Opioid Poisoning

By Dr. Daud Jabbar Taib

Department of Forensic Medicine
 Contents
• Introduction • Chronic Opioid Poisoning
• Signs and Symptoms • Heroin
• Fatal dose and Period
• Treatment
• Post-mortem findings
• Medico-legal value
 Introduction
• Opium (afim) is a dried juice obtained by incision of unripe capsule of white poppy
plant, called papaver somniferum.
• Its activity is due to Phenanthrene and Isoquinoline group of alkaloids.
Morphine (10%)

Codeine (0.5%)
Phenanthrene Thebaine (0.3%)

Synthetic derivatives
(Dionin, Heroin)
• The narcotic properties in phenanthrene group is due to the synthetic derivatives.
Papaverine (1%)

Isoquinoline

Narcotine (6%)
• Narcotine have mild analgesic but no narcotic properties.
• The ripe and dry poppy capsules contain only a trace of opium and are used for sedative
and narcotic effects.
• The poppy seeds (khas khas) creamish in colour, are harmless as they do not contain
opium. They are used as food.
• Crude opium is dark brown but becomes black on standing.
• It occurs in round, irregular, flattened masses, with characteristic smell and bitter taste.
• The principal alkaloids of opium used in medicine are Morphine and codeine.
 Signs and Symptoms
• They usually appear within ½ hour to 1 hour after ingestion and within 3-5 mins after
injection.
Acts on
Stimulation Depression Narcosis
CNS
• The effects can be described in three stages,
1. Excitement, 2. Stupor and 3. Narcosis.
• Stage of Excitement:- In adults, sense of well-being of brief duration, laughter,
hallucinations, and rapid heart rate occurs. In children, convulsions may occur.
• This stage is absent if dose is taken is large.
• Stage of Stupor: - followed by weariness, headache, giddiness, a sense of weight in
limbs, diminished sensibility, and a strong tendency to sleep (from which patient can be
aroused by painful stimuli).
• Face and lips are cyanosed, pupils are contracted, and itching sensation felt all over the
skin.
• Pulse and Respiration are almost normal.
• Stage of Narcosis: - Patient passes into deep coma from which he cannot be aroused,
muscle are relaxed and reflexes are abolished.
• Pupils are contracted to pin-point and do not react to light, blood pressure falls and
pulse is rapid and feeble. Breathing is slow, gradually diminishing in rate.
• Skin is cold, with profuse perspiration and, the temperature is sub-normal
(hypothermia- body temperature less than 35˚C).
 Fatal Dose and Period
• In a person not addicted to opium,
• 200 mg of morphine and it’s equivalent of opium 2 mg is fatal.
• 10 ml of tincture of opium is regarded as dangerous dose.
• The fatal dose of tincture of opium recorded in children varies from 1-3 drops.
• The usual fatal period is about 9-12 hours.
 Treatment
• Gastric lavage with Tepid water in early stage and then with a solution of potassium
permanganate, 1:5000 strength, till the washed water returns with it's original pink colour.
• In the absence of potassium permanganate, should be washed out with infusion of tea or
tannic acid or a mixture of finely powdered animal charcoal and water.
• Artificial respiration or oxygen may be needed.
• Antibiotics may be needed in case of prolonged coma.
• Body warmth must be maintained.
• The rest of the treatment is symptomatic, but treatment must be continued till the patient is
conscious and even then care must be taken that a relapse does not occur.
 Antidotes
Use till pupils began
to dilate, respiration 0.4-0.8mg IV or IM, repeated every 10-
becomes normal,
patient is aroused 15 mins

Specific
Max dose antidote
is 40mg Nalorphine for
Morphine
Naloxone

IV in dose of
Drug of choice as
5-10mg every Max dose is 10
15 mins antidote, it is a
mg
pure antagonist
 Post-Mortem Findings
External Findings Internal Findings
• Smell of opium. • Stomach contains small, soft, brownish
• Face deeply cyanosed, almost black and lump of opium.
fingernails blue. • Trachea, bronchi, lungs and brain shows
• Neck veins are engorged and distended. marked degree of congestion.

• Froth from mouth and nose. • Trachea covered with froth and lungs are
edematous.
 Medico-Legal Values
• It is suicidal poison of choice for painless death.
• Not used for homicide but sometimes used in infants (Infanticide).
• Accidental poisoning can occur in children and infants, by drugging them to keep
them quite or from overdose of a medicinal preparation.
• Sometimes opium is used to steady the nerves before doing some bold acts, e.g.
homicide.
• Opium and its preparations causes addictions, of which, heroin is the most dangerous.

Chronic Opioid Poisoning
• Also known as Morphinomania or
Morphinism.
• Results from regular use of morphine,
used medically to relief pain and
otherwise used as aphrodisiac or to just
get high.
• Users develops rapid tolerance and high
physical dependence induced.
• Larger and larger doses are required to get
the same effect and later just to remain
normal (prevent withdrawal symptoms).
Physical degeneration: emaciation,
anorexia, impotence, infection (skin
ulceration), constipation.
Mental degeneration: loss of memory,
depression, irritability, gradual
characteristics dementia.
Moral degeneration: crimes which
addicts commits for more supplies
Loss of tolerance to drug
Infection is
Death common
Suicide
 Synthetic derivate of opium. Most • Booting or Fooling: a process in which
dangerous among addictive drugs. Smoked small amount of blood is withdrawn and
ensure needle in vein to keep lumen
Routes open, this helps to assess potency and
Potent narcotic of
analgesic with entry Injected keeps high by intermittent dose or
Heroin strong euphoric injection.
effect.
Inhaled • Tolerance occurs rapidly, if withheld
as snuff
In form of white to dark patient can experience withdrawal
brown powder. Known symptoms. General feeling of
as brown sugar, smack, heaviness and
dope Withdrawal cramp like pain in
• Heroin rapidly metabolizes and no detectable drug may be symptoms limbs
found, after 30-60 mins of injection.
Sweating,
• However morphine alkaloid may be detected in urine, for malaise, anxiety,
hours or days after single exposure. depression
Confusion state
• Autopsy: blood, urine, bile and liver should be collected. Large doses with hallucination,
Lungs and Brain should also be preserved as heroin are required illusion and
concertation is high in acute death. personality
changes, rapidly
develops
Thank You