.

Preparation

No special preparation is required before being treated with narcotics, although, as with all medications, individuals should tell their physician about all prescription and non-prescription drugs, supplements, and herbal remedies that they are taking, as certain medications may enhance the effects of narcotics.

Aftercare

When an individual is prescribed narcotics regularly for an extended period, tolerance may develop. With tolerance, the individual must take higher and higher doses to achieve the same level of pain control. In some cases, when narcotics are stopped abruptly, withdrawal symptoms may develop. These include:

• anxiety
• irritability
• rapid breathing
• runny nose
• sweating
• vomiting and diarrhea
• confusion
• shaking
• lack of appetite

In order to prevent withdrawal symptoms, the dose of narcotics can be gradually diminished, a process known as tapering, until they can be discontinued completely without unpleasant effects. Individuals may also be treated with the drug cloindine (Catapres) to relieve some withdrawal symptoms.

Risks

All narcotics have the potential to become physically and psychologically addictive. When used regularly, tolerance can develop. Abuse and dependence on narcotic prescription drugs in an increasing problem among the elderly particularly and among members of the middle class generally.

Overdose and withdrawal symptoms and reactions caused by contamination with other drugs or toxic chemicals are common reasons for drug-related visits to the emergency room by individuals using street narcotics recreationally. Overdose is treated with the drug naloxone (ReVia). Naloxone blocks and reverses the effects of narcotics. When given intravenously it is effective within one to two minutes.

KEY TERMS

Tapering— Gradually reducing the amount of a drug when stopping it abruptly would cause unpleasant withdrawal symptoms.

Normal results

When used as prescribed, narcotics are a generally safe and effective way to relieve pain and control cough and severe diarrhea. Individuals should not be afraid they will develop an addiction after a short-term course of narcotics following a dental or medical procedure, provided that they follow their physician's instructions for taking the drugs.

Resources

ORGANIZATION

National Institute on Drug Abuse/National Institutes of Health. 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561. (301) 443-1124. 〈http://www.nida.nih.gov〉.

United States Drug Enforcement Administration. Dr Mailstop: AXS, 2401 Jefferson Davis Highway, Alexandria, VA 22301. (202) 307-1000. 〈http://www.dea.gov〉.

OTHER

"Narcotics." United States Drug Enforcement Administration (undated) [cited March 25, 2005] 〈http://www.usdoj.gov/dea/concern/narcotics.html〉.

National Institute on Drug Abuse. February 4, 2005 [cited March 25, 2005]. 〈http://www.nida.nih.giv/ResearchReport/Prescription/Prescription.html〉

Stephens, Everett. Toxicity, Narcotics January 7, 2005 [cited March 25, 2005]. 〈http://www.emedicine.com/emerg/topic330.htm〉.

NARCOTICS ACTS

Background

Control over, and prevention of, the distribution and usage of narcotic drugs has been a major priority of the federal government and the various state governments since the early part of the twentieth century. Notwithstanding these efforts, statistics on the use of narcotics in the United States remain startling. According to statistics from the U.S. drug enforcement administration, between 10,000 and 24,000 metric tons of marijuana were available on American streets. This is in addition to large quantities of other forms of narcotics, including: 260–270 metric tons of cocaine, 110–140 metric tons of methamphetamine, and 13–18 metric tons of heroin.

According to the National Household Drug Survey on Drug Abuse, conducted by the sub-stance abuse and mental health services administration, 55.6 percent of respondents between the ages of 18 and 25 said that they had used illicit drugs. This compares to 53.3 percent of respondents between the ages of 26 and 34, and 28.4 percent of respondents between the ages of 12 and 17. The National Institute on Drug Abuse's 2002 Monitoring the Future Study found that 53 percent of high-school seniors claimed to have used narcotics, including 41 percent who said that they had used drugs in the past year, and 25.4 percent who said that they had used drugs in the past month.

