Narcotic Abuse Overview

Pain is one of the most common reasons people seek medical treatment. Doctors can prescribe several different drugs to relieve pain. The most potent pain-relieving drugs are narcotics.

In the United States, narcotics are widely prescribed to treat painful conditions. Narcotics are often prescribed in conjunction with other less potent drugs (such as nonsteroidal antiinflammatory medications) or as a pill that has a combination of a narcotic with either acetaminophen (for example, Tylenol) or aspirin (Arthritis Pain, Aspergum Cherry, Aspergum Orginal, Aspir-Low, Aspirin Lite Coat, Aspirin Low Strength, Bayer Aspirin, Bayer Aspirin Regimen, Bayer Childrens Aspirin, Bufferin, Bufferin Arthritis Strength, Easprin, Ecotrin, Empirin, Fasprin, Genacote, Halfprin, Norwich Aspirin, St. Joseph Aspirin, St. Joseph Aspirin Adult Chewable, Stanback Analgesic, Tri-Buffered Aspirin, Zorprin). Acetaminophen is also commonly found in many different products that are available as over-the-counter (OTC) medications. With the public often using OTC products that contain acetaminophen as well as prescription narcotics that might also have acetaminophen, the U.S. Food and Drug Administration (FDA) has become concerned about dangerous interactions from combining these medications. There is not just the potential for narcotic abuse but the concern that patients are accidentally ingesting too muchacetaminophen from combining these products with the potential for severe liver damage or even death.

The use of prescription pain relievers without a doctor's prescription only for the experience or the feeling it causes is often called "nonmedical" use. Narcotic use is considered abuse when people use narcotics to seek feelings of well-being apart from the narcotic's pain-relief applications.

The U.S. Substance Abuse and Mental Health Services (SAMHSA) report that after marijuana, nonmedical use of painkillers is the second most common form of illicit drug use in the United States. According to SAMHSA, 21% of people age 12 and older (5.2 million individuals) reported using prescription pain relievers nonmedically in 2007. The U.S. Drug Enforcement Agency suggests that the number of people abusing any prescription drugs is even higher at 7 million individuals.

SAMHSA's Drug Abuse Warning Network reported that approximately 324,000 emergency department visits in 2006 involved the nonmedical use of pain relievers (this includes both prescription and over-the-counter pain medications). According to the U.S. Department of Health and Human Services, there were an estimated 90,232 emergency department visits related to narcotic analgesic abuse in 2001.

• Morphine (Avinza, Kadian, Morphine IR, MS Contin, MSIR, Oramorph SR, Roxanol) and codeine are natural derivatives of the opium poppy. Related medications that are semisynthetic include drugs such as heroin, oxycodone(Percocet, Percodan, OxyContin), and hydrocodone and acetaminophen(Vicodin). Synthetic medications in this class include drugs such asmethadone (Diskets, Dolophine, Methadose), meperidine (Demerol), andfentanyl. All medications in this group are called opiates or narcotics. Some chemicals, called endorphins, occur naturally in the body and produce a morphine-like effect.
• The most commonly abused illicit narcotic is heroin, but all prescription narcotics have the potential for abuse. In 2008, the Florida Medical Examiners Commission noted that prescription opioid painkillers (such as Vicodin, Percocet, and OxyContin) caused more deaths than illicit substances such as heroin.

Narcotics have many useful pain-relieving applications in medicine. They are used not only to relieve pain for people with chronic diseases such as cancer but also to relieve acute pain after operations. Doctors may also prescribe narcotics for painful acute conditions, such as corneal abrasions, kidney stones, and broken bones.

When people use narcotics exclusively to control pain, it is unlikely that they become addicted or dependent on them. A patient is given a dosage of opioids strong enough to reduce their awareness of pain but not normally potent enough to produce a euphoric state.

Adequate pain control is the goal for the medical use of narcotics. Thus, patients or health-care professionals should not allow fear of addiction to interfere with using narcotics for effective pain relief.

The difference between opioid abuse, dependence, and addiction

There is somewhat of a continuum between opioid abuse, opioid dependence, and addiction. Individuals who use narcotics to the extent that they start to interfere with the person's ability to do routine activities or fulfill regular responsibilities at home, at school, or at work would be considered to be abusing opioids. Other signs that individuals are abusing opioids include maladaptive behaviors that impact adversely on relationships, worsening of interpersonal problems, or frequent involvement with legal problems related to opioid use.

Individuals who have opioid dependence often will manifest some of the following symptoms.

• Ingestion of larger and larger amounts of opioids or for longer periods of time than intended
• Desire or compulsion to take the drug with significant amount of time spent trying to obtain opioids
• Withdrawal symptoms if the drug is stopped or the amount taken is reduced
• The need for increased amounts of drug to achieve the original effects (tolerance)
• Social, recreational, occupational, or pleasurable activities are neglected
• Persistent use of narcotics even when evidence that is harmful to their body, mood, thinking, or actions
• Addiction is elevated narcotic abuse that becomes a craving, with compulsive need to use opioids and often self-destructive behavior