Author: Angela Doel

Narcotics, also known as opioids, share a number of side effects in common that can range to mild to life-threatening. Opioids include several substances that alter brain chemistry to relieve pain. Some opioids are also used to treat coughing and diarrhea.¹ Examples of opioids include heroin and pharmaceutical drugs like OxyContin, Vicodin, codeine, morphine, methadone, and fentanyl.²

In this Article:

• What are Opioids and How Do They Differ in Potency?
• What Are Narcotic Side Effects?
• What are Narcotic Withdrawal Symptoms?
• What are the Signs of Overdose Risk?
• Do Certain Narcotics Have Less Dangerous Side Effects Than Others?
• How Does Opioid Addiction Develop?
• How Can I Avoid Misusing Opioids?

What are Opioids and How Do They Differ in Potency?

Narcotics/opioids are controlled substances that the government classifies from Schedule I to Schedule V based on their potential for physical dependence, addiction, and harmful side effects. Most opioids, with the exception of heroin, are Schedule II narcotics. Examples include oxycodone and hydrocodone. They are used to relieve severe pain when other types of painkillers are ineffective. When taken correctly under the supervision of a healthcare provider, these medications can be effective in reducing pain.²

Fentanyl is another Schedule II narcotic that is 50-100 times stronger than morphine.³ It is often used to treat chronic pain in patients who have developed resistance to other narcotics.² Its effects are active at much lower doses than other narcotics. This potency creates a higher risk of negative side effects, including overdose.² Illegal fentanyl is often mixed into heroin, which can be life-threatening.¹

The types of narcotics differ in a few important ways: the form of the drug (i.e., pill, powder, liquid, tar, etc.), the drug’s potency, how long its effects last, and its potential for misuse. Narcotic safety and potency are also related to whether a particular drug is regulated and made according to pharmaceutical standards.²

Though narcotics are prescribed by doctors to treat pain, suppress cough, cure diarrhea, and help with sleep regulation, negative effects may still occur and depend heavily on the dose, how it is taken, and any previous exposure to the drug.¹

What Are Narcotic Side Effects?

Opioids are effective in relieving pain and helping people to feel better. However, even opioids prescribed to you can have side effects. Common side effects of narcotics include:^1,4

• Drowsiness
• Apathy
• Inability to concentrate
• Confusion
• Nausea
• Constipation
• Euphoria
• Slowed breathing
• Flushing of the face and neck
• Pupil constriction
• Slowed physical activity

Misusing narcotics increases the risk of experiencing unpleasant and potentially dangerous or life-threatening side effects.⁴ As the dose increases, both the pain relief and potential of experiencing harmful effects also increase. Some of these preparations are so potent that a single dose can be life-threatening to a person based on their medical history.¹

Opioid misuse can adversely affect one’s breathing. A condition called hypoxia can occur when the brain receives too little oxygen. The results of hypoxia may include psychological and neurological effects, including permanent brain damage, coma, and potentially even death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether the associated damage can be reversed.⁴

What are Narcotic Withdrawal Symptoms?

Chronic opioid use can lead to physical dependence on narcotics. Withdrawal takes place when you are physically dependent on a substance and stop taking it. The type and intensity of physical symptoms you experience during withdrawal depend on the drug used, the daily dose, the interval between doses, the duration of use, and the physical and behavioral medical history of the person. These symptoms usually appear shortly before the time of the next scheduled dose if missed.²

People who become dependent on opioid medication and stop using the narcotic can experience unpleasant withdrawal symptoms. These symptoms include:⁴

• Muscle and bone pain
• Diarrhea and vomiting
• Sleep problems
• Cold flashes with goosebumps
• Uncontrollable leg movements
• Severe cravings

These symptoms can be extremely uncomfortable and are the reason many people find it difficult to stop using opioids.⁴ Medicines are being developed to help with the withdrawal process. Lofexidine is a non-opioid medicine designed to reduce opioid withdrawal symptoms and was approved by the U.S. Food and Drug Administration (FDA) in 2018.⁴

The FDA has also approved the sale of a device, NSS-2 Bridge, that can help ease withdrawal symptoms.⁴ The NSS-2 Bridge is a small electrical device placed behind the person’s ear that can be used for up to five days during the acute withdrawal phase.³

What are the Signs of Overdose Risk?

