The Dark Side of opioids/Narcotics drugs: Misuse, Addiction, and Societal Impact..pharmacyteach.com

   

             

1.  

Introduction:

i.            Definition:

                    The class of substances that have the potential to induce sleepiness, dull the senses, and relieve pain are called narcotics or narcotic drugs. These substances are derived from or chemically related to opium, which is extracted from the opium poppy plant. They often have a sedative effect on the central nervous system and can be habit-forming or addictive when used improperly.

For Example; Opioids, Morphine, Heroin, and Codeine.

 

ii.            Importance of Understanding Narcotics:

                                          The knowledge or importance of understanding narcotics is essential for public health, safety, and individual well-being. It supports informed decision-making, promotes responsible drug use, and informs public policies and strategies aimed at reducing the harm associated with narcotics.

iii.            Purpose of Article:

                          The purpose of this article is to give detailed information about narcotic drugs, their types, medical uses, side effects, misuse and abuse, and narcotic drug laws and regulations.

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classification of antibiotics 

2) History of Narcotic Drugs:

A) Early use of Narcotics:

Ancient Egyptians: They used opium for medicinal purposes. Opium poppies were cultivated, and opium preparations were used as remedies for various ailments, including pain relief. Opium was also used in the mummification process.

Ancient Greece: In ancient Greece, opium was known for its pain-relieving properties, and it was used in various medical treatments. The term "narcotic" is derived from the Greek word "narkotikos," which means "numbing" or "deadening."

Ancient China: Opium was used in traditional Chinese medicine as early as the 7th century BCE. It was considered valuable for its therapeutic effects and was used to treat conditions such as pain, diarrhea, and dysentery.

          B) Evolution of Narcotic Drug Trade:

                                  The evolution of the narcotic drug trade is marked by ongoing efforts to regulate and control these substances due to concerns about addiction, health risks, and the societal impact of drug abuse. However, the trade has adapted to changing circumstances and continues to pose significant challenges to governments and law enforcement agencies worldwide.

The key stages in the evolution of the narcotic drug trade are:

• ·         Early Trade and Medicinal Use (Ancient Times): Narcotic substances, such as opium, were traded and used for medicinal and ritualistic purposes in ancient civilizations like Mesopotamia, Egypt, Greece, and China. These early trade networks were localized and primarily for regional consumption.

• ·         Colonialism and the Opium Trade (17th to 19th Centuries): The opium trade expanded significantly during the colonial era. European colonial powers, particularly the British, established opium trade routes with Asia, most notably with China.

• ·         Development of New Opioids (19th Century): The 19th century saw the development of potent opioid drugs like morphine and heroin. Morphine, derived from opium, was widely used for pain relief during the American Civil War. Heroin, initially marketed as a non-addictive alternative to morphine, was later recognized as highly addictive.

• ·         Early Regulation and Control (Late 19th to Early 20th Century): Concerns about addiction and the negative societal impact of narcotics led to early attempts at regulation. The U.S. Pure Food and Drug Act of 1906 required the labeling of medicines containing opiates and cocaine.

• ·         International Drug Control (20th Century): The 20th century marked the internationalization of efforts to control narcotic substances. The Single Convention on Narcotic Drugs of 1961 and subsequent international agreements aimed to establish a framework for global control of narcotics.

• ·         Changing Drug Landscape (21st Century): The 21st century has seen shifts in drug preferences, with the emergence of new synthetic drugs, such as synthetic opioids and designer drugs. These substances pose new challenges for law enforcement and public health.

      C) Regulatory measures and control:

                   The regulatory measures and control of narcotics are essential to manage the use, distribution, and impact of these substances, which have the potential for abuse, addiction, and harm to individuals and society. These measures are typically implemented at both national and international levels and involve various strategies and policies.   

Some of them are;

1.      Dispense only on prescription

2.      Dispense the exact amount written by a physician

3.      Follow pharmaceutical guidelines

4.      Follow pain management guidelines

5.      Patient Monitoring

6.      Law enforcement

7.      Public Education

3) Types of Narcotic Drugs:

types of narcotics 

              I.      Natural Narcotics:

                 The term "natural narcotics" typically refers to substances derived from natural sources that have narcotic or sedative effects on the central nervous system. These substances can induce feelings of relaxation, pain relief, and euphoria, but they also carry a high potential for addiction and abuse of relaxation, pain relief, and euphoria, but they also carry a high potential for addiction and abuse.

