Session 17 Narcotic Analgesics 180 Minutes Session 17

Session 17 – Narcotic Analgesics 180 Minutes Session 17 Narcotic Analgesics Drug Recognition Expert Course

Session 17 – Narcotic Analgesics Learning Objectives • Explain a brief history of the Narcotic Analgesic category of drugs • Identify common drug names and terms associated with this category • Identify common methods of administration for this category • Describe the symptoms, observable signs and other effects associated with this category Drug Recognition Expert Course 17 -2

Session 17 – Narcotic Analgesics Learning Objectives (Cont. ) • Describe the typical time parameters, i. e. Onset and duration of effects associated with this category • List the clues that are likely to emerge when the drug influence evaluation is conducted for a person under the influence of this drug category • Describe the procedures for examining and determining the ages of injection sites • Correctly answer the “topics for study” questions at the end of this session Drug Recognition Expert Course 17 -3

Session 17 – Narcotic Analgesics Narcotic Analgesic • An “Analgesic” is a medication or drug that relieves pain. It differs from an anesthetic, in that it lowers one’s perception or sensations of pain, rather than stopping nerve transmission • A Narcotic is a drug derived from Opium, or produced synthetically that relieves pain, but also induces euphoria, alters mood, and produces sedation Drug Recognition Expert Course 17 -4

Session 17 – Narcotic Analgesics Narcotic Analgesic (Cont. ) Non-Narcotic Analgesics such as: • Aspirin • Tylenol • Motrin Do NOT produce narcosis Drug Recognition Expert Course 17 -5

Session 17 – Narcotic Analgesics Types of Narcotic Analgesics • Opiates • Natural alkaloids • Opium derivatives • Synthetics Drug Recognition Expert Course 17 -6

Session 17 – Narcotic Analgesics Types of Narcotic Analgesics (Cont. ) • Opiates • Natural alkaloids • Opium derivatives • Synthetics Drug Recognition Expert Course 17 -7

Session 17 – Narcotic Analgesics Three Characteristics Common to All Narcotic Analgesics • Relieve pain • Produce withdrawal signs and symptoms • Suppress the withdrawal signs and symptoms of chronic narcotic analgesic administration Drug Recognition Expert Course 17 -8

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -9

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -10

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Codeine Hydrocodone (Lortab) Hydromorphone (Dilaudid) Drug Recognition Expert Course Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -11

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -12

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -13

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -14

Session 17 – Narcotic Analgesics Commonly-Abused Opiates and Their Derivation From Opium (Cont. ) Raw Opium Other Alkaloids Powdered Opium (Smoking Opium) Morphine Diacetyl Morphine (Heroin) Hydromorphone (Dilaudid) Drug Recognition Expert Course Codeine Hydrocodone (Lortab) Oxymorphone (Numorphan) Thebaine Buprenorphine (Subutex) Oxycodone (Oxycontin) 17 -15

Session 17 – Narcotic Analgesics Common Synthetic Opiates • Demerol • Methadone • Fentanyl Drug Recognition Expert Course 17 -16

Session 17 – Narcotic Analgesics Common Synthetic Opiates (Cont. ) • Demerol • Methadone • Fentanyl Drug Recognition Expert Course 17 -17

Session 17 – Narcotic Analgesics Common Synthetic Opiates (Cont. ) • Demerol • Methadone • Fentanyl Drug Recognition Expert Course 17 -18

Session 17 – Narcotic Analgesics Methods of Administration • • • Orally Smoked Snorted Suppositories Injected Transdermal (Patches) Drug Recognition Expert Course 17 -19

Session 17 – Narcotic Analgesics The Concept of Tolerance for a Drug • The same dose of the drug will produce diminishing effects • A steadily larger dose is needed to produce the same effects Drug Recognition Expert Course 17 -20

Session 17 – Narcotic Analgesics Observable Effects of Narcotic Analgesics “On the Nod” • Semiconscious • Droopy eyelids (Ptosis) • Head slumped forward, chin on chest • Easily awakened • Normally alert to questions Drug Recognition Expert Course 17 -21