The efforts of law enforcement officers have had some effect on the use and transfer of narcotics in the past, although these efforts have been costly. In 2001, federal agents seized approximately 1,215 metric tons of marijuana, 106 metric tons of cocaine, 3.6 metric tons of methamphetamine, and 2.5 metric tons of heroin. The costs to society in enforcing narcotics laws have continued to increase. In 1992, the total estimated costs to society of narcotics use was $102 billion. By 2000, this number had grown to $160 billion, including almost $15 billion in health care costs.

Development of Federal Narcotics Laws

During the Civil War, forms of opiates were considered "miracle" drugs that could be used as anesthetics when a doctor performed surgery. Without opiates, surgeries during that period, which often consisted of amputations, involved a group of men holding down a patient while a doctor sawed off the limb of a patient. By the 1870s, opiates, cocaine and other drugs were used in a variety of medical concoctions, leading to increases in addictions.

The use of opium, cocaine, and other drugs continued through most of the nineteenth century. The type of addiction during that time that caused the most concern was alcoholism, and because the causes of addiction and the dangers of narcotics were both unknown, doctors recommended morphine and heroin as remedies for addiction to alcohol. Cocaine was also used in tonics, such as the mixture that became known as Coca-Cola. Moreover, patients, including those of Sigmund Freud, were treated for depression with cocaine.

Congress enacted the pure food and drug act of 1906, ch. 3915, 34 Stat. 768, which formed the food and drug administration (FDA) and gave it the power to regulate food and drugs. Drug addiction began to drop as a result of early FDA regulations. Eight years later, Congress enacted the Harrison Tax Act, ch. 1, 38 Stat. 789, which prohibited the dispensation and distribution of narcotic drugs. In 1922, Congress enacted the Narcotics Drug Import and Export Act, ch. 202, 42 Stat. 596, which prohibited importation and use of opium and other narcotics except for medical purposes.

Between 1922 and 1970, Congress enacted several additional laws that were designed to curb narcotics importation, trade, and use. Drugs such as marijuana and heroin were prohibited, as was the cultivation of opium poppies. The Narcotic Control Act of 1956, ch. 629, 70 Stat. 567 criminalized the transport of narcotics, including marijuana. Some legislation began to focus upon rehabilitation of narcotics addicts. For example, the Narcotic Addict Rehabilitation Act of 1966, Pub. L. No. 89-793, 80 Stat. 1438, provided for treatment of addicts as an alternative to incarceration.

Comprehensive Drug Abuse and Control Act

By the late 1960s, illicit drug use in the United States had become widespread. Moreover, use of narcotics became more open, causing concerns among many communities, law enforcement personnel, and legislators. Existing narcotics laws were failing to curb the usage of narcotics drugs. For example, about half of the amphetamines and barbiturates produced legally in the United States were being distributed through illegal means.

In response to these problems, Congress in 1970 enacted the Controlled Substances Act (CSA) as Title II of the Comprehensive Drug Abuse Prevention and Control Act, Pub. L. No. 91-513, 84 Stat. 1242. The CSA developed a complex regulatory system designed to control the distribution of drugs. It established five schedules of drugs, with each schedule representing the degree with which the drug is likely to be abused and the level of accepted medical use. Most narcotics, such as marijuana, cocaine, and heroin, fall within Schedule I, which includes drugs with high potential for abuse and with no accepted medical use.

The CSA has been amended dozens of times since is original enactment. In 1974, Congress enacted the Narcotic Addict Treatment Act of 1974, Pub. L. No. 93-281, 88 Stat. 124, which allows practitioners to dispense narcotics for detoxification and similar purposes. Other amendments to the CSA have established federally funded prevention and treatment programs, including drug-awareness education programs.