 

a)    Opium:

           It is derived from the sap of the opium poppy (Papaver somniferum), made into a liquid, powder, or solid. The opium poppy is a crucial source of many narcotics. Opium contains alkaloids like morphine and codeine, which are potent pain relievers and central nervous system depressants.

b)   Morphine: 

          Morphine is one of the primary alkaloids found in opium. It is a powerful painkiller used in medical settings for severe pain relief.

c)    Heroin:

          It is an opiate (narcotic) drug processed from morphine and extracted from certain poppy plants. Heroin comes in a white or brownish powder or a black sticky substance known as “black tar heroin.” It is highly addictive and illegal in most countries due to its potential for abuse.

                 II.     Synthetic Narcotics:

                Synthetic narcotics, also known as synthetic opioids, are a category of drugs that are chemically synthesized in a laboratory and designed to mimic the effects of natural narcotics, such as opium-derived compounds like morphine and codeine. These synthetic opioids are created by altering the chemical structure of the original molecules to produce substances that may have similar pain-relieving and sedative properties but can vary in potency and other characteristics.

 

a.     Fentanyl:

Fentanyl is a synthetic opioid that is much more potent than morphine or heroin. It is often used in medical settings for severe pain management, especially in surgical procedures.

 

b.    Methadone:

 Methadone is a synthetic opioid primarily used in medication-assisted treatment (MAT) for opioid addiction. It helps reduce withdrawal symptoms and cravings, allowing individuals to transition away from more potent opioids.

 

c.     Synthetic Cannabinoids:

   Synthetic cannabinoids, often referred to as "synthetic marijuana" or "spice," are a class of drugs designed to mimic the effects of naturally occurring cannabinoids, such as THC (delta-9-tetrahydrocannabinol), which is the psychoactive compound found in marijuana. These synthetic compounds are typically sprayed onto plant material and sold as a smoking blend or in liquid form for use in e-cigarettes or vaporizers. They can be much more potent and have unpredictable effects on users.

 

 

4) Medical Uses of Narcotics:

      The medical uses of narcotics are;

a)    Pain Management:

o   Acute Pain Management: Opioids are often used to manage acute pain, which is typically short-term and results from injuries, surgeries, or medical procedures. They can provide effective pain relief during the immediate postoperative period or following trauma.

o   Chronic Pain Management: In some cases, opioids are prescribed to individuals with chronic pain conditions that are unresponsive to other treatments. Chronic pain conditions, such as cancer pain or severe neuropathic pain, may require long-term opioid therapy.

o   End-of-Life Care: Opioids are commonly used in palliative care and hospice settings to provide comfort and pain relief to individuals with terminal illnesses. They can improve the quality of life for patients in their final stages of life.

o   Pain in Non-Surgical Settings: Opioids can be prescribed for non-surgical conditions, such as severe back pain or kidney stones, when other pain management strategies are insufficient.

b)    Anesthesia:

    They are commonly used in anesthesia to achieve various goals during surgical procedures. Anesthesia aims to provide pain relief, sedation, and muscle relaxation, ensuring the patient is comfortable and unconscious during surgery.

 

o   Pain Management: Opioid narcotics are potent analgesics, meaning they are effective at relieving pain. Opioids are administered to reduce pain during and after surgery.

o   Sedation: Opioids can contribute to sedation or a state of calm and relaxation. They work in conjunction with other anesthetic agents to maintain the patient's unconsciousness and reduce awareness of the surgical procedure.

o   Blunting Stress Response: Surgical procedures can induce stress responses in the body, which can lead to increased heart rate, blood pressure, and other physiological changes. Opioids help dampen these responses, promoting hemodynamic stability during surgery.

o   Muscle Relaxation: Some opioids, when used in conjunction with other medications, contribute to muscle relaxation. This effect can be beneficial during surgical procedures where muscle relaxation is required, such as abdominal or thoracic surgeries.

 

c)    Treatment of Opioid Addiction:

           The treatment of opioid addiction, also known as opioid use disorder (OUD), typically involves a combination of medical, psychological, and social interventions. Opioid addiction is a complex condition, and successful treatment often requires a comprehensive and individualized approach.

 

The following are some critical components for its treatment;

1)      Medication-Assisted Treatment (MAT):

                   MAT is considered one of the most effective approaches for opioid addiction treatment. It involves the use of FDA-approved medications to reduce cravings, prevent withdrawal symptoms, and stabilize individuals with OUD.

 Common medications used in MAT include:

Ø  Methadone

Ø  Naltrexone

Ø  Buprenorphine

 

2)      Counseling and Behavioral Therapies:

·         Behavioral therapies, such as Cognitive-Behavioral Therapy (CBT), Contingency Management, and Motivational Interviewing, are essential components of OUD treatment.

