Narcotic Pain Relievers

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What is a narcotic?

A narcotic is a pain-reducing chemical derived from opium (or synthetically produced) with the side effects of euphoria, stupor, and insensibility.

  • Opiate – is a naturally occurring narcotic alkaloid found in the opium poppy plant, such as
    • Morphine
    • Codeine
  • Opioid – any fully or semi-synthetic narcotic (does not come directly from the poppy plant) that has opiate-like activity (made to mimic the effects of an opiate), such as
    • Hydrocodone
    • Oxycodone

The terms opiate and opioid are often used interchangeably, although there is a distinct difference.  But under most circumstances, either term will do.  Opiates will be used in the course to mean both opiates and opioids, unless stated otherwise.

(Alkaloid – a naturally occurring organic nitrogenous molecule that has a pharmacological effect on humans or animals)


How do they work?

Narcotics activate receptors in the body.  When these receptors are activated, there is decreased nerve transmission to the Central Nervous System’s (CNS) centers for pain processing, thus diminishing the feeling of pain.  Our brain produces natural chemicals that do the same thing, but with severe pain, we may need to take narcotics to help relieve most or all of the pain.


Effects of Narcotics

  • Analgesia (pain relief) from most sources of pain. Some pain cannot be relieved with opiates, however.  Pain from some malignant tumors, for example.
  • Euphoria – feelings of well being
  • Sedation – narcotics can cause drowsiness and reduce anxiety.

Take Note:  Some people have the opposite effects to sedation and euphoria.  Narcotics can cause sleeplessness and anxiety in some people.

Narcotics also:

  • Reduce the cough reflex (Tylenol with Codeine is a good example)
  • Cause Nausea and vomiting
  • Cause Constipation – this side effect may be the reason for taking the narcotic. Lomotil is a narcotic used to treat acute diarrhea.  But usually constipation is an unwanted side effect, and stimulant laxatives are prescribed if constipation develops.
  • Judgment and motor skills impairment – for many people, this side effect only lasts a few days until their bodies have adjusted to the narcotic.

Cause dependence and addiction


Treating Narcotic Addiction

Specific drugs help overcome addiction by reducing the symptoms of withdrawal.  These drugs bind more tightly to the receptors than do the analgesics.  These drugs, called opioid antagonists, prevent the drug a patient is addicted to from binding with receptors and producing euphoria. 

Commonly prescribed opioid antagonists include:

  • Methadone satisfies the addict’s opioid receptors without producing euphoria.
  • Buprenorphine is a sublingual drug that prevents opioid withdrawal. This is step one.

Buprenorphine-naloxone is used as a maintenance drug (step two) and is taken 3 to 4 days after taking buprenorphine (step one).  Prescribers must have a special DEA number to prescribe this drug.


Combination Analgesics

Often, the combination of a narcotic and a nonnarcotic oral analgesic helps to relieve pain better than either agent alone.  Pain is being tackled by two different agents and less of each is required to relieve pain. 

However, one must be careful to not take too much aspirin or acetaminophen when taking combination drugs or toxicity can result. No more than 4 mg per day of aspirin or acetaminophen is recommended.

Common combination pain relievers include:

  • Tylenol with Codeine (acetaminophen with codeine)
  • Lortab, Vicodin (hydrocodone with acetaminophen)
  • Percocet (oxycodone with acetaminophen)
  • Percodan (oxycodone with aspirin)

Medications for Anxiety and Panic Disorders

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The major class of medication used to treat anxiety and panic disorders is called benzodiazepine sedative hypnotic anxiolytics. Benzodiazepines are medications that work on the central nervous system (by enhancing the inhibitory effects of GABA) and are used as sedatives (calming effect), hypnotics (sleep aid), and anxiolytics (relieves anxiety).

Benzodiazepines are not for everyday stress and anxiety; they are prescribed for chronic and/or debilitating anxiety, panic disorders, and post-traumatic stress. Because the risk of dependence is high, many doctors prescribe for the short-term only. Not every patient is an ideal candidate for these drugs; those with alcohol or drug dependence have a very high risk of becoming dependent on benzodiazepines. The elderly and others at risk for falls are also at risk because the medications may cause dizziness and impaired cognitive ability.


Commonly Prescribed Benzodiazepines

  • Lorazepam
  • Alprazolam
  • Clonazepam
  • Diazepam
  • Oxazepam
  • Chlordiazepoxide

Benzodiazepines are fast-acting and effective at relieving anxiety, but physical dependence is an all-too-common result of continued use of the medication. Other medications may be prescribed that are not as fast-acting but are unlikely to cause dependence. These medications include buspirone, SSRIs, SNRIs, and tricyclic antidepressants.

Benzodiazepines are the first-line treatment for generalized anxiety disorder and panic disorder. These medications are also used for the following conditions:

  • alcohol withdrawal symptoms
  • insomnia
  • seizure disorders
  • muscle spasms
  • induction of anesthesia

Side Effects of Benzodiazepines

Common Side Effects  - Dizziness, drowsiness, lethargy, antegrade amnesia (difficulty recalling events after taking medication), disorientation, confusion, and disinhibition.

Dependence - occurs less frequently with short-term use.  Long-term users must taper off the drug gradually over several weeks to prevent severe withdrawal symptoms, including anxiety, tremors, profuse sweating, and seizures. Benzodiazepines are classified as a Schedule IV drug.

Long-term users must not stop taking these medications abruptly. Patients must slowly and gradually taper their dose in a prescribed manner in order to prevent severe withdrawal symptoms including seizures. 

Central nervous system depression - CNS depression symptoms include sedation, lightheadedness, and decreased cognitive function. 

Toxicity -  Symptoms of overdose include marked drowsiness, lethargy, and confusion. Gastric lavage (stomach pumping) is often performed in the case of an overdose followed by the administration of activated charcoal. Flumazenil may be administered intravenously as an antidote to counteract the effects of benzodiapine toxicity. 

Mixing benzodiazepines with alcohol or other depressants can be deadly! Respiratory depression is increased when other depressants are used simultaneously.

Paradoxical Reactions - Side effect that is opposite of what is expected:  insomnia, anxiety, and rage. 

May cause paranoid and suicidal ideation.





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