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