Narcotic
Analgesics
(Opiates)
By: Missy Beckwith
This is a fact sheet on the various aspects of Narcotic
Analgesics (Opiates). It describes what opiates are,
effects they have, risks in taking them, and treatment
options if someone is abusing them and addicted.
11/12/2011
Fact Sheet on Narcotic Analgesics (Opiates)
What are Opiates ?
Opiates are a type of narcotic drug that act as depressants in the central nervous system (CNS).
The opiate analgesics block pain signals by attaching to opiate receptors located in various parts
of the body and brain. Opiates come from opium, which can be produced naturally from poppy
plants or derived from semi-synthetic alkaloids. Opiate drugs are extracted from poppies grown
mostly in the Middle East and Southeast Asia. Some of the most common opiates include
morphine, codeine, heroin, hydrocodone and oxycodone.(1) Opiates are a major ingredient in
many different medicines, the result of the beautiful
poppy plant, and the drug comes from a class of drugs
known as opioids. Experts say that opiates are among
the oldest-recorded medications known to man, used
thousands of years ago in cultures around the
world.(2). Opiates are very addictive, both physically
and psychologically. Use for only a short time normally results in addiction. (5)
What some types of Narcotic Analgesics (Opiates)?
Codeine, Thebaine and Morphine are opiates derived from opium; Heroin is an opiate
derived from morphine.
Codeine is an effective cough suppressant and is the most commonly used narcotic in the
world. Combined with non-narcotic fever medicines like aspirin, ibuprofen or
acetaminophen (Tylenol), it is useful for toothaches and other acute pain. Tylenol #3, is a
well-known example of codeine. It was extracted from opium in 1832.
Thebaine is a weak opiate. Chemical modifications of codeine and thebaine have produced
the opioids hydrododone (Vicodin) and oxycodone (Oxycontin), both of which are stronger
than codeine and are popular drugs of abuse.
Morphine is the first medicinal plant alkaloid ever isolated. It was used to kill pain on Civil
War battlefields in the United States in the 1860s, and addiction to it became known as the
"soldier's disease." Morphine is injectable and is a controlled substance in the United States
under the controlled substances act of 1970. Used clinically to treat the pain of heart attack, it
may also be added to spinal and epidural anesthesia for prolonged post-surgery comfort.
Hydromorphone (Dilaudid) is a more potent semi-synthetic opioid derived from morphine.
Morphine was extracted from opium in 1817 by Frederick Serturner.
Heroin is derived from morphine. The chemical acetic anhydride is used in the production of
heroin. Heroin can cross the blood-brain barrier more readily than morphine. The production
and possession of heroin became illegal in the United States in 1924, but it is still a common
street drug. Intravenous administration of heroin exposes you to toxins and blood-borne
pathogens because it is sometimes diluted with food substances or cleansers. Heroin addicts
share needles and engage in criminal behavior to support their habits. (10)
What are some theraputic uses for Narcotic Analgesics (Opiates)?
They can also depress the respiratory system. Doctors often prescribe them for severe or chronic
pain. (5) Drugs that can be classified as opiates are most often used for pain relief, especially
after major surgeries, life-threatening accidents, chronic pain from illnesses such as cancer or
rheumatoid arthritis, difficult childbirths, and other very serious problems. However, opiates in
smaller doses are used for other medical purposes as well, including some diarrhea medications,
severe coughs, and anxiety. They are often combined with other medications in order to alleviate
symptoms while the underlying problem is treated or cured, depending on the situation. (4)
Opiates can appear in many forms: white powder or crystals; small white, yellow or orange pills;
large colorful capsules; clear liquid and dark brown, sticky bars or balls. Heroin accounts for the
majority of illicit opiate abuse.(5)
What are some Prescription and Illicit Opiates and some of their
Street Names?

