Opium is the latex obtained by incision from the capsule of small plant : Papaver somniferum (Poppy)
Family : papaveraceae
It is a herb growing up to 1 meter in height. Each plant bears 5 to 8 capsules. flowers are white.
Since opium is highly addictive, there are strict restrictions regarding the cultivation of poppy plant. It can only be grown for therapeutic purposes, and permission must be sought from the government for cultivation and subsequent sale of the extract to the pharmaceutical companies. India produces 70-80 % of opium world wide for therapeutic purposes.
Synonyms - अहिफेन, निफेन, अफेन, नागफेन, अफीम etc.
Active principles -
a) Phenanthrene - 1. Morphine
b) Benzyl Isoquinoline - 1. Papaverine
Signs and Symptoms
A) Stage of Excitement -
This is the stage of short duration and may not be manifested if, a heavy dose is ingested. This is the stage of a sense of well being and increased mental and physical activities are noticed as below :
i) Freedom from anxiety
iv) Flushing of face
v) Increased action of heart.
vi) In children it may present with convulsion.
The excitement is so much that the patient becomes a maniac.
B) Stage of Stupor -
This also lasts from a few minutes to a few hours and is invariably present in all cases of opium poisoning. The patients are frequently brought for medical aid at this stage. This is the stage when depressive actions start appearing.
This is noticed by :
ii) Heaviness of body
v) Drowsiness and intense desire to sleep, from where the patient can be aroused but likes to sleep.
vi) Pupils are contracted and pin point.
vii) The face and lips are slightly cyanosed.
vii) The pulse and respiration is normal.
C) Stage of Coma -
i) This is the stage of coma where the person cannot be aroused. There is no response on talking and shaking.
ii) Later on there is no response to deep pain.
iii) The muscles are relaxed and reflexes are lost.
iv) All secretions are depressed and suspended.
v) Pupils are contracted, pin point and insensitive to light. They dilate only when asphyxia sets in, which is a terminal feature of poisoning.
vi) Respiration is slow, deep in character and subsequently labored - Chyne stokes type.
vii) Pulse is feeble and slow, gradually it becomes irregular and imperceptible.
viii) Rarely there could be convulsions before death.
Fatal Dose - 1. Opium - 2 gm
2. Morphine - 0.2 gm
3. Codeine - 1/2 gm
Fatal Period - 1 to 12 hrs.
Management/ Treatment :
A) According to Modern :
i) Supportive measures -
a. Maintenance of patient airway.
b. Endotracheal incubation, assisted ventilation.
ii) Stomach wash ( in oral ingestions)
iii) Antidotes : 1. Naloxone 0.4 to 2 gm I.V
2. Nalorphine 5 to 10 gm I.V
iv) Physostigmine salicylate 0.04 mg/kg I.V may be given to reverse respiratory depression if both regular antidotes are not available.
v) Amiphenazole 20 to 40 mg IV can also be given and repeated as required.
vi) Convulsions may be treated with benzodiazepines in the usual manner, though this is frequently not necessary if naloxone is available.
B) According to Ayurveda :
The Juice extracted from the plant brhatkshudra (बर्हत्क्षुद्र) in the quantity of one pala mixed with milk if taken orally cures all the ill effects of the opium and the person thus gets rid from the death.
1) External appearance
A) Injection marks, dermal abscesses, scarring. Look for injection marks in antecubital fossae, forearms, back of the hands, neck, groin and ankles.
D) Blueish of finger nails and face.
E) Presence of white, fine froth around the face and nose.
F) Petechial hemorrhages in the skin and other parts.
2) Internal appearance
A) The stomach may contain dark brown lumps. The walls may or may not be congested.
B) Gross pulmonary edema with froth exuding out of mouth and nostrils, especially in sudden heroin-related death.
C) Cerebral edema.
D) Congestion of liver with enlargement of hepatic lymph nodes. chemical analysis of lymph nodes may reveal presence of morphine.
1) It is the commonest drug used for suicidal purposes, primarily because the death is painless, 40% of all suicidal cases are caused by opium. In the urban community morphine is used more frequently.
2) For homicidal purposes opium is rarely used of bad tastes.
3) Accidental poisoning is more frequent in children.