3.3 Narcotics Continued

Psychological Dependence

Use can create psychological dependence. Long after the physical need for the drug has passed, the addict may continue to think and talk about using drugs and feel overwhelmed coping with daily activities. Relapse is common if there are no changes to the physical environment or the behavioral motivators that prompted the abuse in the first place.

Physical Dependence and Withdrawal

Physical dependence is a consequence of chronic opioid use, and withdrawal takes place when drug use is discontinued. The intensity and character of the physical symptoms experienced during withdrawal are directly related to the particular drug used, the total daily dose, the interval between doses, the duration of use, and the health and personality of the user. These symptoms usually appear shortly before the time of the next scheduled dose.

Early withdrawal symptoms often include watery eyes, runny nose, yawning, and sweating. As the withdrawal worsens, symptoms can include:  Restlessness, irritability, loss of appetite, nausea, tremors, drug craving, severe depression, vomiting, increased heart rate, and blood pressure, and chills alternating with flushing and excessive sweating.

However, without intervention, the withdrawal usually runs its course, and most physical symptoms disappear within days or weeks, depending on the particular drug.

What are their Overdose Effects?

Overdoses of narcotics are not uncommon and can be fatal. Physical signs of narcotics/opioid overdose include:

• constricted (pinpoint) pupils
• cold clammy skin, confusion
• convulsions
• extreme drowsiness
• slowed breathing

Which Drugs Cause Similar Effects?

With the exception of pain relief and cough suppression, most central nervous system depressants (like barbiturates, benzodiazepines, and alcohol) have similar effects, including slowed breathing, tolerance, and dependence. What is their legal status in the United States? Narcotics/opioids are controlled substances that vary from Schedule I to Schedule V, depending on their medical usefulness, abuse potential, safety, and drug dependence profile. Schedule I narcotics, like heroin, have no medical use in the U.S. and are illegal to distribute, purchase, or use outside of medical research.

Fentanyl

Heroin

Hydromorphone

Methadone

Morphine

Opium

Oxycodone

What is Fentanyl?

Fentanyl is a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic.

What is its Origin?

Fentanyl was first developed in 1959 and introduced in the 1960s as an intravenous anesthetic. It is legally manufactured and distributed in the United States. Licit fentanyl pharmaceutical products are diverted via theft, fraudulent prescriptions, and illicit distribution by patients, physicians, and pharmacists.

From 2005 through 2007, both fatal overdoses associated with abuse of clandestinely produced fentanyl and law enforcement encounters increased markedly. According to the Centers for Disease Control and Prevention, there were 1,013 fatal overdoses recorded from April 2005 to March 2007. More recently, there has been a re-emergence of trafficking, distribution, and abuse of illicitly produced fentanyl with an associated dramatic increase in overdose fatalities.

What are Common Street Names?

Common street names include:

Apache, China Girl, China Town, Dance Fever, Friend, Good-fellas, Great Bear, He-Man, Jackpot, King Ivory, Murder 8, and Tango & Cash.

What does it Look Like?

Fentanyl pharmaceutical products are currently available in the following dosage forms: oral transmucosal lozenges commonly referred to as fentanyl “lollipops” (Actiq), effervescent buccal tablets (Fentora), sublingual tablets (Abstral), sublingual sprays (Subsys), nasal sprays (Lazanda), transdermal patches (Duragesic), and injectable formulations.

Clandestinely produced fentanyl is encountered either as a powder or in counterfeit tablets and is sold alone or in combination with other drugs such as heroin or cocaine.

How is it Abused?

Fentanyl can be injected, snorted/sniffed, smoked, taken orally by pill or tablet, and spiked onto blotter paper. Fentanyl patches are abused by removing its gel contents and then injecting or ingesting these contents. Patches have also been frozen, cut into pieces, and placed under the tongue or in the cheek cavity. Illicitly produced fentanyl is sold alone or in combination with heroin and other substances and has been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone. According to the National Forensic Laboratory Information System, reports on fentanyl (both pharmaceutical and clandestinely produced) increased from nearly 5,400 in 2014 to over 14,600 in 2015, as reported by federal, state, and local forensic laboratories in the United States.

What is the Effect on the Body?

Fentanyl, similar to other commonly used opioid analgesics(e.g., morphine), produces effects such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

What are the Overdose Effects?

