Opioid Poisoning

• Derived from Papaver somniferum
• Toxic part - Unripe fruit capsule, latex juice
• Active Principles
  • Phenanthrene derivatives
    • Morphine
    • Codeine
    • Thebaine
  • Benzyl-isoquinolone derivatives
    • Papaverine
    • Noscapine

All the planrt alkaloids have a pyridine nucleus

• Marquis test
  • Specimen + H2SO4 + Formalin
    • Purple red color
    • Changes to violet

• Ideal suicidal poison
• Rare in homicide
• Postmortem
  • Deeply cyanose complexion
  • Trachea has frothy secretions
  • Opium disappears with putrefaction
• May be used in infanticide
• Body Packers
  • Confirm with CT or X-ray
  • Avoid endoscopy
• Chasing the dragon
  • Heating heroin in aluminium foil
• Fentanyl
  • Preferred drug of abuse of anesthesiologists
• Heroin is Diacetyl Morphine

• Features of Opioid intoxication
  • Pinpoint pupils - not always present
  • Urticaria & Bronchospasm
    • From Histamine release
  • Lung injury
    • With Heroin overdose
• Rx of Opioid intoxication
  • Maintain Airway & Ventilation - Most important
  • Naloxone

FM & Toxicology - Gautam Biswas - 2nd edition Page No: 475

Tintinalli's Emergency Medicine , 8th Ed Page no 1251-1253

• Binds to Opioid receptors
  • 4-types - Mu, kappa, delta, OFQ/N
• Inhibits neurotransmission

• Smoking
• Snorting
• Chasing the dragon
• IV (mainlining)
• Subcutaneous (skin popping)
• With Cocaine (speed balling)

• Hepatic conjugation
• Excretion in Urine

• Stage of Exceitement
  • Euphoria
• Stage of Stupor
  • Pupils contracted
  • Deep drowsiness
• Stage of Coma
  • Constricted Pupils
  • Hypothermia
  • Weak pulse
  • Slow Respiratiopn
  • Increased Sphincter tone
  • Pink froth from mouth
• Fatal dose ( difficult to remember )
  • Opium: 2 g
  • Morphine: 200 mg
  • Codeine: 50 mg

• Stomach wash
  • With KMnO4
  • Even in IV consumption
  • Activated Charcoal - Method of choice following oral ingestion
• Naloxone
• Add Flumazenil if no response to naloxone

• Yawning, Lacrimation, sweating
• Rhinorrhea, Piloerection
• Vomitting, diarrhea, Abd cramps
• Rx
  • Clonidine, Antiemetics
  • Methadone to reduce craving