From: ADrugs and their Effects@ by the National Information Service on Drug Abuse.

 

The narcotics or opiates relieve pain and In high dates can cause sleep. They include opium, morphine and codeine. Heroin is also a narcotic and is obtained from morphine. Pethidine and methadone are synthetic drugs with a morphine- like action.

Opium comes from the seed pod of the opium poppy plant, Papaver somniferum. Opium eating was known in Asia for thousands of years, but the practice of smoking opium developed. in China only after tobacco was introduced. Morphine was isolated from opium at the beginning of the 19th century. It was named after Morpheus, the Greek god of dreams. 'Heroin which is produced by the chemical alternation of morphine, was discovered in 1874, and Is 2-3 times stronger than morphine.

The narcotics, and especially morphine, have proved very useful for their analgesic or pain-killing effects. However, a major difficulty with the narcotics is that they can produce an intense physical dependence. This brings about a continued need to use the drug. Search has continued for some newer, safer analgesic which is 1ess likely to be abused.

As a result, methadone and pethidine were introduced with Buprenorphine (see web page Methadone Maintenance versus Buprenorphine Maintenance) being trial in Queensland at the present. At first it was thought that these drugs would not cause a problem of physical dependence. Unfortunately it has not turned out this way and these drugs are now also abused.

Because of its greater strength, heroin has been the narcotic of choice for the illegal (street) user. However, any of the other narcotics may be used instead if heroin is in short supply.

MEDICAL USE

There is a considerable difference in strength between the various narcotics, but they can all produce similar affects if the dose is suitably adjusted. The most valuable property of the narcotics is their ability to relieve pain. They do not actually stop the pain. but alter a person's reaction to it, so that it does not bother him as much. Some of the narcotics are also used in small doses to relieve diarrhoea and to reduce cough. In some States, methadone is used to treat narcotic dependence.

IMMEDIATE EFFECTS

The appeal of the narcotics lies in their ability to produce a sense of well-being. Low doses may produce feelings of warmth, peacefulness, contentment and happiness. Higher doses may produce a pleasant dream-like state and sleep. In addition, drowsiness, dizziness, inability to concentrate, apathy and lethargy can occur.

Physical responses include a general slowing down of breathing, constriction of pupils, warming of the skin, increased perspiration, constipation, nausea and sometimes vomiting. An overdose may lead to shock, coma and death.

TOLERANCE AND DEPENDENCE

Regular use of narcotics quickly leads to psychological dependence and the development of tolerance and physical dependence. As tolerance develops, the 'high' is lost. The user needs the drug just to feel normal and avoid withdrawal sickness. This leads to an overwhelming compulsion to continue drug use.

Withdrawal symptoms usually develop within 6.-12 hours after drug use is stopped. Restlessness and depression become more evident with symptoms reaching their peak intensity at 2-3 days following the last dose. However, for long-acting narcotics such as methadone, buprenorphine symptoms may not appear for several days. Restlessness, yawning, chills, short jerky breathing, cramps, vomiting and diarrhoea, running nose and eyes, muscle aches, and jerks and tremor can occur. In more severe cases.. terrifying hallucinations develop.

Narcotics themselves cause little direct physical damage apart from some problems occurring because of persistent constipation and reduced sex drive.

However, in most cases where the use of illegal narcotics is involved, much more serious problems can arise. Once a person is dependent on narcotics, he will go to great lengths to keep up his supply of the drug. The cost of obtaining illegal narcotics is very high, and narcotic users often turn to crime to support their habit. The habitual user thus often becomes involved in a life-style which includes unhygienic living conditions, poor eating habits and inadequate general medical care. Use of street samples, which are usually contaminated, and unsterile and shared syringes are additional problems the habitual user faces. Commonly reported disorders in such users include hepatitis, tetanus, heart and lung abnormalities, scarred veins, local skin infections, ulcers and abscesses. Serious lung damage and death may result from injection of insoluble materials such as chalk or talc which are sometimes found in illicit heroin.

Narcotic analgesics have an effect both on the female menstrual cycle, and associated fertility. Many female opiate users thus have menstrual disorders and experience some difficulty failing pregnant. Therefore, pregnant women or women considering having a child need to consult their doctor about their current or potential drug use. Infants born to mothers who are dependent may show signs of withdrawal. These signs include irritability, sneezing, yawning, vomiting, tremors and increased respiratory rate. The opportunity to provide prenatal care for the mother lessens the possibility of mortality and morbidity in the foetus.

That the Federal Department of Health and the Queensland Alcohol, Tobacco and other Drug Services branch of the Health Department evaluate the Ultra Rapid Opiate Detoxification using Naltrexone Induction under General Anaesthesia for best practice (See Web Page Rapid Opiate Detoxification Using Naltrexone Under General Anaesthesia.) Note Dr George O=Neil paper 9^th January 1998. Dr George O=Neil has in the last 18 months treated more than 1,000 people in W.A. The death rate from heroin overdose in Perth W.A. has dropped by seven per cent. There=s no doubting the fact that Dr O=Neil treating 1,000 people has been a factor in the down turn in deaths. UROD treatment is for those who have a support network, recognising that what happens to patients after detoxification is often more important than what happens during it.

(1). Naltrexone Detoxification Induction under General Anaesthesia for addicts who pre detox evaluation identify indicators of good prognosis of benefit from Naltrexone treatment.

(2). Recognising that what happens to patients after detoxification is often more important than what happens during it.

(3). The patient has a support network for a drug free recovery.

(4). Naltrexone Maintenance/Rehabilitation Program/Follow-up Urinalysis/Evaluation of clinical outcomes for the most safe and cost effective method for Rapid Opiate Detoxification using Naltrexone under general anaesthesia.