Diagnosis of Narcotic Abuse
Diagnosing narcotic abuse and dependence is complicated because users are aware that their drug use activity is illegal. Physiologically, the user's brain requires the drug as a substitute for endorphins, which makes it difficult to stop regardless of whether or not the user recognizes the problem. Drug dependency may be discovered by friends or family members, though the stigma associated with drug use causes families to deny or avoid the problem.
Frequently, something in the life of the user reveals his or her dependence. Difficulty at work; criminal activity (e.g., theft, forgery); prescription records gathered by insurance companies and doctors; withdrawal; or the discovery of an illness, like HIV infection, may uncover the problem.
The physical signs of drug dependence, like injection marks on the skin ("tracks"), deterioration of nasal tissue from snorting and constricted or dilated pupils may be present. Screening for the presence of narcotics in the body may involve laboratory tests, like urinalysis or hair analysis. Testing cannot determine the length of time that drugs have been used.
Differential diagnosis may be necessary in cases where signs indicate nonnarcotic drug use or the presence of a medical condition. Benzodiazapine and barbiturate use can produce symptoms similar to narcotic intoxication and withdrawal. Hypoglycemia (low blood-sugar, fatigue), electrolyte imbalance, head or brain injury, and stroke can produce delirium and cause slurred speech, inability to concentrate, and impaired memory, which are also signs of intoxication.
Narcotic Abuse Course
The average age range of onset for drug use is 18 to 25. Those who use narcotic drugs usually progress to drug dependency. Narcotic addiction may develop after medical treatment. Some users become dependent on the euphoric effects of narcotics following surgery or long-term treatment for pain. It is likely that risk factors for drug abuse are present in these people before treatment.
Complications of Narcotic Abuse
"Tracks," visible puncture scars, are caused by repeated injection. Scarring of the veins may lead to swelling. Many users switch from the veins in the forearm to those in the feet, inside the thigh, or in the neck. Others stop using veins and inject directly into the first layer of skin, known as "skin-popping." It eventually leads to cellulitus (infection into connective tissue) and abscess, where cell death causes pus to collect beneath the skin. Round, healed scars are common signs of skin-popping.
Criminal activity associated with drug dependency includes theft and forgery (of doctors' signatures), as well as the transportation, sale, and production of illegal substances.
Narcotic Abuse Prognosis
The estimated death rate in those dependent on narcotics includes death by overdose as well as by murder associated with drug-related crime. It increases 2% for every year of use, so those who have been using for 10 years stand a 20% chance of drug-related death.
Treatment for Narcotic Abuse
Intoxication is treated in cases of overdose, when severe respiratory depression occurs. Naltrexone, an opiate agonist drug, may be used to revive a person who has overdosed. It binds to opioid receptors in the brain and counteracts the effects of drugs like heroin, morphine, and codeine. Its side effects include nausea and headache and it may be associated with liver toxicity.
Detoxification is the first step in treatment. Withdrawal may last from a couple of days to 2 weeks. Two drugs, methadone and clonidine, are used to treat it. Methadone (a synthetic narcotic) can reduce the discomfort of withdrawal and is given in tapering doses until withdrawal ends. Because methadone is a narcotic, side effects are similar to the effects of heroin or morphine, but they have a slower onset, last longer, and are less severe. Also, respiratory depression can occur in high doses. Clonidine, an antihypertension medication, affects the nervous system and can block the physical manifestations of withdrawal, like anxiety and irritability. Its most common side effects are dry mouth, dizziness, and drowsiness.
Dependence must be overcome by abstinence. Drug counseling, self-help groups, half-way houses, and narcotics anonymous (similar to alcoholics anonymous) may instill in a user the behavioral and psychological changes necessary to break a drug habit. Methadone maintenance is helpful when combined with these strategies. Tapering initially large doses of methadone can help people gradually overcome dependence. Methadone is abused and its use remains controversial. Still, long-term treatment plans (30 days to more than a year) can keep people away from street drugs, needles, and disease. They improve the quality of life for most people who attempt to recover.
Over 11,000 drug treatment centers in the United States provide treatment for intoxication, withdrawal symptoms, and dependence. The aim in detoxification is abstinence. Staff is trained in substance dependence, and most centers employ physicians. Patients choose an inpatient or an outpatient treatment program, depending on the severity of dependence, availability of facilities, insurance coverage, and other considerations. Some facilities specialize only in detoxification or long-term treatment; others provide both.