SOMNIFEROUS POISONS OPIOIDS Known as somniferous poisons or

SOMNIFEROUS POISONS (OPIOIDS) Known as somniferous poisons or narcotics i. Reduce pain ii. Induce sleep Important poisons Excitement i. OPIUM Narcosis

ii. HEROIN (Brown sugar) § Synthetic derivatives of opium (Diacetyl morphine) § Strong analgesic § Narcotics § Cause severe addiction iii. PETHIDINE (Meperidine) § Analgesia § Euphoria § Very high addiction § Difficult to treatment

OPIUM & MORPHINE OPIUM (AFIM): - Dried juice obtained by incision of unripe capsule of white poppy (Papaver somniferum) § There are two groups of alkaloids i. Phenanthrene ii. Isoquinoline

§ § Phenathrene Group i. Morphine about 10% ii. Codeine about 0. 5% iii. Thebaine about 0. 3% iv. Dionin v. Heroin (Diacetyl Morphine) Isoquinoline Group i. Papaverine about 1% ii. Narcotine about 6% (They are mild analgesic but no narcotic effect)

§ Ripe and dry capsule of poppy contain very little opium. § Poppy seeds (khas) are creamish in colour and contain no opium. § Used as food and oil for cooking. § Alkaloids of opium used in medicine are i. Morphine ii. Codeine iii. Apomorphine: Used as emetics They act as narcotic and sedative

SIGNS & SYMPTOMS Acute poisoning , mainly acts on CNS in three stages i. Excitement ii. Stupor iii. Narcosis

STAGE OF EXCITEMENT: i. Sense of well being ii. Laughter iii. Hallucination iv. Increase in H. Rate v. Convulsions may occur in children

STAGE OF STUPOR i. Headache ii. Giddiness iii. Diminished sensibility iv. Strong tendency to sleep v. Awake only by painful stimuli. vi. Pupils are contracted vii. Lips & face are cyanosed viii. Pulse normal ix. Respiration normal

STAGE OF NARCOSIS: i. Deep coma ii. Muscles relaxed iii. Reflexes abolished. iv. Pupils contracted v. No reaction to light vi. BP is low vii. Skin is cold viii. Profuse perspiration ix. Temperature is low less than 35 o. C

IN FATAL-----i. Cyanosis ii. Fine froth for month. iii. Breathing is sighing & irregular (2 -4/m) iv. Pulse is imperceptible. v. Pupils dilate terminally vi. No reaction to light. vii. Coma deep & respiratory paralysis.

DIAGNOSITC POINT: i. Breath smells of opium(raw flesh) ii. Pin point pupils with no reaction to light. iii. Moist perspiring skin ------ iv. Low temp < 35 o. C v. Cyanosis, froth at month & nose.

D/D: i. CVA (elderly hypertensive, pontine hmg) ii. Metabolic conditions a) Uraemic coma b) Diabetic coma iii. Alcohol poisoning iv. Organophosphorous poisoning v. Carbolic acid poisoning vi. Epileptic , hysterical coma and in barbiturate poisoning

TREATMENT Emetics – ineffective – due to depression of vomiting centre.

2. Stomach wash a. with tepid water, initially & then b. with KMNO 4 : 1: 5000 strength till the washed water returns with original pink colour c. Some KMNO 4 should be left in stomach to oxidize alkaloids that is secreted in stomach after absorption d. In the absence of KMNO 4, wash stomach with.

i. Tea or tannic acid ii. Mixture of powder Charcoal & water. IMPORTANT: § Gastric lavage should be done if the drug is taken by Hypo dermic or S / C injection as alkaloid is resecreted into stomach after absorption.

SPECIFIC: § § § Nalorphine (Specific antidote to opium) 5 – 10 mg after every 15 minutes till § Pupils begin to dilate § Response becomes normal § Patient is aroused Maximum dose 40 mg

Naloxone (pure antagonist): § 0. 4 – 0. 8 mg I/m or I/V to be repeated every 10 to 15 minutes § Maximum dose 10 mg i. Antibiotic in case of prolonged coma. ii. Artificial respiration iii. Keep the body warm iv. Symptomatic treatment

MEDICOLEGAL ASPECTS § Mostly suicidal easily availability & painless. § Homicidal rare due to bad smell and taste, mostly used in infanticide. § Accidental poisoning due to over dosage. (death on the needle)

OPIUM ADDICTION Chronic poisoning morphinism morphinomania Chronic poisoning is characterized by 1. Physical 2. Mental 3. Moral degeneration

SIGNS OF PHYSICAL DEGENERATION 1. Emaciation 2. Infections 3. Anorexia 4. Constipation 5. Impotence 6. Sterility, etc

SIGNS OF MENTAL DEGENERATION 1. Loss of memory 2. Irritability 3. Depression 4. Gradual dementia

SIGNS OF MORAL DEGENERATION 1. Criminal attitude 2. Distorted personality

HEROIN (BROWN SUGAR) § It’s a synthetic derivative § Most potent addictive drug § Smack, junk, dope & brown sugar § Can be smoked, inhaled or injected

SHOOTING GALLERY: Is the place where heroin activities are conducted. BOOTING/ FOOLING: Is the process of injecting small amount of drug, withdrawing some blood to ensure that the needle is in the vein & to keep the lumen open, helps to asses the potency of drug & for intermittent injection.

Tolerance develops rapidly Withdrawl symptoms are: § Sweating § Malaise § Anxiety § Depression § General feeling of heaviness § Cramps in limbs In case of severe addiction there is also twitching & convulsions.

§ Heroin is rapidly metabolized, blood samples can be negative after 30 – 60 min. § Urine samples may show morphine alkaloids for hours or days even after a single dose