Anti-Drug Acts and National Drug Control Policy

Despite Congress' efforts to strengthen narcotics laws through the CSA, use and abuse of narcotics remained a major national problem in the 1980s. By 1984, narcotics were a part of an $80 million industry in the United States, and use of illicit drugs had reached epidemic proportions according to findings by Congress. Law enforcement officers were able to interdict only five to 15 percent of the drugs entering into the country. Moreover, statistics showed a high correlation between drug use and criminal activities. For example, about 90 percent of heroin users relied upon crime to fund their habit.

The National Narcotics Act of 1984, Pub. L. No. 98-473, 98 Stat. 2168 established the National Drug Enforcement Policy Board to coordinate efforts among federal agencies to combat narcotics trade and for other programs. Four years later, Congress enacted the National Narcotics Leadership Act of 1988 as Subtitle A of the Anti-Drug Abuse Act of 1988, Pub. L. No. 100-690, 102 Stat. 4181, which replaced the board with the office of national drug control policy. This office continues to implement the country's policies regarding education about the dangers of drug abuse as well as efforts to stifle the drug trade. The Office of National Drug Control Policy and the U.S. Drug Enforcement Administration are the two main federal agencies that are responsible for addressing narcotics issues in the United States.

State Narcotics Acts

Many states have enacted statutes to address narcotics trade and usage within their borders. The vast majority of states adopted the Uniform Narcotics Drug Act, which was first approved by the commissioners on uniform laws and other organizations in 1930. That act and other state laws limited the production of marijuana and generally prohibited more dangerous drugs, including cocaine and heroin. In 1970, the same year that Congress approved the federal Controlled Substances Act, the Commissioners approved the Uniform Controlled Substances Act. This uniform law was eventually approved by 46 states. Although it was updated in 1990 and 1994, few states adopted the amended version.

further readings

Jonas, Stephen. 1990. "Solving the Drug Problem: A Public Health Approach to the Reduction of the Use and Abuse of Both Legal and Illegal Recreational Drugs." Hofstra Law Review 751.

U.S. Department of Justice, Drug Enforcement Administration. 2003. Drugs of Abuse. Washington, D.C.: U.S. Government Printing Office.

cross-references

Drugs and Narcotics; Office of National Drug Control Policy.

Narcotic

The detection of narcotics and other drugs of abuse in the blood , body fluids , and tissues of drug abusers and corpses where the suspected cause of death is related to drug overdose is routine procedure in forensic laboratories. The National Institute on Drug Abuse (NIDA), the Federal Bureau of Investigation (FBI ), the Drug Enforcement Administration (DEA ), and the Department of Justice are the agencies responsible for drug research and preventive programs, regulatory control, classification of drugs of abuse, and law enforcement.

Narcotics are opium (a substance naturally occurring in poppy seeds) and semi-synthetic opioid substances used to relieve intense pain. These drugs block specific receptors that processes pain information in the central nervous system (CNS), such as the brainstem, medial thalamus, spinal cord, hypothalamus, and limbic system, along with peripheral nerve fibers. Narcotics are addictive substances due to the euphoric effect they have on mood and general disposition. Morphine, codeine, and heroin are the main drugs of abuse in the narcotic category.

Morphine is a controlled medication prescribed for the treatment of intense chronic pain and for post-surgery pain due to its strong analgesic (pain-relieving) properties. However, morphine is highly addictive and can present dangerous side effects. Ordinary doses of morphine may lead to respiratory depression, or the slowing or cessation of breathing, through the reduction of sensitivity of the brain cells that regulate breathing. A study funded by the National Institute on Drug Abuse has shown that the chronic administration of morphine to rats reduced the size of nerve cells that produce dopamine by 25%. Dopamine is a natural brain chemical messenger (neurotransmitter) that causes sensations of pleasure, joy, and reward. The euphoric effects of morphine and other opiates indicate that they act upon the dopamine receptors. It is also known that cells decrease sensitivity to a given medication when frequently exposed to it. Therefore, such observed cell size reductions may be the result of cell desensitization to the drug. This explains the tolerance effect that morphine and other drugs of abuse cause in the CNS, leading addicts to intake increased doses to obtain the same initial effects of euphoria. It also explains the deep depressive episodes that take place when the effect of the drug ceases, or when abusers are under detoxification treatment. Besides addiction, the other side effects of morphine chronic intake are sedation, constipation, nausea and vomiting, urinary retention, and respiratory depression. Withdrawal causes acute depression, tremors, emotional instability, and irritability.

