SOMNIFEROUS POISONS Characterized by two set of

symptoms 1. Excitement 2. Narcosis

OPIUM CAPSULE

OPIUM{AFIM}

OPIUM PAPAVER SOMNIFERUMOpium is the dried juice of papaver

somniferum ripe and dry poppy capsule – trace of opium – used as sedative.

Poppy seeds (Khas Khas) harmless.

PROPERTIES Smells like raw flesh. Taste bitter when fresh plastic &

moist internally on keeping becomes hard, brittle &

dark brown.Active Principle Two groups of alkaloids1. Phenanthrene group2. Isoquinoline group

ALKALIODS OF OPIUM Phenanthrene group1. Morphine 9-14 %2. Codeine 2- 4 %3. Thebaine 0.5 % used in analgesic, euphoriants, anti

tussives anti diarrheal. Isoquinoline group1. Papaverine 1 %2. Narcotine 6 %

Opium• Fluid obtained from the poppy plant

• Opiate• a substance derived from opium

• Opioid• substance with morphine-like actions, but not derived

directly from the poppy plants

ROUTES OF ADMINISTRATION1. Oral2. Parental ( IV or

hypodermic)3. Inhalation ( smoked )4. Tropical5. Through orifices

ABSORPTION & EXCRETION Absorbed through GIT excreted in stomach, intestine, bile &

milk eliminated mainly as morphine in urine

& faeces it is excreted in the stomach & small

intestine even after parental use.

MODE OF ACTIONActs as agonists on different opiate receptors

sitesin CNS . There are 3 sub species of opiate receptors e.g Kappa,(OP2) Sigma Delta(OP1)It acts by depression of cortexRespiration and cough centers are stimulated Vagal reflex and vomiting is stimulated

SIGN AND SYMPTOMS 1. STAGE OF EXCITEMENT ( may be absent if a large dose is taken ) Euphoric feeling of well being Restlessness and hallucination Increased pulse rate Flushing of face In children convulsions may occur

2. STAGE OF STUPOR Headache Nausea Vomiting Uncontrollable desire to sleep Pupils contracted Cyanosis Itching sensation Pulse respiration normal

3. STAGE OF NARCOSIS Patient is in deep coma Muscles relaxed and reflexes lost Secretions are suspended except of skin Blood pressure falls pulse is week and slow Cheyne – stroke breathing (R. rate 2-4/m) Lower jaw drops Pin point pupils Bladder distended

UNUSUAL SYPTOMS Vomiting diarrohea Convulsions Increased Temperature Dilated Pupils

DIFFERENTIAL DIAGNOSIS Apoplexy (Pontine hemorrhage) Metabolic conditiona. uraemic coma Barbiturate poisoning Alcoholic coma Hysterical coma Epileptic coma Carbolic acid poisoning

FATAL DOSE Crude Opium 1-2 gramsMorphine 200-400

mgTincture 8-16 mlIn children 1-3 drops

FATAL PERIOD6-12 hours in extreme case 45 minutes

TREATMENT Gastric lavageFirst with warm water then with potassium

permagnate or tannic acid Magnesium sulphate 15 grams as enemaOxygen in halation ANTITODENaloxone hydrochloride is antidote for opiate

poisoning .01 - .02mg /kg / body weight i.v

Nalorphine hydrochloride 10 mg i.v

(total of 40 mg can be given) rest of the treatment is symptomatic Post Mortem Appearance External Specific smell Deep cyanosis Pin point Pupils Froth Well marked lividity

Internal Smell of opium (musty) Marked venous congestion Blood is dark & fluid. Stomach congested may

contain black particles of opium. Bladder full of urine

MEDICO LEGAL ASPECTS Suicidal Accidental Homicidal (rare) but used for

infanticide Cattle poisoning Drug addiction

MANY PRODUCTS, MARKETED FOR ADULTS AND CHILDREN, WERE SOLD FOR PAIN AND COUGH RELIEF. THEY ALL CONTAINED OPIUM.

PROLONGED USE OF OPIUM{MORPHINISM} In young adults Can tolerate up to 3 _6 gm per day Effects are Multiple scar mark Dry skin mouth tongue and hair Nausea vomiting Depression hallucination Dementia anorexia

WITHDRAWAL SYMPTOMS 1st few hours fear and anxiety 8_16 hrs restlessness 14 hrs sweating and running nose and eyes 24 hrs dialted pupil and shivering 36 hours sever twitching of muscle, painful

cramps in legs and abdomen,vomiting,diarrhoea,insomnia

3_4 days symptoms subsides