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Excitement. Narcosis. SOMNIFEROUS POISONS (OPIOIDS). Known as somniferous poisons or narcotics Reduce pain Induce sleep Important poisons i . OPIUM. ii. HEROIN (Brown sugar) Synthetic derivatives of opium ( Diacetyl morphine) Strong analgesic Narcotics Cause severe addiction - PowerPoint PPT Presentation
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SOMNIFEROUS POISONS SOMNIFEROUS POISONS (OPIOIDS)(OPIOIDS)
Known as somniferous poisons or narcotics Known as somniferous poisons or narcotics
i.i. Reduce pain Reduce pain
ii.ii. Induce sleepInduce sleep
Important poisonsImportant poisons
i. i. OPIUMOPIUM Excitement
Narcosis
ii. ii. HEROINHEROIN (Brown sugar) (Brown sugar) Synthetic derivatives of opium (Diacetyl Synthetic derivatives of opium (Diacetyl
morphine)morphine) Strong analgesicStrong analgesic Narcotics Narcotics Cause severe addictionCause severe addiction
iiiiii. PETHIDINE. PETHIDINE (Meperidine)(Meperidine) AnalgesiaAnalgesia EuphoriaEuphoria Very high addictionVery high addiction Difficult to treatment Difficult to treatment
OPIUM & MORPHINEOPIUM & MORPHINE
OPIUM (AFIM)OPIUM (AFIM):-:- Dried juice obtained by Dried juice obtained by
incision of unripe capsule of white incision of unripe capsule of white
poppy (Papaver somniferum)poppy (Papaver somniferum)
There are two groups of alkaloids There are two groups of alkaloids
i.i. PhenanthrenePhenanthrene
ii.ii. IsoquinolineIsoquinoline
Phenathrene GroupPhenathrene Group
i.i. Morphine about 10%Morphine about 10%
ii.ii. Codeine about 0.5%Codeine about 0.5%
iii.iii. Thebaine about 0.3%Thebaine about 0.3%
iv.iv. DioninDionin
v.v. Heroin (Diacetyl Morphine)Heroin (Diacetyl Morphine) Isoquinoline GroupIsoquinoline Group
i.i. Papaverine about 1%Papaverine about 1%
ii.ii. Narcotine about 6%Narcotine about 6%
(They are mild analgesic but no narcotic (They are mild analgesic but no narcotic effect)effect)
Ripe and dry capsule of poppy contain very Ripe and dry capsule of poppy contain very little opium.little opium.
Poppy seeds (khaskhas) are creamish in Poppy seeds (khaskhas) are creamish in colour and contain no opium.colour and contain no opium.
Used as food and oil for cooking.Used as food and oil for cooking. Alkaloids of opium used in medicine areAlkaloids of opium used in medicine are
i.i. MorphineMorphine
ii.ii. CodeineCodeine
iii.iii. Apomorphine: Used as emeticsApomorphine: Used as emetics
They act as narcotic and sedative
SIGNS & SYMPTOMSSIGNS & SYMPTOMS
Acute poisoning , mainly acts on CNS Acute poisoning , mainly acts on CNS
in three stages in three stages
i.i. ExcitementExcitement
ii.ii. StuporStupor
iii.iii. NarcosisNarcosis
STAGE OF EXCITEMENT:STAGE OF EXCITEMENT:
i.i. Sense of well beingSense of well being
ii.ii. LaughterLaughter
iii.iii. HallucinationHallucination
iv.iv. Increase in H.RateIncrease in H.Rate
v.v. Convulsions may occur in childrenConvulsions may occur in children
STAGE OF STUPORSTAGE OF STUPOR i.i. HeadacheHeadache
ii.ii. GiddinessGiddiness
iii.iii. Diminished sensibilityDiminished sensibility
iv.iv. Strong tendency to sleepStrong tendency to sleep
v.v. Awake only by painful stimuli.Awake only by painful stimuli.
vi.vi. Pupils are contractedPupils are contracted
vii.vii. Lips & face are cyanosedLips & face are cyanosed
viii.viii. Pulse normalPulse normal
ix.ix. Respiration normal Respiration normal
STAGE OF NARCOSISSTAGE OF NARCOSIS::
i.i. Deep comaDeep coma
ii.ii. Muscles relaxedMuscles relaxed
iii.iii. Reflexes abolished.Reflexes abolished.
iv.iv. Pupils contractedPupils contracted
v.v. No reaction to light No reaction to light
vi.vi. BP is lowBP is low
vii.vii. Skin is coldSkin is cold
viii.viii. Profuse perspiration Profuse perspiration
ix.ix. Temperature is low less than 35Temperature is low less than 35ooCC
IN FATAL------IN FATAL------
i.i. CyanosisCyanosis
ii.ii. Fine froth for month. Fine froth for month.
iii.iii. Breathing is sighing & irregular (2-4/m)Breathing is sighing & irregular (2-4/m)
iv.iv. Pulse is imperceptible.Pulse is imperceptible.
v.v. Pupils dilate terminallyPupils dilate terminally
vi.vi. No reaction to light.No reaction to light.
vii.vii. Coma deep & respiratory paralysis.Coma deep & respiratory paralysis.
DIAGNOSITC POINT:DIAGNOSITC POINT:
i.i. Breath smells of opium(raw flesh)Breath smells of opium(raw flesh)
ii.ii. Pin point pupils with no reaction to light.Pin point pupils with no reaction to light.
iii.iii. Moist perspiring skin -----------Moist perspiring skin -----------
iv.iv. Low temp < 35Low temp < 35ooCC
v.v. Cyanosis, froth at month & nose.Cyanosis, froth at month & nose.