Heroin is an illegal and highly addictive narcotic with the fastest action on brain receptors. Heroin is a semi-synthetic derivate of morphine, sold on the black market either as a black gluey substance known as "black tar" or in a more "purified" form, mixed with sugar, starch, powdered milk, or quinine. The purification process is done by reacting heroin with other drugs or poisons, such as strychnine, which increases the risk of death or irreversible brain damage. Since abusers usually inject heroin in an intravenous or intramuscular solution, often while sharing needles, the risk for abusers contracting hepatitis C and HIV is a large concern among public health authorities. Other forms of heroin consumption involve inhaling it through the nose (snorting) or smoking the drug. As tolerance develops, abusers may inject heroin three or four times per day. After the initial rush of euphoria, users become drowsy, respiratory depression sets in, and higher mental functions are clouded. Heroin is converted into morphine in the brain, so the withdrawal symptoms are the same as with morphine, although more severe with heroin. Another risk imposed by heroin is that its illegal manufacture is accomplished by criminals who use toxic compounds and poisons in the process. The product can also be mixed with other dangerous drugs. In addition, the user does not know exactly how much heroin is in the purchased drug; it may have enough to induce an accidental overdose. It can also be contaminated with fungus and other pathogens , leading to infections. Lung complications, such as tuberculosis and pneumonia, are common among drug abusers. Inflamed veins or arteries are also common, due to the poor solubility (dissolvability) of substances mixed with the abused drugs.

Law enforcement against international drug traffickers who illegally bring narcotics and other illicit drugs of abuse into the United States requires a continuous effort and strategic planning from the FBI and DEA. It also involves collaboration with other international agencies, such as Interpol and the police of other countries where these drugs are originally produced, as well as those that are used as routes for drug dealers.

Forensic identification of addicts involves the examination of physical indicators such as needle marks in the veins of arms and legs, bluish bruises due to collapsed veins in these areas, and pinpoint pupils. Frequent snorting of cocaine or heroin leads to the destruction of nasal cartilages and nosebleeds. To determine what drugs a suspect is using, laboratory tests are performed on blood or urine samples that allow for the detection of both classes of drugs and specific drugs of abuse. Interrogation of arrested addicts helps local investigators to identify and arrest street drug dealers. The use of trained dogs in ports and airports is also a useful resource for the rapid identification of packages and luggage containing drugs. In the past, "mules," or people hired to carry drugs between countries, hid drugs wrapped in plastic inside their own body cavities. After the installation of x-ray scanners in airports, mules were more easily detected and arrested.

see also DEA (Drug Enforcement Administration); FBI (United States Federal Bureau of Investigation); Homogeneous enzyme immunoassay (EMIT); Illicit drugs; Immune system; Interpol; Nervous system overview; Neurotransmitters; Psychotropic drugs.

Narcotic drugs

A category of addictive drugs that reduce the perception of pain and induce euphoria.

A narcotic is a depressant that produces a stuporous state in the person who takes it. Narcotics, while often inducing a state of euphoria or feeling of extreme well being, are powerfully addictive. The body quickly builds a tolerance to narcotics, so that greater doses are required to achieve the same effect. Because of their addictive qualities, most countries have strict laws regarding the production and distribution of narcotics.

