This document provides an overview of the history and use of narcotics such as opium, morphine, and heroin. It discusses how opium was used medically and recreationally over centuries and led to increased addiction rates. The rise of heroin in the late 19th century and efforts to regulate narcotics through laws and policies are described. The physical, psychological, and social effects of narcotic use and addiction are summarized. Methods of treatment for narcotic addiction including withdrawal, drug therapies, and support groups are also outlined.

1. Albia Dugger • Miami Dade College
Chapter 8
Narcotics

2. History
• Opium-based drugs such as morphine and heroin are referred
to as narcotics
• Throughout history, opium has figured prominently in wars
between nations, the economies of some countries, in
medicine, and in the work of lyricists and authors
• Laudanum, a mixture of opium and alcohol, was developed in
the 1500s by Paracelsus

3. Opium Poppies in Afghanistan

4. History
• By 1906, opium and its derivatives were found in more than
50,000 medicines
• The hypodermic needle hastened the effects of morphine
• By the late 1800s, an estimated 4.59 per 1,000 people were
dependent on opiates
• Ironically, the drug promoted to help people overcome
morphine dependency was heroin

5. History
• The Harrison Act of 1914 made narcotic use without a
prescription illegal
• The typical opiate addict shifted from a middle-class woman
to a young, lower-class man
• Perceptions of the opiate addict went from unfortunate victim
to a deviant criminal who was a threat to society

6. Perceptions of Narcotics
• Narcotics were
advertised as a cure
for addiction to
tobacco

7. Illicit Opium Production

8. Extent of Narcotic Use
• During the 1930s, morphine abuse exceeded heroin abuse –
by the 1940s, heroin addiction was greater
• Heroin use increased greatly beginning in the late 1960s and
early 1970s.
• In 2010, about 200,000 Americans had used heroin in the
previous month
• In the US, more than 800,000 people are addicted to heroin
and other narcotics

9. Students Reporting Heroin Use

10. Extent of Narcotic Use
• Controlled users (chippers) fit the following pattern:
• Seldom used the drug more than once a day
• Could keep opiates around without using them
• Avoided opiates when addicts were present
• Did not use opiates to alleviate depression
• Seldom binged on opiates
• Knew the opiate source or dealer
• Took opiates for recreation or relaxation
• Did not take opiates to escape life’s daily hassles

11. Extent of Narcotic Use
• 68% of heroin addicts admitted into treatment are male, 59%
are White, and ¾ have been in treatment previously
• Increase in abuse is significantly higher in rural areas than in
metropolitan areas
• During the Vietnam War, 10-15% of US troops were addicted
to heroin

12. Worldwide Comparison
• More than 15 million people worldwide illegally use opium,
morphine, and heroin
• Afghanistan is the largest heroin producer worldwide
• China is believed to have the largest number of narcotic
addicts
• An estimated 24 million to 34 million people throughout the
world use opium

13. Characteristics of Narcotics
• Opium poppy
• Plant from which narcotics are derived
• Narcotic
• An opium-based central nervous system depressant used
to relieve pain and diarrhea
• Opiate
• A class of drugs derived from opium
• Opioid
• Drugs with characteristics similar to those of opium

14. Opium
• The opium poppy, Papaver somniferum, is cultivated
throughout Asia and the Middle East
• When the seedpod is cut open, it exudes a white, milky sap
which dries to a brown, thick, gummy resin (opium)
• There is only a ten-day window in which opium can be made
from the resin of the opium poppy

15. Papaver somniferum

16. Morphine
• In 1803, Friedrich Serturner of Germany synthesized
morphine from opium and called it morphium
• Morphine is about ten times more potent than opium,
although physicians thought it was safer and purer
• Codeine was isolated from opium 30 years later
• How morphine is administered and its dosage has a bearing
on its effectiveness

17. Heroin
• Heroin (diacetylmorphine) was first synthesized from
morphine in 1874
• When heroin was introduced, it was believed not to be
addicting
• When smoked, its effects are rapid – it is ineffective when
ingested
• Heroin is three to ten times more powerful than morphine
because it is more lipid-soluble

18. Synthetic Opiates
• Fentanyl (Sublimaze)
• Synthetic narcotic 1,000 times more potent than heroin
• Greater risk of a fatal overdose than heroin
• China white
• Synthetic analgesic drug derived from fentanyl that mimics
heroin but is considerably more potent
• Meperidine
• Synthetic derivative of morphine widely used as an
analgesic – less potent than morphine

19. Synthetic Opiates
• Propoxyphene hydrochloride (Darvon)
• Mild narcotic that has the potential to cause dependence
• Methadone
• Drug given to heroin addicts to block withdrawal effects
and euphoria
• Oxycodone (Percodan)