Opium (illicit)

Heroin (illicit)

Codeine

Fentanyl

Hydrocodone

Methadone

Morphine

Darvocet

Percocet

Vicodin(3)
Narcotic/Opiate Class Drugs
Generic
Name
Trade
Name
Common/Street
Name(s)
fentanyl
Sublimaze
China girl, dance fever,
friend, goodfellas, king
ivory
heroin
(diacetyl
morphine)
none (banned
in U.S.)
brown sugar, H, Henry,
horse, junk, skag, smack
methadone
Dolophine
frizzies
morphine
Duramorph,
Roxanol,
generic
dreamer, hows, M, Miss
Emma
If the prescription is not prescribed to you then it is an illicit drug in those cases. People can be
criminally charged and serve prison time for selling (regardless if they are their own) and using
medications that are not their own.
What are physiological effects from the abuse of opiates, both primary
effects and secondary or side effects?
Some physical indications of opiate use include: extreme loss of appetite and weight, needle
tracks or punctures, black and blue marks from "skin popping", scars along veins, cramps,
nausea, vomiting, excessive scratching and complaint of itching, excessive sweating,
constipation, raw, red nostrils from snorting, runny nose, pin-point pupils and watery eyes,
reduced vision, drowsiness, euphoria, trance-like states, excessive thirst, tremors, twitching,
unkempt appearance, strong body odor, irritability, chills; slight hallucinations and lethargy.
Opiates reduce attention span, sensory and motor
abilities, produce irrational behavior, depression,
paranoia, and other psychological abnormalities. (5)
Even with short term use, patients can experience
one or more side effects. They can include sedation,
euphoria, dizziness, fatigue, depression, tremors,
sleeplessness, anxiousness, flu-like symptoms, upset
stomach, dry mouth, pupil constriction, itching,
hallucination, delirium, sweating, muscle and bone
pain, confusion, extreme irritability and muscle spasms. Taking too much of an opiate
medication, or more frequently than prescribed can be dangerous, even fatal. Combining opiates
with alcohol and some other drugs can also lead to severe reactions. More serious side effects
can include severe respiratory depression, confusion or stupor, coma, clammy skin, circulatory
collapse and cardiac arrest. (6)
Are there Possible Complications from Withdrawal?
Complications include vomiting and breathing in stomach contents into the lungs. This is called
aspiration, and can cause lung infection. Vomiting and diarrhea can cause dehydration and body
chemical and mineral (electrolyte) disturbances.
The biggest complication is return to drug use. Most opiate overdose deaths occur in people who
have just withdrawn or detoxed. Because withdrawal reduces your tolerance to the drug, those
who have just gone through withdrawal can overdose on a much smaller dose than they used to
take. Those withdrawing from opiates should be checked for depression and other mental
illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant
medications should NOT be withheld under the assumption that the depression is only related to
withdrawal, and not a pre-existing condition.
Treatment goals should be discussed with the patient and recommendations for care made
accordingly. If a person continues to withdraw repeatedly, methadone maintenance is strongly
recommended. (8)
How Do Opioids Affect the Brain?
Opioids act by attaching to specific proteins called opioid
receptors, which are found in the brain, spinal cord, and
gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and
spinal cord, they can effectively change the way a person
experiences pain.
In addition, opioid medications can affect regions of the brain
that mediate what one perceives as pleasure, resulting in the
initial euphoria or sense of well-being that many opioids
produce. Repeated abuse of opioids can lead to addiction—a
chronic, relapsing disease characterized by compulsive drug
seeking and abuse despite its known harmful consequences. (7)
What are the Withdrawal Effects from Opiates?
When the drugs are stopped, the body needs time to recover, and withdrawal symptoms result.
Withdrawal from opiates can occur whenever any chronic use is discontinued or reduced.
Symptoms
Early symptoms of withdrawal include:








Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning
Late symptoms of withdrawal include:






Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting
Opioid withdrawal reactions are very uncomfortable but are not life threatening.
Symptoms usually start within 12 hours of last heroin usage and within 30 hours of last
methadone exposure.(8)
What are the Health Risks of Abusing Opiates?
Opiate abuse is associated with serious health conditions, including fatal overdose, spontaneous
abortion, collapsed veins, and, particularly in users who inject the drug, infectious diseases,
including HIV/AIDS and hepatitis.
The short-term effects of Opiate abuse appear soon after a single dose and disappear in a few
hours. After an injection of heroin, the user reports feeling a surge of euphoria ("rush")
accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities. Following this
initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental
functioning becomes clouded due to the depression of the central nervous system. Long-term
effects of heroin appear after repeated use for some period of time. Chronic users may develop
collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease.
Pulmonary complications, including various types of pneumonia, may result from the poor health
condition of the abuser, as well as from heroin's depressing effects on respiration. In addition to
the effects of the drug itself, street heroin may have additives that do not readily dissolve and
result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause
infection or even death of small patches of cells in vital organs. (9)
What are Treatment Approaches to
Opiate Abuse and Dependence?
There is a broad range of treatment options for opiate
addiction, including medications as well as behavioral
therapies. Science has taught us that when medication treatment is integrated with other
supportive services, patients are often able to stop heroin (or other opiate) use and return to more
stable and productive lives. Longer-term treatment is recommended for most people following
withdrawal. This can include self-help groups, like Narcotics Anonymous or SMART Recovery,
outpatient counseling, intensive outpatient treatment (day hospitalization), or inpatient
treatment.(8)
Drug Detoxification is not designed to target other complex aspects of addiction such as
psychological, social or behavioral health. Drug detoxification is using paired up with other
types of therapies to address these issues. There is usually an evaluation process that starts off
drug detoxification to determine if the drug is present in the body and to see if there are any other
medical issues that need to be addressed.
Rapid Detoxification is a “new way to treat an old problem”1 This form of treatment is a rapid
way to treat the drug addiction to bypass the physical withdrawal effects. This sort of treatment
takes place over a matter of hours versus days like traditional detoxification. After-care is crucial
with rapid detoxification.(11)
Methadone maintenance treatment programs is one form of treatment for people who are
addicted to heroin or other opiate drugs. It is also important for people to receive substance abuse
counseling, psychosocial therapies, and other supportive services to enhance retention and
successful outcomes in methadone maintenance treatment programs. Methadone, a synthetic
opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of
success when prescribed at a high enough dosage level for people addicted to heroin. Other
approved medications are naloxone, which is used to treat cases of overdose, and naltrexone,
both of which block the effects of morphine, heroin, and other opiates.
For the pregnant opiate abuser, methadone maintenance combined with prenatal care and a
comprehensive drug treatment program can improve many
of the detrimental maternal and neonatal outcomes
associated with untreated opiate abuse. There is preliminary
evidence that buprenorphine also is safe and effective in
treating heroin dependence during pregnancy, although
infants exposed to methadone or buprenorphine during
pregnancy typically require treatment for withdrawal
symptoms. For women who do not want or are not able to
receive pharmacotherapy for their opiate addiction,
detoxification from opiates during pregnancy can be accomplished with relative safety, although
the likelihood of relapse to opiate use should be considered.
Buprenorphine is another addition to the array of medications now available for treating
addiction to heroin and other opiates. This medication is different from methadone in that it
offers less risk of addiction and can be dispensed in the privacy of a doctor's office. Several other
medications for use in opiate treatment programs are also under study.
There are many effective behavioral treatments available for opiate addiction. These can include
residential and outpatient approaches. Several new behavioral therapies are showing particular
promise for heroin addiction. Contingency management therapy uses a voucher-based system,
where patients earn "points" based on negative drug tests, which they can exchange for items that
encourage healthful living. Cognitive-behavioral interventions are designed to help modify the
patient's thinking, expectancies, and behaviors and to increase skills in coping with various life
stressors. In addition, personal and private drug testing will reinforce the behavior which leads to
discontinuance of opiate/herion use. (9)
References
(1) http://psychology.about.com/od/oindex/g/what-are-opiates.htm
(2) http://www.livestrong.com/article/75425-types-opiate-drugs/#ixzz1dRIKvBoW
(3) http://addictionscience.net/ASNdrugs.htm#OpiateClass
(4) http://www.homemadedrugs.net/opiates
(5) http://www.humordiagnostica.co.za/f_Illicit_Drugs_of_AbuseFAQ.aspx
(6) http://www.opiates.com/prescription-painkillers/prescription-painkillers-side-effects.html
(7) http://www.nida.nih.gov/infofacts/PainMed.html
(8) http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm
(9) http://www.homedrugtestingkit.com/opiates.html
(10) http://www.livestrong.com/article/75425-types-opiate-drugs/
(11) http://www.opiates.com/opiates/opiate-treatment.html