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The most important constituents of opium are the alkaloids, whichconstitute in good opium about one-fifth of the weight of the drug. No fewer than twenty-one have been reported.
The principal alkaloid, both as regards its medicinal importance, and the quantity in which it exists, is Morphine. Next to this, Narcotine and Codeine are of secondary importance. Among the numerous remaining alkaloids, amounting in all to about 1 per cent of the drug, are Thebaine, Narceine, Papaverine, Codamine and Rhoeadine.
Meconic acid exists to the extent of about 5 per cent combined with morphine. This acid is easily identified, and is important in toxicological investigation, as corroborative of the presence of opium.
Meconin and meconiasin exist in small quantity only. Mucilage, sugar, wax, caoutchouc and salts of calcium, and magnesiumare also contained in opium, and sulphuric acid is found in the ash. The presence of starch, tannin, oxalic acid and fat, common constituents of most plants, indicates adulteration, as these substances do not occur normally in the drug. Powdered poppy capsules stones, small shot, pieces of lead, gum, grape must, sugary fruits, and other mechanical impurities, have also been used as adulterants of opium. The drug should not contain more than 12 1/2 per cent of moisture.
The comatose patient will ahve slow, shallow, irregular respiration. The decrease in rate is usually more marked than is the case after barbiturate intoxication. The pupils may be constricted, but asphyxial changes often obscure this. Pulse rate is slowed until tachycardia of shock supervenes.
1. Analgesia: relieves pain following the administration of doses so small that they do not cause general central nervous system depression with sedation, respiratory depression, or other disabling results. Morphine alters the individual -psychic- perception, processing of the pain. The patient may report that the pain is still present but is less distressing.
opiates are commonly said to produce euphoria, but this is an oversimplification. When given to a person who has not experienced the effect of the drug before and who is not in pain, morphine and codeine will more commonly produce a subjectively unpleasant reaction. In the presence of pain or fear, the reaction of a patient to an opiate may be much less dysphoric, and , in some people, the relief from anxiety and aggressive feelings may be pleasurable enough to provoke a desire for repetition of the experience. In these persons opium seems to increase selfconfidence and inner peace to a pathological degree.
In therapeutic doses, the sedative effects are minimal. After increasingly larger doses, the subject will become drowsy, inattentive, and inefficient and fall into a sleep from which arousal is still easy. Very large doses induce coma.
3. on respiration: depression
it is used as a drug of first choice in acute pulmonary edema, the mechanism by which it works is not clear.
on cough: depression
4. other areas of the CNS: nausea and vomiting:
motion aggravates and recumbency reduces the emetic effect. Following the initial stimulation, the vomiting center is depressed, so that vomiting does not result from closely spaced doses.
Morphine stimulates the release of growth hormone and prolactin but depresses the titer of LH and FSH. With chronic use, this leads to an altered menstrual pattern.
5. on the cardiovascular system: the skin is warm and flushed. The heart rate is slowed down only by large doses. Postural hypotension severe enough to cause dizziness or fainting can occur even after therapeutic doses
Many of the strong analgesics have been shown to be potent histamine liberators. This explains the itching and urticaria that appear after administration of these drugs.
6. on the gastrointestinal tract: constipation
therefore it was used by the Chinese to treat diarrhoe
7. on the eyes: miosis, may be overridden by the shock-mydriasis in intoxications.
Tolerance to all of the depressant effects listed above except constipation develops quickly.
Tolerance means that ever larger doses are required to elicit the same effect.
Addiction: The compulsive user usually looses interest in everything but the need to maintain the habit, which inevitably forces the individual into criminal activity. It is this rather than any inherent action of the drug that is damaging to the individual.
Withdrawal symptoms: pain, sleeplessness, diarrhoe