Historically, the term narcotic was used to refer to the drugs known as opiates. Opium, morphine, codeine, and heroin are the most important opiate alkaloids— compounds extracted from the milky latex contained in the unripe seedpods of the opium poppy. Opium, the first of the opiates to be widely used, was a common folk medicine for centuries, often leading to addiction for the user. The invention of the hypodermic needle during the mid-19th century allowed opiates to be delivered directly into the blood stream, thereby dramatically increasing their effect. By the late 20th century, the legal definition of a narcotic drug had been expanded to include such non-opiate addictive drugs as cocaine and cannabis.

Narcotic drugs decrease the user's perception of pain and alter his or her reaction to pain. For this reason, narcotics—primarily codeine and morphine—are prescribed legitimately as pain killers. In a medical setting, they are referred to as narcotic analgesics. For pain relief, scientists have developed opioids, which are synthetic drugs with morphine-like properties. Some common synthetic opioids include meperidine (trade name Demerol) and methadone, a drug often used to treat heroin addiction. The use of methadone as a treatment for addiction is controversial, however, since methadone itself is addicting.

Scientists have attempted to develop ways to use the pain-killing properties of narcotics while counteracting their addictive qualitites. Such investigations have led to the discovery of narcotic receptors in the brain , and of the body's own natural pain-killing substances, called endorphins. Narcotics behave like endorphins and act on, or bind to, the receptors to produce their associated effects. Substances known as narcotic or opioid antagonists are drugs that block the actions of narcotics and are used to reverse the side effects of narcotic abuse or an overdose. A new class of drugs, a mixture of opioids and opioid antagonists, has been developed so that patients can be relieved of pain without the addictive or other unpleasant side effects associated with narcotics.

Narcotic drugs are among those substances used illegally, or abused, by adolescents. Some estimate that as many as 90% of adult drug addicts began a pattern of substance abuse during adolescence .

Further Reading

Sanberg, Paul R. Prescription Narcotics: The Addictive Painkillers. New York: Chelsea House, 1986.

Traub, James. The Billion-Dollar Connection: The International Drug Trade. New York: J. Messner, 1982.

Willette, Robert E., and Gene Barnett, eds. Narcotic Antagonists: Naltrexone Pharmacochemistry and Sustained-Release Preparations. DHHS Publications No. ADM 81-102 490 1, NIDA Research Monograph No. 28. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 1981.

nar·cot·ic / närˈkätik/ • n. a drug or other substance affecting mood or behavior and sold for nonmedical purposes, esp. an illegal one. ∎ Med. a drug that relieves pain and induces drowsiness, stupor, or insensibility. • adj. relating to or denoting narcotics or their effects or use: the substance has a mild narcotic effect. DERIVATIVES: nar·cot·i·cal·ly / -tik(ə)lē/ adv. nar·co·tism / ˈnärkəˌtizəm/ n. ORIGIN: late Middle English: from Old French narcotique, via medieval Latin from Greek narkōtikos, from narkoun ‘make numb.’

narcotic Any drug that induces sleep and/or relieves pain. The term is used especially in relation to opium and its derivatives. These drugs have largely been replaced as sedatives because of their addictive properties, but they are still used for severe pain, notably in terminal illness. Other narcotics include alcohols and barbiturates.

narcotic (nar-kot-ik) n. a drug that relieves pain and also induces stupor and insensibility. Now largely obsolete in medical contexts, the term was used particularly for morphine and other derivatives of opium (see opiate) but also referred to other drugs that depress brain function (e.g. general anaesthetics and hypnotics).

narcotic substance inducing stupor XIV; adj. XVII. — (O)F. narcotique or medL. narcōticus, sb. -icum — Gr. narkōtikós, sb. -ikón, f. narkoûn benumb, stupefy, f. nárkē numbness, stupor; see -OTIC.

narcotic Any drug that induces stupor and relieves pain, especially morphine and other opiates. Such narcotics are addictive and cause dependence, and their medical use is strictly controlled.

War on Drugs the efforts, including the use of military forces, of the United States government to suppress the illegal trade in narcotics worldwide.

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