1. SOMNIFEROUS POISONS (OPIOIDS)
Known as somniferous poisons or narcotics
Reduce pain
Induce sleep
Important poisons
i. OPIUM
Excitement
Narcosis

2. 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

3. OPIUM & MORPHINE
OPIUM (AFIM):- Dried juice obtained by incision of unripe capsule of white poppy (Papaver somniferum)
There are two groups of alkaloids
Phenanthrene
Isoquinoline

4. Phenathrene Group
Morphine about 10%
Codeine about 0.5%
Thebaine about 0.3%
Dionin
Heroin (Diacetyl Morphine)
Isoquinoline Group
Papaverine about 1%
Narcotine about 6%
(They are mild analgesic but no narcotic effect)

6. 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
Morphine
Codeine
Apomorphine: Used as emetics
They act as narcotic and sedative

7. SIGNS & SYMPTOMS Acute poisoning , mainly acts on CNS in three stages
Excitement
Stupor
Narcosis

8. STAGE OF EXCITEMENT: Sense of well being Laughter Hallucination
Increase in H.Rate
Convulsions may occur in children

9. STAGE OF STUPOR Headache Giddiness Diminished sensibility
Strong tendency to sleep
Awake only by painful stimuli.
Pupils are contracted
Lips & face are cyanosed
Pulse normal
Respiration normal

10. STAGE OF NARCOSIS: Deep coma Muscles relaxed Reflexes abolished.
Pupils contracted
No reaction to light
BP is low
Skin is cold
Profuse perspiration
Temperature is low less than 35oC

11. IN FATAL------ Cyanosis Fine froth for month.
Breathing is sighing & irregular (2-4/m)
Pulse is imperceptible.
Pupils dilate terminally
No reaction to light.
Coma deep & respiratory paralysis.

12. DIAGNOSITC POINT: Breath smells of opium(raw flesh)
Pin point pupils with no reaction to light.
Moist perspiring skin
Low temp < 35oC
Cyanosis, froth at month & nose.

13. D/D: CVA (elderly hypertensive,pontine hmg) Metabolic conditions
Uraemic coma
Diabetic coma
Alcohol poisoning
Organophosphorous poisoning
Carbolic acid poisoning
Epileptic ,hysterical coma and in
barbiturate poisoning

14. TREATMENT
Emetics – ineffective – due to depression of vomiting centre.

15. Stomach wash
with tepid water, initially & then
with KMNO4 : 1: 5000 strength till the washed water returns with original pink colour
Some KMNO4 should be left in stomach to oxidize alkaloids that is secreted in stomach after absorption
In the absence of KMNO4, wash stomach with.

16. IMPORTANT: Tea or tannic acid Mixture of powder Charcoal & water.
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.

17. 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

18. Naloxone (pure antagonist):
0.4 – 0.8mg I/m or I/V to be repeated every 10 to 15 minutes
Maximum dose 10 mg
Antibiotic in case of prolonged coma.
Artificial respiration
Keep the body warm
Symptomatic treatment

19. 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)

20. OPIUM ADDICTION
Chronic poisoning
morphinism
morphinomania
Chronic poisoning is characterized by
Physical
Mental
Moral degeneration

22. SIGNS OF PHYSICAL DEGENERATION
Emaciation
Infections
Anorexia
Constipation
Impotence
Sterility, etc

23. SIGNS OF MENTAL DEGENERATION
Loss of memory
Irritability
Depression
Gradual dementia

24. SIGNS OF MORAL DEGENERATION
Criminal attitude
Distorted personality

25. HEROIN (BROWN SUGAR) It’s a synthetic derivative
Most potent addictive drug
Smack,junk,dope & brown sugar
Can be smoked, inhaled or injected

26. 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.

27. 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.

28. 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