·         Counseling helps individuals address the psychological and social aspects of their addiction, develop coping strategies, and make positive behavioral changes.

 

3)      Support Groups:

   Participation in support groups, such as Narcotics Anonymous (NA) or SMART Recovery, can provide valuable peer support, encouragement, and a sense of community for individuals in recovery.

 

4)      Medical and Mental Health Care:

   Comprehensive healthcare is essential, as individuals with OUD may have other medical or mental health issues that need attention. Treating co-occurring conditions is crucial for long-term recovery.

 

5)      Relapse Prevention:

    Learning relapse prevention strategies is a key aspect of treatment. Individuals in recovery work on identifying triggers and developing skills to prevent relapse.

 

6)      Family and Social Support:

     Involving family members and loved ones in the treatment process can be beneficial. Family therapy and support can help rebuild relationships and create a stable support network for the individual in recovery.

 

7)      Recovery Planning:

      Creating a personalized recovery plan with clear goals and strategies for maintaining abstinence is essential. This plan should be adaptable to the individual's changing needs and circumstances.

 

8)      Long-Term Follow-Up:

       Opioid addiction is a chronic condition, and long-term follow-up care is crucial to monitor progress and provide ongoing support

 

 

5) The Dark Use of Opioids/Narcotics: Misuse and Abuse

a) Addiction and Dependency:

                   The repeated over and misuse of narcotics causes its addiction. Addiction is a condition in which something that started as pleasurable now feels like something you can't live without, it is an irresistible craving for a drug, and continued use of the drug causes harmful consequences.

Narcotics can lead to both physical and psychological dependence. Physical dependence occurs when the body becomes reliant on the drug to function normally. Psychological support involves a strong craving or compulsion to use the drug to achieve the desired effect.

Prolonged narcotics use can lead to serious health issues, including respiratory depression (slowed breathing), constipation, and weakened immune function. Overdoses can be fatal, as they can cause respiratory failure.

 

 The Known risk factors of narcotics misuse and addiction include:

·         Poverty

·         Unemployment

·         Family history of substance abuse

·         Personal history of substance abuse

·         Mental disorder

·         Heavy tobacco use

·         History of severe depression or anxiety

·         Stressful circumstances

·         Prior drug or alcohol rehabilitation

b) Health Consequences:

Some of the key health consequences associated with narcotics are:

o   Respiratory Depression: One of the most immediate and life-threatening effects of opioids is respiratory depression, where breathing becomes slow and shallow. In severe cases, it can lead to respiratory arrest, oxygen deprivation, and death.

o   Constipation: Opioids are known for their constipating effects, which can lead to chronic constipation and bowel problems. This can be especially problematic for individuals who use opioids over an extended period.

o   Infectious Diseases: Injecting opioids using shared needles can increase the risk of contracting infectious diseases such as HIV and hepatitis B and C. This is a significant concern in communities with high rates of injection drug use.

o   Mental Health Effects: Opioid use can contribute to or exacerbate mental health conditions like depression and anxiety. The cycle of addiction can lead to worsening mental health and vice versa.

o   Physical Health Complications: Prolonged opioid use can lead to various physical health issues, including hormonal imbalances, immune system suppression, and increased susceptibility to infections.

o   Nasal and Pulmonary Issues: Snorting opioids can lead to damage to the nasal passages, including perforations, as well as pulmonary issues due to the inhalation of powder residues.

o   Neonatal Abstinence Syndrome (NAS): Pregnant individuals who use opioids can pass the drugs to their unborn babies, leading to neonatal abstinence syndrome. NAS can cause withdrawal symptoms in newborns, including irritability, feeding difficulties, and seizures.

c)  Societal Impacts:

                         It affects society in many ways;

1.      Worsening mental health issues

2.      Increasing violent crimes

3.      Destroying families

4.      Financial distress

5.      Loss of employment

6.      Unexpected expenses for related health issues

 

6) Narcotics Drug Law and Regulations:

a) International Agreement:

o   Single Convention on Narcotic Drugs (1961): This is one of the most important international treaties related to narcotic drugs. It established the framework for the control of the production and distribution of narcotic drugs, including opiates, cannabis, and synthetic opioids.

o   Convention on Psychotropic Substances (1971): This treaty focuses on the control of psychotropic substances, which are drugs that have the potential for abuse and can produce effects on mental functioning.