D/D:D/D:
i.i. CVA (elderly hypertensive,pontine hmg)CVA (elderly hypertensive,pontine hmg)
ii.ii. Metabolic conditionsMetabolic conditions
a)a) Uraemic comaUraemic coma
b)b) Diabetic comaDiabetic coma
iii.iii. Alcohol poisoningAlcohol poisoning
iv.iv. Organophosphorous poisoningOrganophosphorous poisoning
v.v. Carbolic acid poisoningCarbolic acid poisoning
vi.vi. Epileptic ,hysterical coma and inEpileptic ,hysterical coma and in
barbiturate poisoningbarbiturate poisoning
Emetics – ineffective – due to depression Emetics – ineffective – due to depression
of vomiting centre.of vomiting centre.
TREATMENTTREATMENT
2.2. Stomach washStomach wash
a.a. with tepid water, initially & thenwith tepid water, initially & then
b.b. with KMNOwith KMNO44 : 1: 5000 strength till the : 1: 5000 strength till the
washed water returns with original pink washed water returns with original pink
colourcolour
c.c. Some KMNOSome KMNO44 should be left in stomach should be left in stomach
to oxidize alkaloids that is secreted in to oxidize alkaloids that is secreted in
stomach after absorptionstomach after absorption
d.d. In the absence of KMNOIn the absence of KMNO44, wash , wash
stomach with.stomach with.
i.i. Tea or tannic acidTea or tannic acid
ii.ii. Mixture of powder Charcoal & water.Mixture of powder Charcoal & water.
IMPORTANT:IMPORTANT:
Gastric lavage should be done if the drug is Gastric lavage should be done if the drug is
taken by Hypo dermic or S / C injection as taken by Hypo dermic or S / C injection as
alkaloid is resecreted into stomach after alkaloid is resecreted into stomach after
absorption.absorption.
SPECIFICSPECIFIC::
Nalorphine Nalorphine (Specific antidote to opium) (Specific antidote to opium)
5 – 10 mg after every 15 minutes till5 – 10 mg after every 15 minutes till
Pupils begin to dilatePupils begin to dilate
Response becomes normalResponse becomes normal
Patient is arousedPatient is aroused
Maximum dose 40 mgMaximum dose 40 mg
NaloxoneNaloxone (pure antagonist): (pure antagonist):
0.4 – 0.8mg I/m or I/V to be repeated every 10 0.4 – 0.8mg I/m or I/V to be repeated every 10
to 15 minutes to 15 minutes
Maximum dose 10 mgMaximum dose 10 mg
i.i. Antibiotic in case of prolonged coma.Antibiotic in case of prolonged coma.
ii.ii. Artificial respirationArtificial respiration
iii.iii. Keep the body warmKeep the body warm
iv.iv. Symptomatic treatmentSymptomatic treatment
Mostly suicidalMostly suicidal easily availability & painless. easily availability & painless.
HomicidalHomicidal rare due to bad smell and taste, rare due to bad smell and taste,
mostly used in mostly used in infanticide infanticide ..
Accidental Accidental poisoning due to over dosage.poisoning due to over dosage.
(death on the needle)(death on the needle)
MEDICOLEGAL ASPECTS
OPIUM ADDICTIONOPIUM ADDICTION Chronic poisoningChronic poisoning
morphinismmorphinism
morphinomaniamorphinomania
Chronic poisoning is characterized by Chronic poisoning is characterized by
1.1. PhysicalPhysical
2.2. MentalMental
3.3. Moral degenerationMoral degeneration
SIGNS OF PHYSICAL SIGNS OF PHYSICAL DEGENERATIONDEGENERATION
1.1. EmaciationEmaciation
2.2. InfectionsInfections
3.3. AnorexiaAnorexia
4.4. ConstipationConstipation
5.5. ImpotenceImpotence
6.6. Sterility, etcSterility, etc
SIGNS OF MENTAL SIGNS OF MENTAL DEGENERATIONDEGENERATION
1.1. Loss of memoryLoss of memory
2.2. IrritabilityIrritability
3.3. DepressionDepression
4.4. Gradual dementiaGradual dementia
SIGNS OF MORAL DEGENERATIONSIGNS OF MORAL DEGENERATION
1.1. Criminal attitudeCriminal attitude
2.2. Distorted personalityDistorted personality
HEROIN (BROWN SUGAR)HEROIN (BROWN SUGAR)
It’s a synthetic derivativeIt’s a synthetic derivative
Most potent addictive drugMost potent addictive drug
Smack,junk,dope & brown sugarSmack,junk,dope & brown sugar
Can be smoked, inhaled or injectedCan be smoked, inhaled or injected
SHOOTING GALLERY:SHOOTING GALLERY:
Is the place where heroin activities are Is the place where heroin activities are
conducted.conducted.
BOOTING/ FOOLING:BOOTING/ FOOLING:
Is the process of injecting small amount of Is the process of injecting small amount of
drug, withdrawing some blood to ensure drug, withdrawing some blood to ensure
that the needle is in the vein & to keep the that the needle is in the vein & to keep the
lumen open, helps to asses the potency of lumen open, helps to asses the potency of
drug & for intermittent injection.drug & for intermittent injection.
Tolerance develops rapidlyTolerance develops rapidly
Withdrawl symptoms are:Withdrawl symptoms are: SweatingSweating MalaiseMalaise AnxietyAnxiety DepressionDepression General feeling of heavinessGeneral feeling of heaviness Cramps in limbsCramps in limbs
In case of severe addiction there is also In case of severe addiction there is also twitching & convulsions.twitching & convulsions.
Heroin is rapidly metabolized, blood Heroin is rapidly metabolized, blood
samples can be negative after 30 – 60 min.samples can be negative after 30 – 60 min.
Urine samples may show morphine Urine samples may show morphine
alkaloids for hours or days even after a alkaloids for hours or days even after a
single dosesingle dose