20. Common Narcotics

21. Synthetic narcotics come in many forms

22. OxyContin
• OxyContin is a particularly strong painkiller that blocks the
pain signals from nerves
• Thousands have become addicted to it – the number of
addicted babies has doubled or tripled over the past decade
• The manufacturer, Purdue Pharma, admits that dozens to
hundreds of people have died from it

23. Physical and Psychological Effects
• Opiates mimic endorphins in the brain
• Physical problems frequently result from using narcotics in
unclean, unsafe environments
• Narcotics often are contaminated with other drugs, sugar,
starch, powdered milk, quinine, or strychnine
• Sharing needles is a major risk for HIV infection

24. Physical Effects
• Narcotics cause drowsiness, vomiting, nausea, and difficulty
concentrating
• Euphoria is followed by gradually anesthetizing sensations,
then sleep and lethargy
• Opiates impede the ability to urinate, and can cause
potentially serious constipation
• Male addicts have difficulty achieving an erection

25. Emotional and Social Effects
• Narcotics relieve psychic distress arising from anxiety,
hostility, feelings of inadequacy, and aggression
• Heroin addicts have difficulty regulating inhibitions and
frequently make risky decisions
• Users sometimes ignore or become alienated and hostile
toward friends and family members
• Heroin use has been associated with criminal behavior,
unemployment, and violence

26. Needle-Exchange Programs
• The second most common HIV risk is injection drug use
• Many health care personnel favor needle-exchange programs
(NEPs) or giving hypodermic needles to addicts at no cost
• One study reported a 5.9% decrease in HIV infection rates in
cities with NEPs
• Congress banned federal funding for NEPs in 1988 and has
since renewed the ban numerous times

27. NEPs retard the spread of HIV/AIDS

28. Dependency
• Physical dependence, psychological dependence, and
tolerance develop quickly
• Withdrawal symptoms include:
• Diarrhea and runny nose
• Insomnia
• Muscle aches and pains
• Dysphoria
• Fatigue
• Anxiety and irritability
• Stomach cramps

29. Dependency
• Factors affecting the difficulty of withdrawal:
• Availability of a social support network
• Addict’s desire to stop
• Physical environment during withdrawal
• Convenience and practicality of alternative opiates
• About half of narcotic abusers become dependent:
• People can become drug-dependent in less than two
weeks if they take increasing amounts of narcotics
• Average addiction is six to eight years

30. Toxicity
• Narcotics are capable of depressing the respiratory system to
the point of death
• According to the CDC, painkillers kill twice as many people as
cocaine and five times more people than heroin
• Synergistic effect of narcotics and other drugs can be fatal
• Death from an overdose of heroin is slow – people who die
quickly are likely to die from anaphylactic shock

31. Medical Benefits
• Analgesics
• Patients receiving morphine are aware of pain, but their
perception and response are altered in positive ways
• Gastrointestinal difficulties
• In less-developed countries, narcotics treat diarrhea that is
a major cause of death among the young and elderly
• Cough suppressant (antitussive)
• Narcotics slow activity of the cough control center
• Nonopiate dextromethorphan is chemically similar

32. Treatment and Support Groups
• The recidivism (relapse) rate for narcotic addiction is high,
but success improves the longer one is off drugs
• Most addicts are withdrawn from narcotics gradually, although
rapid detoxification can be just as effective
• Addicts in withdrawal receive drugs such as clonidine,
buprenorphine, naltrexone, naloxone, or methadone
• Typically, detoxification is completed in 10 to 14 days on an
inpatient basis

33. Narcotic Antagonists
• Drugs that block narcotics from producing their reinforcing
effects are called antagonists
• They remove the physical need for opiates, but not the
psychic need
• Examples are naltrexone, buprenorphine, nalorphine,
naloxone, and cyclazocine

34. Methadone
• Since 1960, methadone has been the drug used most
frequently to treat heroin addiction
• Methadone is highly specific to opiate addiction
• Methadone use leads to addiction, though many people
consider it preferable to heroin addiction
• Methadone has to be administered daily to avert withdrawal
symptoms

35. Levo-alpha-acetylmethadol (LAAM)
• In 1993 the FDA approved an alternative to methadone called
levo-alpha-acetylmethadol (LAAM)
• Can block the withdrawal symptoms for up to 3 days
• LAAM produces fewer withdrawal symptoms than methadone,
and could help patients who do not benefit from methadone
• Individuals taking LAAM are more likely to stay in treatment

36. Narcotics Anonymous
• Modeled on Alcoholics Anonymous, Narcotics Anonymous
(NA) is a self-help group designed to help people who are
addicted to heroin and medically prescribed narcotics
• More than 58,000 group meetings in 2010
• NA addresses all drugs including alcohol