Chapter 203: Narcotic Abuse

Chapter 203: Narcotic Abuse is a topic covered in the Harrison's Manual of Medicine.

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Narcotics, or opioids, are primarily used for pain management, but due to ease of availability individuals procure and misuse these drugs, with dire consequences including opioid use disorder and overdose. Nearly 4 million individuals in the United States are current misusers of pain relievers, and globally opioid misuse causes the greatest global burden of morbidity and mortality; disease transmission; increased health care, crime, and law enforcement costs; and less tangible costs of family distress and lost productivity.

Opioids bind to specific opioid receptors in the CNS and elsewhere in the body. These receptors mediate the opiate effects of analgesia, euphoria, respiratory depression, and constipation. Endogenous opiate peptides (enkephalins and endorphins) are natural ligands for the opioid receptors and play a role in analgesia, memory, learning, reward, mood regulation, and stress tolerance.

The prototypic opiates, morphine and codeine, are derived from the juice of the opium poppy. The semisynthetic drugs produced from morphine include hydromorphone (Dilaudid), diacetylmorphine (heroin), and oxycodone (Oxy-Contin). The purely synthetic opioids and their cousins include meperidine, propoxyphene, diphenoxylate, fentanyl, buprenorphine, tramadol, methadone, and pentazocine. All produce analgesia and euphoria as well as physical dependence when taken in high enough doses for prolonged periods of time.

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