Scott L. Havsy, DO, JD, DAAPM
Certified in Pain Management

Narcotics Addiction

Narcotic Addiction is on the rise and is a significant health problem especially in the age group of 15 to 25 years of age.  Addiction however, has no cultural, race, origin, religious or age boundaries.  Left untreated, addiction can ruin an individual’s life, often resulting in death and problems with the legal system.

What Are Narcotics?

A narcotic is an opiate that is a chemical which binds to opiate receptors that are found principally in the central nervous system (brain) and the gastrointestinal tract. The receptors in these two organ systems mediate both the beneficial effects and the side effects of opiates.

The analgesic effects of opiates are due to decreased perception of pain, decreased reaction to pain as well as increased pain tolerance. The side effects of opiates include sedation, respiratory depression, and constipation. Opiates can cause cough suppression, which can be both an indication for opiate administration or an unintended side effect.

Physical dependence can develop with ongoing administration of opiates, leading to a withdrawal syndrome with abrupt discontinuation. Opiates can produce a feeling of euphoria, and this effect, coupled with physical dependence, can lead to recreational use of opiates by some individuals.

 By their chemical makeup, opiates can cause tolerance, dependence, withdrawals and addiction. 

Definitions

Toleranceis the process whereby neuroadaptation occurs (through receptor desensitization) resulting in reduced drug effects. Tolerance is more pronounced for some effects than for others; tolerance occurs quickly to the effects on mood, itching, urinary retention, and respiratory depression, but occurs more slowly to the analgesia and other physical side effects. However, tolerance does not develop to constipation or miosis.

Dependenceis characterized by extremely unpleasant withdrawal symptoms that occur if opiate use is abruptly discontinued after tolerance has developed.

Withdrawal symptoms include severe dysphoria, sweating, nausea, rhinorrea, depression, severe fatigue, vomiting and pain. Slowly reducing the intake of opiates over days and weeks will reduce or eliminate the withdrawal symptoms.  The speed and severity of withdrawal depends on the half-life of the opiate; heroin and morphine withdrawal occur more quickly and are more severe than methadone withdrawal, but methadone withdrawal takes longer. The acute withdrawal phase is often followed by a protracted phase of depression and insomnia that can last for months. The symptoms of opiate withdrawal can also be treated with other medications, such as clonidine, antidepressants and benzodiazepines, but with a low efficacy.  

Drug misuse is the use of drugs for reasons other than what the drug was prescribed for. Opiates are primarily misused due to their ability to produce euphoria.

Addictionis the process whereby physical and/or psychological dependence develops to a drug - including opiates. The withdrawal symptoms can reinforce the addiction, driving the user to continue taking the drug.  Psychological addiction is more common in people taking opiates recreationally; it is rare in patients taking opiates for pain relief.

Self-Medication

Often times, individuals self medicate to deal with childhood or adult issues such as physical, emotional and sexual abuse.  Narcotics are specifically designed to bind to the opiate receptors and pleasure centers of the brain.  Constant use to get high or making ones-self feel good so they forget their emotional pain often leads to addiction whereby the narcotics are obtained illegally. 

Treatment for Narcotic Addiction

Buprenorphine is manufactured in two forms:  Suboxone® which contains Naloxone® or Subutex® which does not.  These two drugs bind very tightly to the opiate receptor sites in the brain displacing the narcotic that the patient is addicted to. 

Dr. Havsy is certified in the use of Suboxone® and Subutex® for the treatment of narcotic addiction.  After a history and physical examination is performed, Suboxone® or Subutex® is prescribed when the individual is in moderate withdrawal based on an Opiate Withdrawal Scale.  The following two successive days are the induction period where the physician will adjust your dose.  Once an individual has gone through the two day detox phase and placed on a stable dose, the cravings for narcotics and the withdrawal process usually subsides.

Narcotic addiction is usually a two-fold issue dealing with the physical craving for narcotics and the underlying reason why you became addicted to the drug in the first place.  The underlying reason is often psychological and treatment usually requires an evaluation and treatment by a Chemical Dependency Professional (CDP) and a mental health counselor to deal with underlying psychological issues. 

The use of buprenorphine by itself, will often not allow an addict to successfully deal with their addiction issues whereby they maintain sobriety.  Combining buprenorphine with counseling will dramatically increase the chances of an individual becoming clean and sober.

If buprenorphine is used to early in the withdrawal process or used too quickly between recommended doses, the withdrawal process can actually be worse.

For further questions or to make an appointment please call 253-473-2663. 

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