Somniferous Group

“Thou hast the keys of Paradise

Oh, just, subtle and mighty opium!”

The term Somniferous means sleep producing

 Opium

Opium is the latex obtained by incision from

the capsule of a small plant:
Papaver somniferum (Poppy)
 Physical Appearance

Crude opium is a dark brown or grey.

Irregular mass with a characteristic odour
and bitter taste
 Active Properties

Number of Alkaloids -----Two groups

1. Phenanthrene group----
Morphine,”Codeine and Thebaine

2. Benzyl isoquinoline group --- Papaverine

and Noscapine (Narcotine)
Natural derivatives (Opiates)
Heroin (Diacetyl Morphine)
Apomorphine
Oxymorphone
Hydromorphone
Paregoric (Comphorated tincture of opium) etc
Morphine (Morpheus) Greek God of dreams
(S/O Hypnos, the God of sleep).
Synthetic Derivatives (Opioids)
Pethidine (meperidine)
Methadone
Pentazocine
Propoxyphene
Levorphanol
Diphenoxylate
Fentanyl, etc
 It causes CNS depression, analgesia &
hypnosis.
 Combination of hypnosis & analgesia is
known as narcosis
 Opium is a true narcotic.
 Opium depresses all centers except
acculomotor center, vomiting center &
sweating
 Sign & Symptoms

 Most of these drugs are absorbed from

the GI tract, but maximum effect is
produced by parenteral routes (Especially
intramuscular or intravenous injection)
Acute Poisoning
 Manifestations occur when the therapeutic
dose is exceeded markedly.
 The principal manifestation of acute opiate
and opioid overdose.
In Mild Cases
 Euphoria (feeling of drowsy wellbeing)
 Hallucination
 Tachycardia
 Vomiting
 Lethargy
 Constricted pupils (due to stimulation of 3rd
nerve nucleus)
 Constipation
Toxicity reading, therapeutic doses and fatal
doses. (parenteral)
Toxicity Therapeutic Usual fatal
Compound
rating dose (mg) dose (mg)
Crude Opium 5 --- 500
Morphine 6 10-15 200
Pethidine 5 50-150 1000
Codeine 5 10-60 (Oral) 800 (Oral)
Methadone --- 5-10 100
Heroin 6 --- 50
Pentazocine 5 30-60 300
In severe cases there are:
 Stupor (Progressing to coma)

 Rekaxation of muscles, (myoclonic

jerks and convulsions are common with

pathidine)
 Abolition of reflexes

 Hypotension, with weak, thready pulse

 Cold, clammy skin (hyporthermia with

increased sweating)
 Respiratory depression with slow,
sighing breaths. There may be
sudden, severe pulmonary oedema
with copious frothing from the mouth.
 Cyanosis of extremities.
 Pinpoint constriction of pupils (may
dilate in terminal stages)
 Death (due to respiratory failure) may
be preceded by convulsions)
Marquis Test
Mix 3cc conc. Sulphuric acid with 3 drops of
formalin and add this to the suspected
tissue or fluid. A purplish colour develops
which gradually turns blue.
Chronic Poisoning
Useful pointers which indicate opiate addiction:
 Unusual mood swings, periods of depression
alternating with euphoria
 Amnesia
 Hallucination
 Withdrawal from family, friends & social
activities.
 Frequent domestic strife.
 Long hours of unexplained absence from
home
 Unexplained overspending.
 Frequent conflicts with law (e.g.
driving offences)
 Dwindling sexual drive.
 Pills, syringes etc lying around the
House.
 Bloody swabs or tissue lying around
the house or in the working place
 Periodic disappearances into a locked
room (bathroom, bedroom etc)
 Pinpoint pupils
 Anorexia
 Weight loss, pallor
 Chronic constipation
 Impotence
 Dermal scars from repeated injections
 Periodic withdrawal manifestation–
swelling, tremors.
 Abrupt cessation of opiate intake can cause
a withdrawal reaction (Cold turkey)
Acute Poisoning
1. Establish adequate airways & respiration
2. Use endotracheal intubation, oxygen
3. Stomach wash (In oral ingestion)
4. IV Dextrose (50 ml of 50% solution) and
thiamine (100 mg)
5. The antidote for most opiates & opioids is
naloxone. Dramatic reversal of the following
features is achieved:
miosis, respiratory, depression, hypertension
and coma. Dose is 1.2 mg for an adult and 0.4
mg for a child.
6. Physostigmine salicylate 0.04mg/Kg IV
may be given to reverse respiratory
depression. If both the regular antidotes
are not available.
7. Amiphenazole 20 to 40 mg IV can also be
given and repeated as required.
8. Supportive measures vasopressors for
hypertension, diuretics and antibiotics
for pulmonary oedema etc
9. If convulsions diazepam may be given
10 mg IV and repeated as required.
Chronic Poisoning
1. The drug intake should not be abruptly stopped
but gradually withdrawn in progressively
diminishing amounts. Withdrawal reaction will
take place in severe cases even become fatal.
2. At the same time as the drug of addiction is
being withdrawn, a less potent drug must be
given ---methadone
3. A beta adrenergic blocker like propranolol (80
mg) is said to be quite effective in relieving
the anxiety and craving associated with opiate
addiction --naltrexone (long acting antagonist)
Naltima (50 mg tabs)
4. Antispasmodics can take care of
abdominal cramps, vomiting, diarrhoea
5. Tranquillizers or bed time sedation
6. Psychiatric counselling
Opiate Withdrawal (HEROIN)
Anticipatory Early Fully Developed Protected
(3 to 4 hrs (8 to 10 hrs) (1 to 3 hrs) Abstitinence
Anxiety, Restlessness Tremor, Hypertension
craving , Yawning, piloerection, , bradycardia,
drug- nausea, vomiting, insommia,
seeking sweating, diarrhoea, muscle anorexia,
behavior rhinorrhoea, spasm, stimulus-
maydriasis, hypertension, driven opiate
stomach tachycardia, fever craving
cramps, chills, impulse-
drug-seeking driven drug-
behaviour seeking
behaviour
 Postmortem Appearances
External
1. Look for injection marks on arms,
elbow (inner aspect), forearms, neck, etc
2. Tattoo marks (drug abusers)
3. Cyanosis
4. Froth at mouth and nostrils
5. Characteristic smell around the mouth
(in crude)
6. Emaciated appearance of dead body
Internal
1. Congestion and oedema of lungs with
froth in the airways (heroin lung)
2. Cerebral oedema
3. Congestion of liver, with enlargement
of hepatic nodes (said to be a very
characteristic finding in opiate and
opioid related deaths). Chemical
analysis of the lymph nodes may
reveal presence of morphine.
4. Samples of blood, urine, brain, liver and bile
must always be preserved for chemical
analysis
 Medicolegal Importance
1. Opiates and opioids among the commonest
of the drug. Apart from heroin (Brown
suger), morphine, pethidine and pentazocine
are also extensively abused.
2. Accidental deaths are relatively common
from overdose espacially among intravenois
abuses of heroin (death on the needle)
3. Suicidal deaths are also not uncommon since
opiates are reputed to cause a painless death.
4. Homicide with opiates is rare. Infanticide especially
in rural areas