Narcotic drugs have always been associated with addiction; however, narcotic drugs remain the best agents to relieve pain. Pain management is the reason people are most likely to seek medical attention. Physicians try to balance their desire to elevate suffering against concerns that the patient in pain just wants a drug prescription.

The narcotics that are considered to have the greatest addiction potential include codeine 60 mg, oxycodone, methadone, hydromorphone, demerol (meperidine), fentanyl, and morphine. The World Health Organization (WHO) suggested a progressive treatment of pain. For mild pain: aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs and adjuvants. For moderate pain: mild opioids. For severe pain: traditional opioids.

Physicians remain constrained by problems of drug dependence and addiction and are reluctant to prescribe narcotics or prescribe weak, inferior narcotics such as codeine and demerol.  Weintstein et al polled 386 physicians in Texas and found that a significant number of physicians had prejudice against the use of opioid analgesics, displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. They suggested that new educational strategies are needed to improve pain treatment in medical practice.   

Physician concerns are justified. Narcotic-dependent people routinely solicit prescriptions from a number of physicians and become good at feigning painful conditions. Every primary care physician will have patients who tend to demand prescriptions for pain relievers and other psychotropic drugs and will become chronic users, unless the physician steadfastly resists their demands and limits prescriptions to short term use. 

Prescribed narcotics are always available for sale on the street. Most originate with doctors who are lenient prescribers. Drug traffickers have lists of lenient Doctors who write narcotic prescriptions on demand for a fee.  Prescribed narcotics are always available for sale on the street. For example, about two million Americans have admitted taking OxyContin (oxycodone) illegitimately. The US Drug Enforcement Administration reported that it is one of the most abused prescription drugs.

Oxycontin and Hydrocodone

Another narcotic, hydrocodone also has a high potential for abuse. Hydrocodone, as a narcotic cough medicine, is one of the favorite drugs sought by recreational users when they visit emergency departments. Both drugs act on the opioid mu receptor which blocks the transmission of pain in the spinal cord. In the USA OxyContin is a $1.5 billion per year product. A report in the New York times from rural Kentucky ( July 2004) provides a perspective on narcotic drug use: “Ever since prescription painkillers like OxyContin became the drugs of choice among dealers and addicts in Appalachia, the days of small-town pharmacists' dispensing medicines from behind an ordinary counter have become a quaint memory. Now many pharmacies have turned into virtual fortresses. Some have bars over the windows. The most sought-after drugs are stored in vaults. The pharmacists often work behind safety glass, and some have even armed themselves. Surveillance cameras and alarm systems monitor every spot. Dan Smoot, chief detective for Operation Unite, an anti-drug task force said that prescription drugs remained the top problem for police agencies in the mountains. Mr. Smoot recently led the largest drug raid in Kentucky history, arresting over 200 people on charges of buying or selling prescription drugs on the black market.”

Muscle Relaxants

The muscle relaxer, carisoprodol (Soma) is another favorite street drug which contains a metabolite of meprobamate, an old tranquilizer. Taken with alcohol, Soma produces stupor or "Soma coma." Tramadol (Ultram) is a pain medication that can produce a mild euphoric state. Dextromethorphan is a cough suppressant found in many cough syrups, which produces a euphoric state when taken in large quantities and can produce visual hallucinations.    People who take opioid analgesics for many days will develop physical dependence and will suffer withdrawal effects if the drug is discontinued suddenly. Symptoms of withdrawal include drug cravings, muscle cramps, joint pains, anxiety, nausea and vomiting. Withdrawal is most intense following IV heroin use and is relatively milder after taking oral medications.

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