a. Dependence. Dependence is a side effect of narcotics, which has caused
much concern among many health-care professionals. There are two types of
(1) Psychological. Psychological dependence is produced when the drug
causes an emotional or mental desire to repeat the use of the drug. Consequently, the
individual taking the drug has a craving for the pleasurable mental effects produced by
the drug (that is, euphoria, and so forth).
(2) Physiological (physical). Physical dependence is produced by prolonged
use of a drug whose pharmacological action causes the body to adapt to its presence.
When the drug is withdrawn after the person has become physically dependent, the
body of the individual reacts in a hyperexcited way. You have probably read about or
seen heroin (narcotic) addicts who are undergoing withdrawal. These episodes of
withdrawal are characterized by stimulation of the central nervous system.
b. Tolerance. Tolerance is the body's ability to adapt to the presence of a
foreign chemical substance (drug). This results in the requirement for progressively
larger doses of the drug in order to obtain the same effect in the patient. It should be
noted that tolerance is frequently seen in patients who abuse narcotics. Tolerance is
not of great concern in narcotic therapy of short duration. However, for those
chronically ill patients who are on long-term narcotic therapy, increased doses of the
narcotic agents might be indicated to maintain the desired level of analgesia.
c. Drowsiness. Drowsiness is another side effect of narcotics. For this reason,
individuals who are receiving narcotics should seriously examine their activities that is,
driving) for safety purposes.
d. Miosis. Miosis (constricted pupils) is an effect commonly known as "pinpoint"
pupils. Miosis is commonly seen in patients who are taking narcotic agents.
Section II. NARCOTIC AGENTS AND NARCOTIC ANTAGONISTS
11-5. SPECIFIC NARCOTIC AGENTS
a. Morphine. Morphine is the basis of the narcotic effect of opium and is the
standard by which other analgesics are judged. It is used in moderate to severe pain, is
the analgesic of choice for myocardial infarction, and is used to treat acute pulmonary
edema. Morphine is most frequently given IM or SC, 10-15 mg every 4 hours, or IV,
where 4-10 mg are diluted and given slowly over 4-5 minutes. It is used less frequently
by the oral route (1/15--1/6 the effectiveness of parenteral administration) in a dose of 8-
20 mg every 4 hours. The most common side effects associated with morphine are
drowsiness, nausea, and vomiting. Morphine is supplied as an injection containing 8,
10, and 15 milligrams per milliliter; in tablets of 10, 15, and 30 milligrams; and as an oral