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

Bacterial diseases of the heart and liver (acquired through infected needles), and other infectious diseases like AIDS, hepatitis, and tuberculosis may also develop during the course of drug dependency. In some large, urban areas, it is estimated that 60 percent of those dependent on heroin are infected with HIV.

"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 percent for every year of use, so those who have been using for 10 years stand a 20 percent chance of drug-related death. In 2013, drug overdose deaths surpassed car crashes and the leading cause for injury death in the United States.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 05 May 2001

Last Modified: 28 Sep 2015