Along with alcohol, opiates are the oldest known depressants. At one time the term narcotic referred specifically and only to opiates, but when drug control laws were strengthened in the early twentieth century the language of those laws expanded the dictionary definition of narcotic and made it a synonym for all controlled drugs.
Although opiates have various medical uses, the main therapeutic application is pain control. Other common uses are for fighting coughs and reducing diarrhea. Some other therapeutic uses of specific opiates are given in this book’s alphabetical listings of drugs.
The chance of medical opiate usage turning a person into an addict is slim. Very few persons receiving medical opiates find them attractive, and almost all patients who enjoy opiates already have a drug abuse problem. Researchers examined records of 11,882 patients who received narcotics and found 4 with a subsequent addiction problem who lacked a prior drug addiction history. The chance of developing dependence is higher, but a patient can be weaned off opiates in ways that avoid withdrawal symptoms.
Illicit users of opiates generally seek to achieve a mental state of indifference in which problems and frustrations no longer feel bothersome. A person high on opiates is oblivious to the world and unlikely to bother anyone. Some users experience euphoria.
Classic unwanted actions from opiates are constipation, urinary difficulty, low blood pressure, and breathing trouble. MAOI drugs, described earlier, may interact dangerously with opiates. In contrast to such problems, a desirable drug interaction is that opiates may boost pain relief from aspirin.
Originally the phrase “being hooked on a drug” referred to being so resonant with (that is, dependent on) an opiate that a withdrawal syndrome occurred if dosage stopped. Symptoms of opiate withdrawal are similar to those of influenza: sweats, goose bumps, muscle aches, cramps, runny nose, diarrhea, and sleep difficulties. Although conscienceless and irresponsible addicts may be particularly short-tempered and dangerous if undergoing withdrawal, for other persons the experience is miserable, but not horrible, and usually lasts only a few days. Traditionally those few days are the extent of withdrawal, but some authorities believe a subsequent stage of withdrawal occurs in which a person experiences aches, insomnia, and grouchiness for several months. Such symptoms, however, may simply be signs that the psychological buffer provided by opiate use is no longer available.
Drug addiction “maintenance” programs are designed to supply enough drug to hold off withdrawal but not enough to produce recreational sensations. Unless participants supplement the legal dosage with illicit supplies, such persons will not experience opiate effects enjoyed by addicts. Someone on a maintenance dose can adequately perform job duties and safely operate a motor vehicle. Performance may not be as sharp as in a drug-free state, but performance is in the normal range.
Opiates have a wide range of effects on fetal behavior. If a pregnant woman uses opiates regularly the fetus soon adapts to the presence of the drug and seems to develop normally, although an infant can be born resonant with (that is, dependent on) the drug and undergo withdrawal. Intermittent use of opiates is more damaging to a fetus than regular use, with the changing drug environment causing extra stress as a fetus copes with one condition and then another. Opiates cause fetal metabolism to increase, diverting energy away from body development. Infants born to opiate users are commonly smaller than normal, and early slowness of brain development has been observed.
Evidence exists that fetal exposure causes long-lasting problems in children, involving impulsiveness and inattention, but some researchers feel that home environment (often involving a single-parent opiate abuser with additional problems) is a better explanation for those difficulties.
For information about specific opiate class depressants, see alphabetical listings for: buprenorphine, codeine, dihydrocodeine, etorphine, heroin, hydrocodone, hydromorphone, morphine, nalbuphine, opium, oxycodone, pholcodine, and thebaine.