2 NON-NARCOTIC ABUSE In recent years, a number of synthetic, non-narcotic drugs have been receiving the attention of the abuser. Stimulants (like the amphetamine* drugs) and depressants (like the barbiturates) head the list. Certain tranquilizers are also increasingly used for nonmedical purposes. Abuse of the hallucinogenic agents has received considerable publicity. Many of these non-narcotic drugs are important—even essential— in the practice of medicine; they are, in fact, far more widely prescribed by doctors than are the narcotics. (The hallucinogens are an exception; no useful medical application has been demonstrated.) The medical need for abusable drugs requires that they be manufactured in large quantities by many manufacturers and widely distributed. In spite of the many security precautions of the drug distribution chain, a system of such complexity and size provides many opportunities for illegal diversion. Abuse can be found in all age groups and social classes. People who would be repelled at the thought of using marihuana, or who use alcohol with discretion, may have no qualms about abusing barbiturates or amphetamine. So far, the social stigma attached to the abuse of the narcotics has not become a part of the barbiturate and amphetamine abuse picture. TERMINOLOGY For years the term "addiction" has been reserved for drugs causing physical dependence and the term "habituation" has been applied to drugs which produce only psychological dependence. Since these terms have often been used interchangeably, there is considerable confusion as to which drugs actually cause physical dependence. Recognizing this situation, the World Health Organization's *Drug products prescribed by physicians usually have two names: a generic name and a chemical name. The generic name identifies the pure drug itself: for instance, amphetamine sulfate, a drug used to treat overweight and mild depression. The chemical name describes the chemical structure of the drug molecule. For amphetamine sulfate, the chemical name is alpha-methylphenethylamine. In addition to these two names, many drug manufacturers use trademarks to identify their particular brand of a drug. 'Benzedrine' is Smith Kline & French Laboratories' trademark for amphetamine sulfate. Generic names have been used throughout this Manual, except in the Appendices. (WHO) Expert Committee in this field recommends scrapping both addiction and habituation in favor of a more general term"drug dependence." Drug dependence is described as "a state arising from repeated administration of a drug on a periodic or continuous basis." Since there are many different kinds of agents involved in drug dependence, the term is further qualified: "drug dependence of the morphine type," "drug dependence of the cocaine type,' “drug dependence of the barbiturate type," "drug dependence of the marihuana type," "drug dependence of the amphetamine type,' and "drug dependence of the alcohol type." The World Health Organization has emphasized that this term drug dependence— is general in nature and has been selected because it will apply to all types of drug abuse. This description in no way affects the international control measures in force for morphine-like, cocaine-like and hallucinogenic compounds. Nor does it necessarily imply that amphetamine-like or barbiturate-like compounds should or will be brought under international control. The WHO terminology simply permits precision in discussing the different types of drug abuse. DRUG GROUPS NARCOTICS Narcotics are drugs which produce insensibility or stupor due to their depressant effect on the central nervous system. Included in this definition are opium, opium derivatives (morphine, codeine, heroin) and synthetic opiates (meperidine, methadone). Under Federal narcotic laws, however, the term "narcotics" also embraces the coca leaf and its derivative, cocaine. Pharmacologically, this drug is a stimulant, not a depressant, but for law enforcement purposes it is considered a narcotic. Marihuana is regulated in the same way as narcotics. Pharmacologically, this drug is a hallucinogen; but since it is controlled by the Federal Bureau of Narcotics, it is often mistakenly assumed to be a narcotic. Since the enactment of the Harrison Act in 1914 (the first important Federal narcotics legislation), a considerable number of newer synthetic compounds have been made subject to narcotic regulation. Medical Use Cocaine, once widely used as a local anesthetic, has been largely replaced by newer, more efficient drugs. Marihuana also was once used in the practice of medicine. Today, however, it is no longer considered medically useful. The abuse of these substances will be discussed under "Stimulants" and "Hallucinogenic Drugs." The opiate-type narcotics are capable of relieving or modifying pain. They are particularly valuable when used to relieve severe pain caused by injury, burns and various diseases. These narcotics are also used by physicians to relieve pain in prolonged conditions such as cancer. However, the physician who uses narcotics over a long period of time in a patient must balance the beneficial, pain-killing effects of the drug against the possibility of establishing physical dependence. 6 Generally speaking, the opiates exert their greatest effect on the central nervous system (brain and spinal cord). They decrease or numb the patient's perception of pain, alter the psychological reaction associated with pain and induce lethargy or sleep. Morphine is the standard by which other narcotic agents are evaluated. Narcotics are also used in very small dosages for the suppression of cough or for the control of diarrhea. When used for these purposes, narcotics are usually combined with other drugs. Examples include: elixir of terpin hydrate with codeine; paregoric. Abuse The appeal of opiates lies in their ability to produce euphoria while relieving fear, tension, or anxiety. Under the influence of opiates, a person is usually lethargic and may display symptoms of deep intoxication. The price tag on this abuse is high. Chronic use may lead to both physical and psychological dependence. Many experts consider psychological dependence to be the more serious problem in the rehabilitation of users. As tolerance develops, there is a need for everincreasing doses (see page 59 for a definition of tolerance). When supplies are cut off, serious and painful withdrawal symptoms may develop. Symptoms of withdrawal from opiates include: I. Nervousness, restlessness, anxiety. 2. Yawning, running eyes and nose, sweating. 3. Enlargement of the pupils, "gooseflesh," muscle twitching. 4. Severe aches of back and legs, hot and cold flashes. 5. Extreme restlessness, vomiting, diarrhea. 6. Loss of appetite and weight, sleeplessness. 7. Increase in breathing rate, blood pressure and temperature. |