opium poisoning

What is the source of opium?

Opium is obtained from the coagulated air-dried latex of unripe capsules of the white poppy plant Papaver somniferum.

Which are the three major opiate receptors?

• Mu (μ, OP3): Euphoria, analgesia, respiratory depression

• Kappa (κ, OP2): Miosis, spinal analgesia

• Delta (δ, OP1): Spinal and supraspinal analgesia

How are opioids metabolized?

Primarily in the liver via glucuronidation; excreted in urine and faeces.

What are the three stages of acute opium poisoning?

1. Stage of Excitement: Euphoria, convulsions in children

2. Stage of Stupor: Sleepiness, pinpoint pupils, cyanosis

3. Stage of Narcosis: Deep coma, Cheyne-Stokes respiration, pinpoint pupils, leading to death from respiratory paralysis

What is the fatal dose of opium and morphine?
What is the usual fatal period in opium poisoning?

2 gm of opium or 200 mg of morphine in non-addicts.
: Few hours to 2 days.

What is the initial emergency treatment for opium overdose?

• Maintain airway and respiration

• Gastric lavage with KMnO₄ (1:5000)

• Purgative: Magnesium sulphate

• IV fluids and correction of electrolytes

• Antibiotics to prevent lung infections

Which opioid antagonist is preferred for acute poisoning?

Naloxone (0.4–2 mg IV, repeated every 10–15 mins up to 10 mg)

What precaution is taken before naltrexone therapy?

Ensure opioid-free for at least 5 days; test tolerance with naloxone.

What are the hallmark postmortem findings in opium poisoning?

• Intense cyanosis (face, lips, fingertips)

• Pulmonary oedema with frothy discharge

• Congested organs

• Smell of opium in stomach (disappears with decomposition)

• Petechial haemorrhages on pleura

What are the common modes of opium poisoning?

• Suicidal: Oral or injection

• Homicidal: Rare, may be used in infants

• Accidental: In children, addicts, breastfed infants

• Aphrodisiac use: Common but leads to tolerance and addiction

What are symptoms of chronic opium use?

Anorexia, constipation, insomnia, fatigue, impotence, mental depression, moral decline.

What is the treatment for chronic morphine addiction?

• Gradual withdrawal

• Methadone (30–40 mg/day, tapered)

• Nutritional support

• Psychiatric counselling

• Propranolol for anxiety

What are the typical withdrawal symptoms

• Nausea, diarrhoea, lacrimation, yawning

• Mydriasis, rhinorrhoea, sweating, muscle twitching

• Goosebumps, insomnia, increased BP & RR