Session 17 – Narcotic Analgesics Other Effects • • Slowed reflexes Slow and raspy speech Slow, deliberate movements Inability to concentrate Slowed breathing Skin cool to the touch Possible vomiting Itching of the face, arms or body Drug Recognition Expert Course 17 -22

Session 17 – Narcotic Analgesics Onset and Duration of Effects Immediate: • Pleasure or euphoria • Relief from withdrawal • Relief from pain Drug Recognition Expert Course 17 -23

Session 17 – Narcotic Analgesics Onset and Duration of Effects (Cont. ) 5 -30 minutes: Onset of physical effects • “On the nod” • Poor motor coordination • Depressed reflexes • Slowed breathing Drug Recognition Expert Course 17 -24

Session 17 – Narcotic Analgesics Onset and Duration of Effects (Cont. ) Physical effects usually are observable for up to 4 -6 hours Drug Recognition Expert Course 17 -25

Session 17 – Narcotic Analgesics Signs and Symptoms of Withdrawal From Heroin Symptoms normally begin 4 -6 hours following injection: • Aches • Chills • Insomnia • Nausea Drug Recognition Expert Course 17 -26

Session 17 – Narcotic Analgesics Signs and Symptoms of Withdrawal From Heroin (Cont. ) Signs appear 8 -12 hours following injection: • Tearing • Goose bumps • Vomiting • Sweating • Yawning • Runny nose Withdrawal signs and symptoms closely resemble those of Influenza or the common cold Drug Recognition Expert Course 17 -27

Session 17 – Narcotic Analgesics Signs and Symptoms of Withdrawal From Heroin (Cont. ) Signs and symptoms intensify 14 - 24 hours after injection: • Dilation of pupils • Goosebumps • Loss of appetite Drug Recognition Expert Course • Slight tremors 17 -28

Session 17 – Narcotic Analgesics Signs and Symptoms of Withdrawal From Heroin (Cont. ) Situation worsens 24 - 36 hours after injection: • Insomnia • Depression • Vomiting • Diarrhea • Hot and cold flashes • Weakness Drug Recognition Expert Course 17 -29

Session 17 – Narcotic Analgesics Signs and Symptoms of Withdrawal From Heroin (Cont. ) Reaching the peak 2 - 3 days after injection: • Muscular and abdominal cramps • Severe tremors and twitching • Elevated temperature • Sharp loss of weight Drug Recognition Expert Course 17 -30

Session 17 – Narcotic Analgesics Overdose Signs and Symptoms • Breathing will become slow and shallow • Death can occur from severe respiratory depression Drug Recognition Expert Course 17 -31

Session 17 – Narcotic Analgesics Overdose Signs and Symptoms (Cont. ) Other signs: • clammy skin • convulsions and coma • blue lips and pale or blue body • extremely constricted pupils • recent needle marks Drug Recognition Expert Course 17 -32

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics • HGN - None • VGN - None • Lack of convergence - None Drug Recognition Expert Course 17 -33

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics (Cont. ) Psychophysical Tests: Performance on Modified Romberg Balance, Walk and Turn, One Leg Stand Finger to Nose will be impaired and will reflect slow and deliberate movements Drug Recognition Expert Course 17 -34

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics (Cont. ) Vital Signs: • Pulse - Down • Blood pressure - Down • Body temperature - Down Muscle tone - Flaccid Drug Recognition Expert Course 17 -35

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics (Cont. ) Dark Room: • Pupils - Constricted (Miosis) • Reaction to light - Little or none visible Drug Recognition Expert Course 17 -36

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics (Cont. ) General Indicators • • Constricted pupils Depressed reflexes Droopy eyelids Drowsiness Drug Recognition Expert Course • Dry mouth • Euphoria • Facial itching 17 -37

Session 17 – Narcotic Analgesics Evaluation of Subjects Under the Influence of Narcotic Analgesics (Cont. ) General Indicators • • • Nausea “On the nod” Puncture marks Slowed reflexes Slow, raspy speech Slowed breathing Drug Recognition Expert Course 17 -38

