Narcotic drugs have always been associated with addiction; however, narcotic
drugs remain the best agents to relieve pain. Pain management is the reason
people are most likely to seek medical attention. Physicians try to balance
their desire to elevate suffering against concerns that the patient in pain just
wants a drug prescription. The narcotics that are considered to have the
greatest addiction potential include codeine 60 mg, oxycodone, methadone,
hydromorphone, demerol (meperidine), fentanyl, and morphine. The World Health
Organization (WHO) suggested a progressive treatment of pain. For mild pain:
aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs and adjuvants. For
moderate pain: mild opioids. For severe pain: traditional opioids. Acetaminophen
is not an effective drug and has toxic effects at dosages required for any
analgesic effects. NSAIDs are better drugs but also have toxic effects that
constrain their use.
Physicians remain constrained by problems of drug dependence and addiction
and are reluctant to prescribe narcotics or prescribe weak, inferior narcotics
such as codeine and demerol. Weintstein et al polled 386 physicians in Texas and
found that a significant number of physicians had prejudice against the use of
opioid analgesics, displayed lack of knowledge about pain and its treatment, and
had negative views about patients with chronic pain. They suggested that new
educational strategies are needed to improve pain treatment in medical practice.
Physician concerns are justified. Narcotic-dependent people routinely
solicit prescriptions from a number of physicians and become good at feigning
painful conditions. Every primary care physician will have patients who demand
prescriptions for pain relievers and other psychotropic drugs and will become
chronic users, unless the physician steadfastly resists their demands and limits
prescriptions to short term use. Prescribed narcotics are always available for
sale on the street. For example, about two million Americans have admitted taking OxyContin
(oxycodone) illegitimately. The US Drug Enforcement Administration reported that
it is one of the most abused prescription drugs.
Oxycontin and Hydrocodone The narcotic, hydrocodone has a high
potential for abuse. Hydrocodone, as a narcotic cough medicine, is one of the
favorite drugs sought by recreational users when they visit emergency
Fentanyl Fentanyl has become the most dangerous of the narcotic drugs available on the street.
Increasing deaths from Fentanyl use is headline news in 2017. Fentanyl was
developed in 1959 and used first as an anesthetic. For medical use slow-release
transdermal patches for chronic pain relief were introduced in the mid-1990s.
Illicit analogues have been killing people on the streets since the late 1970s
under the name “China White” and more recently as green tablets. Canadians are now the world’s biggest per capita
consumers of legal opioids, with more than 30 million high-dose tablets and
patches distributed every year.
The muscle relaxer, carisoprodol (Soma) is another favorite street drug
which contains a metabolite of meprobamate, an old tranquilizer. Taken with
alcohol, Soma produces stupor or "Soma coma." Tramadol (Ultram) is a pain
medication that can produce a mild euphoric state. Dextromethorphan is a cough
suppressant found in many cough syrups, which produces a euphoric state when
taken in large quantities and can produce visual hallucinations. People who take
opioid analgesics for many days will develop physical dependence and will suffer
withdrawal effects if the drug is discontinued suddenly. Symptoms of withdrawal
include drug cravings, muscle cramps, joint pains, anxiety, nausea and vomiting.
Withdrawal is most intense following IV heroin use and is relatively milder
after taking oral medications.
Street Market in Legal Drugs
Prescribed narcotics are always available for sale on the street. Most
originate with doctors who are lenient prescribers. Drug traffickers have lists
of lenient Doctors who write narcotic prescriptions on demand for a fee.
Prescribed narcotics are always available for sale on the street. For example,
about two million Americans have admitted taking OxyContin (oxycodone)
illegitimately. The US Drug Enforcement Administration reported that it is one
of the most abused prescription drugs. Another narcotic, hydrocodone also has a
high potential for abuse. Hydrocodone, as a narcotic cough medicine, is one of
the favorite drugs sought by recreational users when they visit emergency
departments. Both drugs act on the opioid mu receptor which blocks the
transmission of pain in the spinal cord. In the USA OxyContin is a $1.5 billion
per year product. A report in the New York times from rural Kentucky ( July
2004) provides a perspective on narcotic drug use: “Ever since prescription
painkillers like OxyContin became the drugs of choice among dealers and addicts
in Appalachia, the days of small-town pharmacists' dispensing medicines from
behind an ordinary counter have become a quaint memory. Now many pharmacies have
turned into virtual fortresses. Some have bars over the windows. The most
sought-after drugs are stored in vaults. The pharmacists often work behind
safety glass, and some have even armed themselves. Surveillance cameras and
alarm systems monitor every spot. Dan Smoot, chief detective for Operation
Unite, an anti-drug task force said that prescription drugs remained the top
problem for police agencies in the mountains. Mr. Smoot recently led the largest
drug raid in Kentucky history, arresting over 200 people on charges of buying or
selling prescription drugs on the black market.”
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