Signs and Symptoms of Narcotic Abuse

The symptoms of narcotic use are considered disorders:

  • Intoxication
  • Withdrawal
  • Tolerance
  • Abuse
  • Dependence

Intoxication and withdrawal are described as opioid-induced disorders by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Symptoms of Intoxication

Intoxication is the immediate effect of an opiate drug, which occurs more quickly when the drug is taken intravenously (IV) or nasally ("snorted") as opposed to orally.

When taken IV, there is a "rush" of the drug to the brain, which causes a "high." If taken orally, the drug's effects are gradual. Physical signs of intoxication include slurred speech, strange behavior, lack of coordination, constricted pupils, and constipation (caused by drying of natural secretions). Psychological effects include euphoria, tranquility, apathy, and impaired judgment. Although the initial effects are generally calming or dulling, psychomotor agitation and aggressiveness can occur.

Overdose (OD)—severe intoxication—occurs when too much of the drug enters the body too quickly, usually after IV injection. Variations in the potency, quality, and dose of narcotic drugs lead to most overdoses. Severe respiratory depression and death can result from OD.

Diagnostic Criteria for Opioid Intoxication

  • Recent use of an opioid
  • Clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria (i.e., general irritability, depression, etc), psychomotor agitation or retardation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, opioid use
  • Pupillary constriction (or pupillary dilation due to anoxia (loss of oxygen) from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use:
    1. Drowsiness
    2. Slurred speech
    3. Impairment of attention or memory
  • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

From the Diagnostic and Statistical Manual of Mental Disorders, IV, TR ed. 2001. Washington, DC: American Psychiatric Association (APA). Used with permission.

Symptoms of Withdrawal

Withdrawal may occur 4 to 12 hours after stopping heavy and prolonged use of narcotics, depending on the drug, and may last 14 days. Physical signs include gooseflesh, muscle aches (often in the legs and back), abdominal cramping and diarrhea, and insomnia. Mentally, a person may experience depression, anxiety, panic, irritability, and craving.

Diagnostic Criteria for Opioid Withdrawal

  • Either of the following:
    1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
    2. Administration of an opioid antagonist after a period of opioid use
  • Three (or more) of the following, developing within minutes to several days after Criterion A:
    1. Diarrhea
    2. Dysphoric mood
    3. Fever
    4. Insomnia (chronic)
    5. Lacrimation (producing tears) or rhinorrhea (running nose)
    6. Muscle aches
    7. Nausea or vomiting
    8. Pupillary dilation, piloerection (goosebumps), or sweating
    9. Yawning
  • The symptoms of Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

From the Diagnostic and Statistical Manual of Mental Disorders, IV, TR ed. 2001. Washington, DC: American Psychiatric Association (APA). Used with permission.

Tolerance describes the body's need for increasing amounts of a drug to get the same effects and, ultimately, to avoid withdrawal. People who have long-time addictions may take dangerously high doses that would kill first-time users.

Abuse is defined as the recreational use of a substance that results in impairment, negative consequences, and decline. Typically, those who abuse substances use them and experience withdrawal less frequently than those who are dependent. However, prolonged, intermittent use of narcotics is uncommon; most people who abuse them become dependent.

Symptoms of Dependence

Dependence means that a drug user is unable to reduce dosage or stop using because the brain is chemically dependent on the drug. The most significant sign of psychological dependence is that the user plans daily activities around obtaining and using the drug. Physiological signs of dependence include withdrawal.

Publication Review By: Karen Larson, M.D.

Published: 05 May 2001

Last Modified: 28 Sep 2015