OPIUM POISONING
DEFINITIONS
OPIUM
The dried sap of the poppy plant (Papaver somniferum)
Dried opium is light brown-yellow powder with characteristic odor
Active pharmacological constituents include:
-Morphine 10%
-Codeine 0.5%
-Thebaine 0.2%
-Papaverine 1%
-Noscapine 6%
OPIATES
Drugs extracted directly from opium e.g. morphine, codeine.
OPIOIDS
Drugs with opiate like effects. These include
-Semi synthetic opioids e.g. heroine, oxycodone.
-Fully synthetic opioids e.g. meperidine, propoxyphene.
ROUTES OF ADMINISTRATION
-Oral*
-Intramuscular *
-Nasal sniffing*
-Intravenous*
-Subcutaneous*
-Inhalational*
-Trans dermal
-Trans mucosal
- Intrathecal
* Important in forensic medicine
USES
Opioids are used as
-analgesics
-antitussives
-antidiarrhoeal agents
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-Intraarticular
ABUSE
Morphine and its derivatives are also used as drugs of abuse
Sale and purchase of opium is under control
MANAGEMENT
SUPPORTIVE CARE
-Endotracheal tube
-Assisted ventilation (temporary ventilation can be provided with bag-valve mask with 100%
Oxygen
-In comatose patient 50% glucose and Thiamine are to be given before Nalaxone
GASTRIC DECONTAMINATION
-Emesis should not be used
-Activated charcoal can be given if bowel sounds are audible
ANTIDOTE
NALAXONE
-If patient is a suspected addict -restrain
-give 0.1mg Nalaxone intravenously, doubled every 2mins until
patient responds or 10-20mg has been given
-If not addicted
Give 2mg every 2-3mins to a total of 10-20mg
-Diagnostic therapeutic test
Complete response to Nalaxone with mydriasis and improved ventilation
-Repeat doses may be necessary because effects of opioids last longer than Nalaxone
-Effects of Nalaxone are limited to 30-60mins and will subside in a short time
- If relapse occurs after first response to Nalaxone continuous infusion can be started
-Careful titration of dose of Nalaxone may help prevent with drawl symptoms in abusers
NALMEFENE
-Long acting (4-8 hrs) pure opioid antagonist
-Dose- 2mg
- Role in acute intoxication is unclear but may have role in place of Nalaxone infusion
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AUTOPSY FINDINGS IN CASE OF CHRONIC MORPHINE
AND OTHER OPIOID ABUSE
-This is a high risk group for transmission of Hepatitis B & C, HIV and AIDS so care should be taken
-Body may be emaciated, dirty and show signs of infection especially in the form of ulceration
-Although clinically constricted pupils are characteristic but after death any kind of pupil
alteration may occur.
-Froth may be exuding from mouth and nostrils (due to pulmonary edema)
-Injection marks:
-commonly on the arms, classically in the antecubital fossa on the front of the elbow or
into one of the prominent veins on the forearms or dorsum of the hand
-usually left sided as majority are right-handed
-in habitual users sclerosis of veins may occur so hands may be used randomly
-veins of dorsum of the foot may be used due to thrombosis and scarring in hands and arms
-old injection marks may sometimes be associated with bruises
-veins may show overlying fibrosis where phlebitis has occurred or old venous thrombosis
with firm cordlike vessels under the skin
-Skin popping
-subcutaneous injections commonly on thighs and abdominal walls
-lead to areas of subcutaneous sclerosis, fat necrosis and abscesses
-deeper injection into muscle can cause chronic myositis
-Tattoo marks commonly found especially on buccal (inner) surface of lower lip
-On Histology
-foreign substances including talc and cotton strands may be discovered as embolic
particles especially in lungs
-pulmonary granulomata are well known in addicts
SAMPLES TO BE COLLECTED
-Blood
-Urine
-Stomach & contents
-Liver
-Kidney
-CSF
-Dry swabs from each nostril if taken by nasal route
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-Brain
-Vitreous humor
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