Opium as a fatal substance

Clinical manifestation and laboratory data of illicit drugs versus other substances intoxication in children

Children are highly sensitive to toxins which can damage their organs and lead to death. Investigating the main causes of intoxication could reduce mortality and morbidity in children. In this cross-sectional study, the documents of all poisoned patients (214 cases) admitted to the emergency department of Taleghani children`s Hospital between April 2020 and 2023 were investigated. Approximately 51% of them were females. There were 87 cases (45.3%) of illicit drug poisoning, which included methadone 43.8%, opium 41.4%, amphetamine 8.2%, cannabis 3.3%, buprenorphine 2.2%, and tramadol 1.1%. Children who were poisoned by illicit drugs presented with impaired level of consciousness (92.5%), unstable vital signs and abnormal laboratory results. The level of serum glucose was higher in methadone toxicity. Three and two cases, due to methadone and opium poisoning died. Children with illicit drugs poisoning in terms of vital signs and laboratory data were worse compared to other poisonings and mortality is high in this group. In this study, the blood sugar in methadone poisoning cases was statistically significantly different from other drugs, and it is suggested that in cases of children suspected of poisoning with illicit drugs and high blood sugar, methadone poisoning should be considered in the differential diagnosis.

Opium poisoning in modern times. An overview

Opium is a substance extracted from Papaver somniferum L that is chronically abused specially in the traditional production regions. Reports on opium poisoning has largely disappeared from the occidental literature on drug problems but recent scientific articles show cases of death related to opium in industrialized countries. This fact led us to consider the interest of knowing the state of the art of acute opium intoxication in modern times. This work shows a compilation of these uncommon cases occurred in different settings and circumstances. Data were obtained by a computer assisted search of the literature using the key words "opium poisoning", "poppy", "poppy seeds", and "papaver somniferum" in PubMed, accompanied by a hand search of the reference lists of all articles for any relevant studies not included in the database. In addition, Google Scholar, government reports, and cases adequately documented on websites were reviewed. Type 1 cases, Accidental opium intoxications when it is used as a recreational drug: Reported cases came mainly from industrialized countries. They were mostly male with a range age of 17-64 years. Many had antecedents of alcoholism or drug abuse and opium tea was used as a substitute of heroin. Rachacha has caused poisonings in France and has been detected in a stash in Spain. Toxicological analysis was documented in forensic cases. The danger of this renewed interest in opium is exemplified in that many of the poisoning cases resulted in fatalities. Type 2 cases, Accidental opium intoxications in children or adults when it used as folk remedy: Pediatric intoxication after the use of opium as folk remedy are mainly published in traditional opium-producing areas with a long history of use or ethnic communities in England or USA. Addiction to opium was common among relatives. Type 3 cases, Opium intoxications with poppy seeds consumed as food: Due to excessive consumption of opium seeds as food, sporadic cases of mild toxicity had been reported and morphine contents were documented. Type 4 cases: Accidental opium intoxications when using the abdominal or pelvic cavity for concealing the drug: Accidental opium body packer intoxications are seen in patients who traveled from illegal opium areas of production. Type 5 cases: Suicides by opium: Opium was a prevalent agent among cases of suicides in Iran but data are scarce.

Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers

Background:

Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers.

Objectives:

In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers.

Patients and Methods:

After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant.

Results:

The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group

Conclusions:

This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.

Hallmarks of opium poisoning in infants and toddlers

Accidental opium intoxication in children is an extremely dangerous poisoning if it remains undiagnosed and untreated. The classic triad of miosis, decreased level of consciousness and bradypnea, which are the hallmarks of opiate intoxication, are used for the diagnosis of opium poisoning in adults and children. Little attention has been paid to the signs of opium intoxication in children and no published study has explored the frequency of hallmarks of this type of poisoning in the paediatric population. We conducted a study in order to evaluate the prevalence of major signs of opium poisoning in infants and toddlers. In this study, a total of 228 infants and 82 toddlers who had been admitted to Loghman Hakim Hospital as a result of opium poisoning between 2001 and 2009 were evaluated, retrospectively.

The most usual sign of opium poisoning was miosis (90%) followed by a decreased level of consciousness (88.4%), bradypnea (28.4%) and seizure (10.3%). The prevalence of the triad of miosis, bradypnea and a decreased level of consciousness was 25.2%. Miosis in association with decreased level of consciousness was detected in 82.6% of our patients. Bradypnea was present in 74 infants and 14 toddlers, which shows a statistically significant difference ( P = 0.01). The mean age and weight of the patients with bradypnea were significantly less than those without bradypnea ( P = 0.008 and P = 0.0001, respectively). Bradypnea and seizure were significantly more common in females (36.7% versus 26%; P = 0.05 and 15.2% versus 6.5%; P = 0.01, respectively). Miosis in association with a decreased level of consciousness is the most useful indicator of opium poisoning in infants and toddlers. Furthermore, seizure is a more common feature of this type of poisoning in infants, especially in those who are less than 1 month old.