Use of the Word "Narcotics"

We've spent this week talking about substance use, abuse and dependence, focusing mostly on alcohol, heroin and cocaine. There are a lot of buzzwords thrown around, and it occurred to me that I didn't really understand the difference between opiates, opioids and narcotics - so I asked our course director (a psychiatrist).

Opiate: any of the narcotic opioids found naturally in the poppy seed.
Common examples: opium, morphine, codeine, heroin

Opioid: synthetic or semi-synthetic opiates.
Common examples: fentanyl, hydromorphone (Dilaudid), methadone, oxycodone

Narcotic: a compound that makes you sleepy (ie, narcosis)! This term is often used erroneously, and carries a weight that usually refers to illegal drugs. I was told never to use this word in the hospital (politely, of course). Of course, certain drugs are classified as "narcotics" (such as cocaine), which elevates legal punishment.

So what do opioids do?

From www.medscape.org

Well your brain has figured out a clever way to make sure that you're rewarded when you do pleasurable things, so that you'll continue to do them. This reward system is stimulated by things such as food, water and sex, and is mediated by the hormone dopamine.

The issue is that certain drugs target this very pathway - alcohol, heroin, nicotine - by exciting this pathway above and beyond the normal amount. This leads to a huge increase in dopamine - 2 to 10x the amount release by the natural rewards. Methamphetamine and cocaine both increase the amount of dopamine released, as well as prevent it from being degraded so that it has a longer effect in your body (these are stimulants).

Drugs are powerful enough that they actually alter the chemistry of your brain, so that as someone continues to use the drug more and more, they require it just to function normally. At this point, they have become sensitized to it and don't even feel high, it's more a matter of using to not feel terrible (withdrawals).

It was a pretty interesting week - we were able to speak with several people who are recovering addicts. Their stories are incredibly intense, and I couldn't help but admire their strength to overcome their addictions. Sometimes it's hard to look at an addict and not say, "just stop using!" I think if nothing else, I learned how absurd is that thought. Kicking an addiction is something that someone fights for a lifetime, not just a few days.