Narcotic analgesics are medications used to treat pain. Narcotics are controlled substances, that is, drugs with moderate to high abuse potential. Pain is one of the most under-treated problems in medicine. This is mainly due to the following reasons:
- fear of addiction: both physicians and patients have this fear; however it has been found that when narcotic analgesics are used as indicated for pain, the potential for addiction (barring pre-existing risk factors) is low. Also, adequate early treatment of pain is directly linked to faster healing and lower overall analgesic use.
- fear of tolerance: i.e. physicians or patients are afraid that if narcotics are used in progressive disease, they will lose their effectiveness.
- fear of physical dependence: Physical dependence is different from addiction. Addiction is psychological dependence on a drug, whereas physical dependence is the presence of withdrawal symptoms when a drug is discontinued.
- fear of respiratory depression: this is only critical when there are respiratory problems, or in head injuries when respirations and the central nervous system are depressed anyway.
- bias of healthcare professionals: many times, medical personnel’s perception of the patient’s pain differs significantly from the patient’s. Patients are easily perceived as whiners, hypochondriacs or addicts by caregivers. The ONLY one who knows how bad the pain is is the patient. Period. End of story. Even if you had the same thing and got by on a baby aspirin a month.
- fear of legal implications: Doctors put their license on the line when they prescribe narcotics, so they are understandably reluctant to prescribe them more than necessary.
A narcotic overdose is treated with a narcotic antagonist, such as Narcan (naloxone) or Trexan (naltrexone).
Narcotic (opioid) analgesics
Brand/Generic Drug Names
Alfenta/alfentanil, Stadol/butorphanol, codeine, Dalgan/dezocine, Duragesic/fentanyl, Dilaudid/hydromorphone, Levo-Dromoran/levorphanol, Demerol/meperidine, Dolophine/methadone, Duramorph or MS Contin/morphine, Nubain/nalbuphine, Roxcodone/oxycodone, Numorphan/oxymorphone, Talwin/pentazocine, Darvocet or Darvon/propoxyphene, remifentanil
Common uses
moderate to severe pain, preoperative and postoperative analgesia
Pharmacology
interact with opioid receptors at spinal cord level depressing pain impulse transmission
Class contraindications
allergy, narcotic addiction, acute bronchial asthma, upper airway obstruction
Class precautions
addictive personality, increased intracranial pressure, severe cardiac, renal, hepatic disease, respiratory conditions, seizure disorders
Interactions
Increased central nervous system depression: barbiturates, narcotics, hypnotics, antipsychotics, alcohol
Adverse Reactions
nausea, vomiting, anorexia, constipation, cramps, light-headedness, dizziness, sedation, respiratory depression, respiratory arrest, circulatory depression, increased intracranial pressure
Additional Information
Assess intake and output, respiratory status, central nervous system status, allergic reaction
Administer antiemetics if vomiting occurs
Provide assistance with walking
Evaluate therapeutic response: decrease in pain
Date of most recent Update
September 09, 2002
Further information is available in the writeup for the
specific name(s) of this medication class