Opioids are highly addictive and overdoses and death are common.¹ In 2019, nearly 50,000 people in the U.S. died from overdoses involving opioids.⁵

The three main symptoms that identify a narcotic overdose, known as the “opioid triad” are:⁶

• Unconsciousness
• Respiratory depression
• Pinpoint dilated pupils

Additional signs and symptoms of an opioid overdose include:⁷

• Unresponsiveness
• Inability to speak
• Limp body
• Pale or clammy face
• Blue lips, fingernails, and skin
• Bluish purple skin tone (for lighter-skinned people) or grayish or ashen skin tone (for darker-skinned people)
• Slow and shallow or irregular/discontinued breathing
• Slow, erratic, or nonexistent pulse
• Choking sounds or a snore-like gurgling noise
• Vomiting

An opioid overdose can be treated with the drug naloxone to restore breathing when given right away.⁷

Do Certain Narcotics Have Less Dangerous Side Effects Than Others?

While narcotics carry different levels of potency, they all have risks for harmful side effects. Even so-called “weak” opioids can have the same harmful effects as morphine.⁸

Examples of “weak” narcotics include opioid analgesics such as codeine and tramadol, which are used to treat severe or chronic pain when a nonsteroidal anti-inflammatory drug proves inadequate.⁸ Breathing problems can occur after using standard doses of codeine or tramadol.⁸ In addition, tramadol has adverse effects unrelated to its opioid effects.⁸

When it comes to the risk of opioid addiction, there is no evidence that, at equivalent strength, weak narcotics carry a lower risk of addiction than other opioids such as low-dose morphine.⁸

On the other end of the spectrum, fentanyl is reported to have fewer gastrointestinal side effects than other opioids.⁹ However, fentanyl is an extremely powerful opioid. In 2017, nearly 60% of opioid-related deaths in the U.S. involved fentanyl.³

How Does Opioid Addiction Develop?

Opioids work by binding to receptors in the brain and body that are involved in feelings of pain and pleasure. When binding to these receptors, they block pain signals and release dopamine, a neurotransmitter that produces a pleasurable feeling. This dopamine release can strongly reinforce the act of taking the drug, making you want to repeat the experience.⁴

Long-term use of prescription narcotics, even as prescribed by a doctor, can cause some people to develop a tolerance to the drug, which means they need higher or more frequent doses of the drug to get the desired effects.⁴ Going without the drug causes a number of physiological effects, from mild to potentially life-threatening.

If you are dependent on opioids, you will require medical support to stop taking the drug.⁴ Research shows that the most effective treatment for opioid use disorder involves the use of medication combined with behavioral therapy.¹⁰

How Can I Avoid Misusing Opioids?

If you are prescribed an opioid drug, you should not use it for more than 3-4 months unless your healthcare provider instructs you otherwise.² Your healthcare provider may suggest that you take your medicine only when you feel pain.²

People misuse opioids by:⁴

• Taking medicine in a way or dose other than your doctor prescribed
• Using another person’s prescription medicine
• Taking medicine for the “high” or pleasurable effects it causes

There are several steps you can take to help prevent opioid misuse and dependency:⁴

• Never take more than the prescribed dose and always follow prescribed directions exactly. If you miss a dose, do not take a double dose to catch up.
• Do not combine opioids with alcohol.
• Do not combine opioids with other medications or drugs without your doctor’s approval.
• Stop taking opioid medications as soon as your doctor agrees they are no longer needed.
• Always follow the prescribed directions.
• When taking liquid doses, use an accurate measuring device and measure out only the prescribed amount.
• Use the medication only in the form in which it was prescribed.
• Never use another person’s prescription or share your prescription with others.
• Do not drive a car or operate heavy machinery while using the medication.

Treatment specialists can help you address the effects of narcotics or opioid misuse. Inpatient detoxification services can help you safely navigate the side effects of opioids. Get help for withdrawal symptoms today. Call (phone) to speak with a treatment specialist about options available to you.

References

1. Department of Justice Drug Enforcement Administration (2020). Narcotics.
2. S. National Library of Medicine. (2021, July 2). Pain medications – narcotics.
3. National Institute on Drug Abuse. (2021). Fentanyl DrugFacts.
4. National Institute on Drug Abuse. (2021). Prescription opioids drugfacts.
5. National Institute on Drug Abuse. (2011, March 11). Opioid overdose crisis.
6. Centers for Disease Control and Prevention. (2016). Poison Center & Public Health Collaborations Community of Practice Newsletter.
7. National Harm Reduction Coalition. (2020, September 1). Training Guide: Opioid overdose basics. Recognizing opioid overdose.
8. National Library of Medicine. (2016, February 25). “Weak” opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine. Prescrire International, (168), 45-50.
9. Barnett M. (2001). Alternative opioids to morphine in palliative care: a review of current practice and evidence. Postgraduate Medical Journal, (77), 371-378.
10. Centers for Disease Control and Prevention. (2020, August 12). RX Awareness.