Death opiates

Taylor K, Elliott S (2009) A validated hybrid quadrupole linear ion-trap LC-MS method for the analysis of morphine and morphine glucuronides applied to opiate deaths. Forensic Sci Int 187(l-3) 34 fl. doi S0379-0738(09)00085-l [pii] 10.1016/j.forsciint.2009.02.011... 

Opiates are widely used all over the world, but recently concerns about opiate use (and deaths from such use) have increased in Australia and the UK (45). The rate of opiate overdose deaths in these countries increased dramatically between 1985 and 1995. Throughout that period, it was four to ten times higher in Austraha than the UK, but the rate of increase may have been greater in the UK in the latter half of the period, since the difference in rate narrowed substantially during that time. Methadone maintenance treatment, estabhshed in Australia in 1969 and in the UK in 1970, has become the main treatment for opiate dependence in both countries. About half of the opiate deaths in the UK were attributed at least in part to methadone. By contrast, considerably fewer (18%) opiate overdose deaths in Austraha were attributed to methadone. The authors suggested that the discrepancy in the rates between the two countries could be artefacts of the differences in (a) the documentation of these deaths, (b) the rate of opiate dependence, (c) the route of opiate administration, (d) opiate purity, and, most importantly, (e) the method of delivery of methadone maintenance treatment. 

Most opiate deaths occur among injectors in their late 20s or 30s, usually after several years of use. As with clients entering treatment, a clear ageing trend is observed among deceased opiate users in many EU countries (Figure 1 2). 

The iaterpretation of forensic toxicology (18) results is often challenging. Courts frequently ask if an amount of dmg detected ia a specimen could cause a specific type of behavior, ie, would someone be under the influence of a dmg at a specific concentration, would a particular dmg concentration cause diminished capacity, or was the dmg the cause of death In a random employee dmg testing case, a worker screened positive for opiates by EMIT and gc/ms analysis of the urine specimen showed low levels of morphine. Although one possibiUty was that the iadividual was a heroia user, a review of foods eaten ia the prior 24 hours suggested a more innocent cause a poppy-seed bagel. 

The nurse should teach the patient taking naltrexone the impact of therapy. While taking the drug, any use of heroin or other opiate by the patient results in no effect. In fact, large doses of heroin or other opiates can overcome the drug s effect and result in coma or death. 

Opiate drug exposure has a significant impact on HIV infection as well as progression to HIV-associated dementia. On a cellular level it is comprehendible that drugs of abuse such as opioids would reduce the threshold for neurotoxicity such that a marginally toxic insult would now be exacerbated and lead to cell death or injury... 

The large numbers of opioid receptors in areas of the brainstem such as the solitary tract and adjacent areas are probably related to respiratory effects of opiates, cough suppression and nausea and vomiting. Opiates acting in the brainstem reduce the sensitivity of the respiratory centres to pC02 and this is the most common cause of death from overdose with street use of opiates. 

Kantak and Miczek 1986). Amphetamine and cocaine, as well as dopaminergic agonists, increase further the already high levels of defensive responses in aggregated rats undergoing withdrawal from opiates, leading in extreme cases to the death of the subjects (Lai et al. 1971 Puri and Lai 1973). 

Narcotic analgesics Morphine and many of its homologues, when administered in medicinal doses, relieve pain and produce sleep. In poisonous doses, these produce stupor, coma, convulsions and ultimately death. Morphine narcotics are sometimes referred to as opiates, since they are obtained from the opium poppy. 

Aimost two-thirds of all drug deaths In Philadelphia and neighboring metro areas were accidental, A large number of deaths stemmed from opiates like heroin. 

Top five drug misuse deaths, 2003 Opiates, including heroin... 

Reduced opiate misuse Reduced crime and imprisonment Reduced HiV-risk behaviours (injecting) improved quality of life Reduced death rate... 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D Tardiff K (2003). Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City. Addiction, 98, 739-47... 

Narcotics Demerol Morphine Heroin Others Natural and synthetic opioids analgesics Oral or injected (IM, IV) Relaxation euphoria feelings of tranquility prevent onset of opiate withdrawal Physical dependence respiratory depression high potential for death due to overdose See Chapter 14... 

Certain forms of dyspnea yield only to opiates. Especially in this category is the dyspnea of acute left ventricular failure and pulmonary edema. Most authorities agree that morphine is contraindicated in patients with pulmonary edema caused by chemical respiratory irritants. If needed in such cases for severe pain, its use should be combined with oxygen inhalation and positive-pressure therapy. In bronchial asthma, morphine is usually contraindicated because there is danger of addiction, the drug tends to depress respiration and to constrict bronchioles, and patients with asthma may be allergic to the drug. Deaths have occurred from the use of morphine in asthma. 

Opiate addiction has also helped spread diseases, such as the human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and tuberculosis among addicts who inject the opiate drugs and share dirty needles. The rate of opiate-associated emergency hospital visits in recent years has significantly increased. Furthermore, the number of deaths related to those opiate overdoses has almost doubled in this period. All of these trends point to the significant social costs associated with opiate abuse in the United States. 

The slowed breathing caused by morphine is dangerous in those who already have trouble breathing. Indeed, the slowing of respiration is considered the most dangerous action of the opiate drugs. At high doses, the respiratory suppression caused by morphine and other potent opioids can lead, in extreme instances, to death. 

An acute dose of 100-200 mg morphine, or its equivalent, in the non-tolerant adult can lead to respiratory depression, coma and death. In the tolerant individual, single doses or more than 10 times this amount are tolerated and have little visible effect. The development of tolerance to the opiates does not appear to be due to enhanced metabolism (metabolic tolerance) but is probably due to opioid receptor insensitivity (tissue tolerance). The dependent person therefore ultimately requires high doses of the opiate to prevent withdrawal effects. 

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