Overdose may result in stupor, changes in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure leading to death. The presence of the triad of symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning.

Which Drugs Cause Similar Effects?

Drugs that cause similar effects include other opioids such as morphine, hydrocodone, oxycodone, hydromorphone, methadone, and heroin.

What is the Legal Status in the Federal Control Substances Act?

Fentanyl is a Schedule II narcotic under the United States Controlled Substances Act of 1970.

In the news

What is Heroin?

Heroin is a highly addictive drug and it is a rapidly acting opioid.

What is its Origin?

Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants grown in Mexico, South America, Southwest Asia (Afghanistan and Pakistan), and Southeast Asia (Thailand, Laos, and Myanmar (Burma).

Heroin comes in several forms, primarily white powder from Mexico and South America; and “black tar” and brown powder from Mexico.

What are Common Street Names?

Common Street Names for Heroin Include:  Big H, Black Tar, Chiva, Hell Dust, Horse, Negra, Smack, and Thunder.

What Does it Look Like?

Heroin is typically sold as a white or brownish powder, or as the black sticky substance known on the streets as “black tar heroin.” Although purer heroin is becoming more common, most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine.

How is it Abused?

Heroin can be injected, smoked, or sniffed/snorted. High purity heroin is usually snorted or smoked.

What is its Effect on the Mind?

Because it enters the brain so rapidly, heroin is particularly addictive, both psychologically and physically. Heroin users report feeling a surge of euphoria or “rush,” followed by a twilight state of sleep and wakefulness.  One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the person must use more heroin to achieve the same intensity. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.

What is its effect on the body?

One of the most significant effects of heroin use is addiction.  With regular heroin use, tolerance to the drug develops. Once this happens, the person must use more heroin to achieve the same intensity. As higher doses of the drug are used over time, physical dependence and addiction to the drug develope.  Effects of heroin use include drowsiness, respiratory depression, constricted pupils, nausea, a warm flushing of the skin, dry mouth, and heavy extremities.

What are its Overdose Effects?

Because heroin users do not know the actual strength of the drug or its true contents, they are at a high risk of overdose or death. The effects of a heroin overdose are slow and shallow breathing, blue lips and fingernails, clammy skin, convulsions, coma, and possible death.

Which Drugs Cause similar Effects?

Other opioids such as OxyContin®, Vicodin®, codeine, morphine, methadone, and fentanyl can cause similar effects as heroin.

What is its legal status in the United States? Heroin is a Schedule I substance under the Controlled Substances Act meaning that it has a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.

Hydromorphone

What is Hydromorphone?

Hydromorphone belongs to a class of drugs called “opioids,” which includes morphine. It has an analgesic potency of two to eight times greater than that of morphine and has a rapid onset of action.

What is its Origin?

Hydromorphone is legally manufactured and distributed in the United States. However, users can obtain hydromorphone from forged prescriptions, “doctor-shopping,” theft from pharmacies, and from friends and acquaintances.

What are the Street Names?

Common street names include:  D, Dillies, Dust, Footballs, Juice, and Smack.

What Does it Look Like?

Hydromorphone comes in tablets, capsules, oral solutions, and injectable formulations.

How is it Abused?

Users may abuse hydromorphone tablets by ingesting them. Injectable solutions, as well as tablets that have been crushed and dissolved in a solution, may be injected as a substitute for heroin.

What is its Effect on the Mind?

When used as a drug of abuse, and not under a doctor’s supervision, hydromorphone is taken to produce feelings of euphoria, relaxation, sedation, and reduced anxiety. It may also cause mental clouding, changes in mood, nervousness, and restlessness. It works centrally (in the brain) to reduce pain and suppress a cough. Hydromorphone use is associated with both physiological and psychological dependence.

What is its Effect on the Body?

Hydromorphone may cause constipation, pupillary constriction, urinary retention, nausea, vomiting, respiratory depression, dizziness, impaired coordination, loss of appetite, rash, slow or rapid heartbeat, and changes in blood pressure.

What are its Overdose Effects?

Acute overdose of hydromorphone can produce: Severe respiratory depression, drowsiness progressing to stupor or coma, lack of skeletal muscle tone, cold and clammy skin, constricted pupils, and reduction in blood pressure and heart rate.  Severe overdose may result in death due to respiratory depression.

Which Drugs cause Similar Effects?