Session 17 – Narcotic Analgesics Narcotic Analgesic Symptomatology Chart HGN None VGN None Lack of Convergence None Pupil Size Constricted Reaction to Light Little or None Visible Pulse Rate Down Blood Pressure Down Temperature Down Muscle Tone Flaccid Drug Recognition Expert Course 17 -39

Session 17 – Narcotic Analgesics Injection Sites Drug Recognition Expert Course 17 -40

Session 17 – Narcotic Analgesics Types of Injections • Intramuscular • Intravenous • Subcutaneous Drug Recognition Expert Course 17 -41

Session 17 – Narcotic Analgesics Primary Injection Instrument Hypodermic syringe • Greater the number of gauge, the smaller diameter of the needle • Most illegal drug users prefer a larger gauge needle Drug Recognition Expert Course Top to bottom Brown - 26 G Orange - 25 G Black - 22 G Green - 21 G Yellow - 20 G White - 19 G 17 -42

Session 17 – Narcotic Analgesics User’s Equipment – Hype Kit • • • Cooker Handle Lighter Tourniquet Cottons Drug Recognition Expert Course 17 -43

Session 17 – Narcotic Analgesics Medical Injection Site • Medical mark is usually intramuscular • There may be multiple injections, if the technician is unable to find a vein during the first try • Usually there will be only one mark and it will be larger than the typical illegal injection. • Legal injections are made with new, sterile needles Drug Recognition Expert Course 17 -44

Session 17 – Narcotic Analgesics Non-Medical Injection Site • Non-Medical (illicit) mark is usually over a vein • Usually multiple marks in various stages of healing • Use of same needle over and over again causes them to be dull or barbed • Injection sites may be jagged Drug Recognition Expert Course 17 -45

Session 17 – Narcotic Analgesics Injection Site Terms “Thrombosed” “Tunnel” or “Corn” Drug Recognition Expert Course 17 -46

Session 17 – Narcotic Analgesics Puncture Healing “Scabbing” and “Trap Dooring” Drug Recognition Expert Course 17 -47

Session 17 – Narcotic Analgesics Puncture Healing Timetable • Scabs develop in about 18 -24 hours • Scab peels, flakes, falls off in about 14 days Drug Recognition Expert Course 17 -48

Session 17 – Narcotic Analgesics Classifying the Age of Puncture Wounds • Fresh - Under 12 hours after injection; • will be a red dot and have an oozing appearance or blood crater with no scab formation • Early - 12 -96 hours after injection; • will have a light scab, light bruise, reddened border and a crater appearance Drug Recognition Expert Course 17 -49

Session 17 – Narcotic Analgesics Classifying the Age of Puncture Wounds (Cont. ) • Late - 5 -14 days after injection; • will have a dark scab, dark bruise and the crater will flatten • Healing - Over 14 days after injection; • scab will be flaking and falling off with shriveled light-colored skin underneath Drug Recognition Expert Course 17 -50

Session 17 – Narcotic Analgesics Other Indicators of Injection Sites • Tattooing • Track Marks Drug Recognition Expert Course 17 -51

Session 17 – Narcotic Analgesics Location of Injection Marks • Anywhere • Arm • Hand Drug Recognition Expert Course 17 -52

Session 17 – Narcotic Analgesics Location of Injection Marks (Cont. ) • Ankles • Feet • Legs Drug Recognition Expert Course 17 -53

Session 17 – Narcotic Analgesics Conclusion Drug Recognition Expert Course 17 -54

Session 17 – Narcotic Analgesics Drug Recognition Expert Course 17 -55

Session 17 – Narcotic Analgesics Drug Evaluation and Classification Exemplar Demonstrations Drug Recognition Expert Course 17 -56

Session 17 – Narcotic Analgesics QUESTIONS? Drug Recognition Expert Course 17 -57

Session 17 – Narcotic Analgesics Topics for Study Drug Recognition Expert Course 17 -58

Session 17 – Narcotic Analgesics Topics for Study (Cont. ) Drug Recognition Expert Course 17 -59