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Medical Author:

Mark Zwanger, MD, MBA

Medical Editor:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Narcotics users can develop tolerance, as well as psychological and physical dependence to opioids when they take them over an extended period of time.

• Tolerance refers to a decreased response to a drug, with increasing doses required to achieve comparable effects.
• Psychological dependence refers to compulsive drug use in which a person uses the drug for personal satisfaction, often in spite of knowing the health risks.
• Physical dependence occurs when a person stops using the narcotic but experiences a withdrawal syndrome (or set of symptoms).
• Signs and symptoms of narcotic abuse
• analgesia (feeling no pain),
• sedation,
• euphoria,
• respiratory depression (shallow breathing),
• small pupils, bloodshot eyes,
• nausea, vomiting,
• itching skin, flushed skin,
• constipation,
• slurred speech,
• confusion, poor judgment, and
• needle marks on the skin.
• Signs and symptoms of narcotic withdrawal: The withdrawal syndrome from narcotics generally includes signs and symptoms opposite of the drug's intended medical effects. The severity of the withdrawal syndrome increases as the drug dose increases. The longer the duration of the physical dependence to the narcotic increases, the more severe the withdrawal syndrome. Symptoms of heroin withdrawal generally appear 12-14 hours after the last dose. Symptoms of methadone withdrawal appear 24-36 hours after the last dose. Heroin withdrawal peaks within 36-72 hours and may last seven to 14 days. Methadone withdrawal peaks at three to five days and may last three to four weeks. Although uncomfortable, acute narcotic withdrawal for adults is not considered life-threatening unless the person has a medical condition that compromises their health (for example, if someone has severe heart disease). Some of the signs and symptoms of narcotic withdrawal are listed below:
• Anxiety
• Irritability
• Craving for the drug
• Increased respiratory rate (rapid breathing)
• Yawning
• Runny nose
• Salivation
• Gooseflesh
• Nasal stuffiness
• Muscle aches
• Nausea or vomiting
• Abdominal cramping
• Diarrhea
• Sweating
• Confusion
• Enlarged pupils
• Tremors
• Lack of appetite

• Complications of narcotic abuse: Many complications can result from narcotic abuse, the most common being infectious conditions.
• Infections of the skin and deeper layers
• Abscesses in skin, lungs, and brain
• Infection of the heart valves
• Pneumonia
• Fluid in the lungs
• Liver dysfunction
• Intestinal slowdown
• Seizures
• Coma and other neurological complications
• Infectious arthritis
• Loss of menstrual cycle
• Overdose and death
• Premature and growth-retarded infants
• Neonatal withdrawal: Up to 70% of babies delivered from pregnant women who use narcotics experience neonatal withdrawal, a potentially fatal condition.

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