Narcotics, addiction liability

Antitussives Codeine, 10-20 mg every 4-6 hours, not to exceed 120 mg in 24 hours (with guaifenesin) Guiatuss AC, Mytussin AC, various generic Acts centrally to increase the cough threshold. In doses required for cough suppression, the addiction liability associated with codeine is low. Many codeine-containing antitussive combinations are schedule V narcotics, and OTC sale is restricted in some states. 

Except for the addiction liability of some of the narcotic antitussives, side effects for most of the centrally acting compounds are relatively few and mild at therapeutic doses. Qualitative comparisons of both side effects and pharmacological profiles have been summarized for many of the compounds described above (97). 

The opium narcotics used in the U.S. are, particularly, morphine and heroin, especially the former but juveniles definitely prefer heroin. Heroin has greater addiction liability than other narcotics, produces more euphoria and stimulation, requires smaller doses, and is easier to traffic in illicitly. Codeine addiction is rare because the drug produces relatively little euphoria, and is thus less desirable to the potential addict, and because it is quite expensive and bulky in effective amounts. Codeine addicts are usually persons who originally received the drug for clinical purposes. Many narcotic addicts also use cocaine, usually in combination with heroin, and resort to whisky or barbiturate when their supply of narcotic is low. Every conceivable method and route are used to get the narcotic into the body. Morphine and heroin, however, are ordinarily taken hypodermically or intravenously cocaine and heroin are employed by snuffing. The use of galenical preparations of opium is rare in the U.S. Occasionally, however, a paregoric addict is discovered. 

Isbell H, Vogel VH, Chapman KW. Present status of narcotic addiction with particular reference to medical indications and comparative addiction liability of the newer and older analgesic drugs. JAMA 1948 138 1019. 

Tolerance, Dependence, and Addiction Liability. Patients treated with long-term opioid therapy often develop tolerance and usually become physically dependent on narcotic analgesics as well. Tolerance results when exposure to a drug results in its decreased effectiveness with time and larger doses are required to achieve the same response (26). Physical dependence is also an adaptive state that is characterized by a specific constellation of withdrawal symptoms that occur upon abrupt cessation or significant reduction in the dose of the opioid or administration of an opioid antagonist (26). Addiction, however, is distinct from physical dependence, and "the term addiction should never be used when physical dependence is meant" (22). The... 

The invention of the hypodermic needle and syringe in the middle of the 19th century resulted in the widespread use of morphine, and addiction became a common problem. An early - and false - hope to circumvent the addiction liability of morphine was provided by a most unlikely candidate heroin. This compound, the diacetyl derivative of morphine 5, is a potent opiate narcotic first synthesized in 1874 via acetylation of morphine, and was introduced into medical practice in 1898 as a cough suppressant [10]. Heroin is a semisynthetic drug, i.e., a chemically modified derivative of a natural product, and retains the stereochemistry of mor-... 

The inability to demonstrate a narcotic-type addiction liability for WIN 20,228 and WIN 20,740, and the previously reported failure to demonstrate this for nalorphine (4), strongly suggest that compounds shown to produce narcotic antagonism in animals will prove to be nonaddicting in studies in man. All three of these compounds are therefore potent nonaddicting analgesics. 

Tolerance to codeine develops very slowly, and the addiction liability is far less than that observed for morphine. Most narcotics such as morphine, codeine, dihydrocodeine, methadone, and levorphanol have antitussive properties. Codeine is used primarily because its addictive liability is low and it is effective orally. The antitussive doses of narcotics are lower than the doses used for analgesic purposes. 

Unlike the narcotic analgesics such as morphine, salicylates do not depress respiration, are relatively nontoxic, and lack addiction liability. They are weak or mild analgesics effective in ameliorating short, intermittent types of pain such as neuralgia, myalgia, and toothache. 

It is a potent synthetic analgetic very much related chemically and pharmacologically to morphine and is invariably employed for the relief of acute pair. It is in many aspects closely related to morphine but its aetion is 6 to 8 times more potent. However, it has been observed that the gastro intestinal effects of this compound are appreciably on the lower range than those experienced with morphine. It is a narcotic with addiction liability quite akin to morphine therefore, almost same stringent precautions must be observed when prescribing this drug substance as for morphine. 

It is, however, pertinent to mention here that in the reeent years, a good nttmber of newer drug substanees have been synthesized metieulously which remarkably exhibited significant antitussive characteristic feature absolutely devoid of the absurd and most diseouraging addiction liabilities of the aforesaid narcotic drugs. Surprisingly, quite a few of these agents usually exert their activity very mueh identical fashion via a central effeet. 

A comparison of the maximum efficacy and addiction/abuse liability of commonly used narcotic analgesics. 

In World War I the Army rejected 1 man in 1,500 as an addict and in World War II 1 in 10,000. The current rate for the adult population is estimated at 1 in 3,000 or a total of 50,000. Another 10,000 adolescent addicts bring the national total to 60,000. They spend in the neighborhood of a quarter of a billion dollars a year for illicit narcotics (51). This represents an unbelievable average of 4,000 a year and suggests that to cover income tax (probably not paid) and other liabilities, an addict requires an income of 10,000 a year (47a). 

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