Drugs that have similar effects include: Heroin, morphine, hydrocodone, fentanyl, and oxycodone.

What is its Legal status in the United States?

Hydromorphone is a Schedule II drug under the Controlled Substances Act with an accepted medical use as a pain reliever. Hydromorphone has a high potential for abuse and use may lead to severe psychological or physical dependence.

Methadone

What is Methadone?

Methadone is a synthetic (man-made) narcotic.

What is its Origin?

German scientists synthesized methadone during World War II because of a shortage of morphine. Methadone was introduced into the United States in 1947 as an analgesic (Dolophinel).

What are Common Street Names?

Common street names include:

Amidone, Chocolate Chip Cookies, Fizzies, Maria, Pastora, Salvia, Street Methadone, and Wafer.

What Does it Look Like?

Methadone is available as a tablet, oral solution, or injectable liquid. Tablets are available in 5 mg and 10 mg formulations. As of January 1, 2008, manufacturers of methadone hydro- chloride tablets 40 mg (dispersible) have voluntarily agreed to restrict distribution of this formulation to only those facilities authorized for detoxification and maintenance treatment of opioid addiction, and hospitals. Manufacturers will instruct their wholesale distributors to discontinue supplying this formulation to any facility not meeting the above criteria.

How is it Abused?

Methadone can be swallowed or injected.

What is its Effect on the Mind?

Abuse of methadone can lead to psychological dependence.

What is its Effect on the Body?

When an individual uses methadone, he/she may experience physical symptoms like sweating, itchy skin, or sleepiness. Individuals who abuse methadone risk becoming tolerant of and physically dependent on the drug. When use is stopped, individuals may experience withdrawal symptoms including: Anxiety, muscle tremors, nausea, diarrhea, vomiting, and abdominal cramps.

What are its Overdose Effects?

The effects of a methadone overdose are slow and shallow breathing, blue fingernails and lips, stomach spasms, clammy skin, convulsions, weak pulse, coma, and possible death.

Which Drugs cause Similar Effects?

Although chemically unlike morphine or heroin, methadone produces many of the same effects.

What is its Legal Status in the United States?

Methadone is a Schedule II drug under the Controlled Substances Act. While it may legally be used under a doctor’s supervision, its non-medical use is illegal.

Morphine

What is Morphine?

Morphine is a non-synthetic narcotic with a high potential for abuse and is derived from opium. It is used for the treatment of pain.

What is its Origin?

In the United States, a small percentage of the morphine obtained from opium is used directly for pharmaceutical products. The remaining morphine is processed into codeine and other derivatives.

What are Common Street Names?

Common street names include Dreamer, Emsel, First Line, God’s Drug, Hows, M.S., Mister Blue, Morf, Morpho, and Unkie.

What Does it Look Like?

Morphine is marketed under generic and brand name products, including: MS-Contin, Oramorph SR, MSIR, Roxanol, Kadian, and RMS.

How is it Abused?

Traditionally, morphine was almost exclusively used by injection, but the variety of pharmaceutical forms that it is marketed as today support its use by oral and other routes of administration.

Forms Include:

Oral solutions, immediate-and extended-release tablets and capsules, and injectable preparations.  Those dependent on morphine prefer injection because the drug enters the bloodstream more quickly.

What is its Effect on the Mind?

Morphine’s effects include euphoria and relief of pain. Chronic use of morphine results in tolerance and physical and psychological dependence.

What is its Effect on the Body?

Morphine use results in relief from physical pain, a decrease in hunger, and inhibition of the cough reflex.

What are its Overdose Effects?

Overdose effects include cold and clammy skin, lowered blood pressure, sleepiness, slowed breathing, slow pulse rate, coma, and possible death.

Which Drugs Cause Similar Effects?

Drugs causing similar effects as morphine include opium, codeine, heroin, methadone, hydrocodone, fentanyl, and oxycodone.

What is it’s Legal status in the United States?

Morphine is a Schedule II narcotic under the Controlled Substances Act.

What is Opium?

Opium is a highly addictive non-synthetic narcotic that is extracted from the poppy plant, Papaver somniferum. The opium poppy is the key source for many narcotics, including morphine, codeine, and heroin.

What is its Origin?

