Transcript File

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 (khaskhas) 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 35oC
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 < 35oC
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 KMNO4 : 1: 5000 strength
till the
washed water returns with original pink
colour
c.
Some KMNO4 should be left in stomach
to oxidize alkaloids that is secreted in
stomach after absorption
d.
In the absence
stomach with.
of
KMNO4,
wash
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 – 0.8mg 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