o   United Nations Office on Drugs and Crime (UNODC): The UNODC is a key agency responsible for implementing and coordinating international efforts to combat drug trafficking and abuse. It provides technical assistance and supports member states in implementing international drug control conventions.

o   International Narcotics Control Board (INCB): The INCB is an independent, quasi-judicial body established by the Single Convention on Narcotic Drugs. Its primary role is to monitor and promote compliance with international drug control treaties. It assesses the production and distribution of narcotic drugs and psychotropic substances and issues recommendations to member states to ensure compliance.

o   1972 Protocol Amending the Single Convention on Narcotic Drugs: This protocol, also known as the "Flexible System," allows for the addition of new substances to the schedules of controlled drugs and adaptations to changing drug trends while maintaining the vital principles of the Single Convention.

b) National and State Laws:

           Following are some common elements of national and state-level narcotic drug laws and regulations:

1.      Classification of narcotic drugs

2.      Prescription and Dispensing

3.      Drug Scheduling

4.      Licensing and Registration

5.      Record-Keeping and Reporting

6.      Prescription Monitoring Programs (PMPs)

7.      Criminal Penalties

8.      Treatment and Rehabilitation

 

C) Enforcement and Penalties:

          Enforcement and penalties related to narcotic drug laws and regulations can vary significantly from one jurisdiction to another. These laws are primarily designed to deter and punish illegal activities involving narcotic drugs, such as possession, trafficking, manufacturing, and distribution.

 

7) Treatment and Rehabilitation:

              The treatment and rehabilitation of narcotics include;

        

The treatment and rehabilitation of narcotics

 

               a)     Detoxification:

            Detoxification is a critical first step in the journey to recovery from narcotics or opioids. However, it is not a standalone treatment for addiction, it is usually followed by other comprehensive addiction treatment programs that include counseling, therapy, and ongoing support that are necessary to address the psychological, behavioral, and social aspects of addiction and promote long-term recovery.

    Some of the key points about the detoxification process for narcotics include;

1.      Medical supervision

2.      Assessment

3.      Medication-Assisted Treatment (MAT)

4.      Supportive Care

5.      Duration of therapy

6.      Withdrawal symptoms

7.      Psychological Support

8.      Aftercare Planning

9.      Relapse Prevention

10.  Individualized Treatment

 

         b)    Behavioral Therapy:

        Behavioral therapy is an essential component of the treatment for individuals with narcotics or opioid use disorders. These therapies aim to help individuals modify their behaviors, thoughts, and attitudes related to drug use, thereby promoting abstinence and supporting long-term recovery.

 Several evidence-based behavioral therapies have been developed to address narcotics addiction effectively, some of the most commonly used behavioral therapies for narcotics addiction are;

1.      Cognitive-Behavioral Therapy (CBT):

            CBT is a widely used and evidence-based therapy that helps individuals identify and change negative thought patterns and behaviors associated with drug use. It focuses on understanding the triggers for drug use, developing coping strategies, and setting goals for sobriety.

 

2.      Contingency Management (CM):

             CM is a behavior-based therapy that involves providing solid rewards or reasons to individuals for meeting specific treatment goals, such as remaining drug-free and attending counseling sessions.

 

3.      Motivational Interviewing (MI):

               MI is a client-centered therapy that focuses on exploring and resolving uncertainty about change. It aims to enhance an individual's motivation to quit drug use and participate in treatment.

 

4.      12-Step Facilitation Therapy:

             This therapy is based on the principles of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It involves participation in 12-step meetings, acknowledgment of powerlessness over addiction, and engagement with a supportive recovery community.

 

5.      Family Therapy:

             Family therapy involves the participation of family members in the treatment process. It aims to improve family dynamics, communication, and support for the individual in recovery.

 

 

      c)    Support Groups:

     Support groups for individuals struggling with narcotics or opioid addiction play a vital role in the recovery process. These groups offer a safe and non-judgmental environment where individuals can share their experiences, receive support, and learn from others who are facing similar challenges.

Following are some well-known support groups for narcotics addiction;

1.      Narcotics Anonymous (NA)

2.      SMART Recovery

3.      LifeRing Secular Recovery

4.      Celebrate Recovery

5.      Women for Sobriety (WFS)

6.      Dual Recovery Anonymous (DRA)

7.      Online Support Groups

      

      The effectiveness of support groups can vary depending on individual preferences and needs. Some individuals may find one group more helpful than another, and it's not uncommon for individuals to try multiple groups before finding the right fit. In many cases, combining support group attendance with professional treatment and therapy can be highly effective in achieving and maintaining recovery from narcotics addiction.