The poppy plant, Papaver somniferum, is the source of opium. It was grown in the Mediterranean region as early as 5000 B.C. and has since been cultivated in a number of countries throughout the world. The milky fluid that seeps from its incisions in the unripe seedpod of this poppy has been scraped by hand and air-dried to produce what is known as opium.

A more modern method of harvesting for pharmaceutical use is by the industrial poppy straw process of extracting alkaloids from the mature dried plant (concentrate of a poppy straw). All opium and poppy straw used for pharmaceutical products are imported into the United States from legitimate sources in regulated countries.

What are Common Street Names?

Common street names include Ah-pen-yen, Aunti, Aunti Emma, Big O, Black Pill, Chandoo, Chandu, Chinese Molasses, Chinese Tobacco, Dopium, Dover’s Powder, Dream Gun, Dream Stick, Dreams, Easing Powder, Fi-do-nie, Gee, God’s Medicine, Gondola, Goric, Great Tobacco, Guma, Hop/hops, Joy Plant, Midnight Oil, Mira, O, O.P., Ope, Pen Yan, Pin Gon, Pox, Skee, Toxy, Toys, When-shee, Ze, and Zero.

What Does it Look Like?

Opium can be a liquid, solid, or powder, but most poppy straw concentrate is available commercially as a fine brownish powder.

How is it Abused?

Opium can be smoked, intravenously injected, or taken in pill form. Opium is also abused in combination with other drugs. For example, “Black” is a combination of marijuana, opium, and methamphetamine, and “Buddha” is potent marijuana spiked with opium.

What is its Effect on the Mind?

The intensity of opium’s euphoric effects on the brain depends on the dose and route of administration. It works quickly when smoked because the opiate chemicals pass into the lungs, where they are quickly absorbed and then sent to the brain. An opium “high” is very similar to a heroin “high”; users experience a euphoric rush, followed by relaxation and the relief of physical pain.

What is its Effect on the Body?

Opium inhibits muscle movement in the bowels leading to constipation. It also can dry out the mouth and mucous membranes in the nose. Opium use leads to physical and psychological dependence and can lead to overdose.

What are its Overdose Effects?

Overdose effects include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, and possible death.

Drugs that Cause Similar Effects Include:

Morphine, codeine, heroin, methadone, hydroquinone, fentanyl, and oxycodone.

What is its Legal Status in the United States?

Opium is a Schedule II drug under the Controlled Substances Act. Most opioids are Schedule II, III, IV, or V drugs. Some drugs that are derived from opium, such as heroin, are Schedule I drugs.

Oxycodone

What is Oxycodone?

Oxycodone is a semi-synthetic narcotic analgesic and historically has been a popular drug of abuse among the narcotic abusing population.

What is its Origin?

Oxycodone is synthesized from thebaine, a constituent of the poppy plants.

What are Common Street Names?

Common street names include: Hillbilly Heroin, Kicker, OC, Ox, Roxy, Perc, and Oxy.

What Does it Look Like?

Oxycodone is marketed alone as OxyContin in 10, 20, 40 and 80 mg extended-release tablets and other immediate-release capsules like 5 mg OxyIR. It is also marketed in combination products with aspirin such as Percodan or acetaminophen such as Roxicet or Percocet. (Note: when acetaminophen is added to a drug, it often gets the suffix “cet.”)

How is it Abused?

Oxycodone is abused orally or intravenously. The tablets are crushed and sniffed or dissolved in water and injected. Others heat a tablet that has been placed on a piece of foil then inhale the vapors.

What is its Effect on the Mind?

Euphoria and feelings of relaxation are the most common effects of oxycodone on the brain, which explains its high potential for abuse.

What is its Effect on the Body?

Physiological effects of oxycodone include pain relief, sedation, respiratory depression, constipation, papillary constriction, and cough suppression. Extended or chronic use of oxycodone containing acetaminophen may cause severe liver damage. 

What are its Overdose Effects?

Overdose effects include:  Extreme drowsiness, muscle weakness, confusion, cold and clammy skin, pinpoint pupils, shallow breathing, slow heart rate, fainting, coma, and possible death.

Which Drugs cause Similar Effects?

Drugs that cause similar effects to Oxycodone include opium, codeine, heroin, methadone, hydrocodone, fentanyl, and morphine.

What is its Legal Status in the United States?

Oxycodone products are in Schedule II of the Controlled Substances Act.

Source:  Drugs of Abuse: A DEA resource guide (DEA, 2017)