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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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.
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