Opium is the juice of the unripe capsules of the Papaver somniferum or white poppy, thickened by evaporation (inspissated), and is obtained by incising the capsules with a small sharp knife, when the juice flows forth, and hardens into a semi-solid mass. It is produced chiefly in Turkey, Asia Minor, Persia, and India.
That used in the United States is almost all brought from Asia Minor and called Smyrna or Turkey opium. Moist opium should contain not less than 9.5% of morphine.
Opium is an exceedingly complex substance, containing the alkaloids morphine, codeine, narceine, narcotine, thebaine, papaverine, porphyroxine, crypto-pine, meconine, opianine, and paramorphine; meconic, thebolactic, and sulphuric acids; fixed oils, odorous principles, extractives, gum, resin, salts, glucose, and other unimportant substances, with about 16 per cent. of water.
Opium is generally considered to be anodyne and anaesthetic when applied to the unbroken skin, yet some authorities consider this doubtful, and attribute any good effect from such application to the moist heat or to the resins and spirits of the liquid preparations. Mucous surfaces, wounds, ulcers, etc., readily absorb opium. The local action of the drug is astringent. In the mouth the mucous lining is dried, the tongue coated, and a sensation of thirst produced. In the stomach opium may cause a short period of irritation of the nerves, with nausea, but soon sensibility is diminished, the secretions checked, sensations of appetite and hunger are lost, the digestive powers fail, and the afferent nerves are depressed, so that the act of vomiting is produced with difficulty, and direct emetics may fail altogether.
In the intestines opium is sedative and astringent. All impressions given to the nerves from the mucous membrane are weakened; the secretions are diminished, peristaltic action is checked, and pain relieved.
Given by the rectum, as in enemata or suppositories, opium allays local pain, checks diarrhoea, and acts as an antispasmodic, keeping the parts at rest, and preventing irritability of the mucous membrane.
The secretion of bile is diminished and the urine lessened in quantity. The bowels are constipated. The skin is the only organ whose action is not decreased by opium. Perspiration, instead of being lessened, is excited, especially by some preparations, which are decidedly diaphoretic.
Opium is eliminated by the breath, perspiration, urine, and milk. This last is to be remembered in giving opium to a nursing mother.
The pre-eminent influence of opium is upon the brain as a stimulant, hypnotic, and narcotic. These actions are more prominent in man than in animals, and in highly civilized than in lower races.
The stimulant effect is noticeable sometimes after a medicinal dose, and precedes the hypnotic action by a short variable period. In persons who are accustomed to large doses of opium the period of stimulation is more marked. The nerve centres which preside over the imagination are specially affected. The imaginative powers are heightened and the will power weakened.
Opium also acts upon the heart as a stimulant, sustaining and strengthening it. The opium pulse resembles the healthy pulse, being strong, moderately slow, and regular; full, compressible, and of moderate length, and is not disturbed by change of position, exercise, or mental agitation - an important difference between the action of opium and other cardiac stimulants.
The anodyne effects of opium depend chiefly on morphine, its most important alkaloid. There are some differences of action between opium and morphine alone, as follows: opium is less soluble than morphine, is more slowly absorbed, and the effects last longer; its local action on the intestines is more pronounced; it reaches the bowels directly and is more constipating. For this reason it is preferred in many cases of intestinal trouble.
Opium is not as powerful a narcotic as morphine, as several of its other alkaloids (thebaine, codeine, and narcotine) have a more or less exciting or convulsant action which modifies the whole drug.
Opium disorders the digestion more than morphine and has greater power as a diaphoretic.
Finally, opium, being of variable strength, is not as reliable as morphine, the quantity of which in a given dose may be accurately determined. The relative strength of opium to morphine is about as 1/5 or 1/3 to 1.
The mildest manifestation of opium on the brain is a quiet, dreamy state, ending after a short time in sleep, either light and natural or heavy, and passing into stupor, according to the size of the dose. There is hyperaemia of the brain in the sleep caused by opium. On awakening there may be slight depression with headache and languor, caused by imperfect aeration of blood - which is in turn the result of diminished respirations - and lasting several hours. There may be nausea, or even vomiting, or the patient may return at once to the normal condition. This is the first stage of opium narcosis. After large doses the second stage comes on quickly, or at once. The symptoms of this condition are very like those of congestion of the brain.
The pupils are contracted, the face flushed, often cyanosed; the pulse is full, slow, and strong; the respirations slow and deep, sometimes stertorous; the skin is usually dry and warm, and unconsciousness is apparently complete, though the patient can usually be roused, and if so, the breathing becomes more rapid and the face regains its natural color.
There is usually retention of urine. Death does not often occur in this stage of opium narcosis.
The third stage is that of prostration with profound coma, from which it may be impossible to rouse the patient; but, if he can be roused and made to speak, his answer, though it may not be complete, will be rational, and there will be no thickness or indistinctness of articulation, as there is in alcoholic poisoning. This is characteristic of opium poisoning. The respirations are weak, shallow, irregular, and slow; they may fall to one or two in a minute, while in the second stage they may frequently be found as low as four or five. The face is pallid and cyanosed; the skin cold and covered with perspiration; the pupils are absolutely contracted, and just before death they dilate widely. The pulse becomes more and more rapid and weak, and death results from failure of the respirations.
In treating opium poisoning the stomach-pump should be employed every half-hour until the patient is out of danger. Removing contents of stomach once is not sufficient, because any opium that may have been absorbed is secreted into the stomach and must be removed to prevent reabsorption.
Potassium permanganate (3-5 gr. in a glass of water) should be the first thing given, and it should be given every half-hour, just after the stomach is washed out with the stomach-pump. Atropine, strychnine, and caffeine may be used hypodermically as stimulants and to counteract the systemic effect of the opium. Care must be taken that the patient does not become chilled or exhausted. Too vigorous exercise or physical stimulation is not good.
The treatment of opium poisoning is mainly directed toward maintaining respiration, and in those cases where symptoms of narcotism arise gradually after the giving of medicinal doses, it is enough simply to work toward this one object, by rousing the patient and trying to keep him roused until the effects wear away of themselves. Naturally, in the case of narcotism after hypodermic injections, emetics would be useless. Black coffee, as strong as possible, is given through a tube into the stomach, if necessary, or by rectum, as it will sometimes be difficult to make the patient swallow.
In those cases where a large dose has been taken by mouth, the stomach must be emptied. A tablespoon-ful of mustard in a glass of warm water may be given, and repeated in ten minutes, and gr. xxx. each of ipecac and sulphate of zinc may be afterwards given and repeated once or twice at intervals of fifteen minutes, with plenty of warm water. If emetics refuse to act on the torpid stomach, the stomach-pump must be used, but, though it acts better than emetics when fluid preparations have been taken, it is useless if the solid drug has been used.
After washing out the stomach, respiration must be supported in every possible way, yet measures which may exhaust the patient's strength are to be avoided Black coffee is given as before mentioned. Cold or alternate hot and cold douches may be applied to the head and chest. Artificial respiration should be kept up untiringly, for hours if necessary, or the battery may be used.
The bladder must be emptied by the catheter, to prevent reabsorption, and the temperature kept up by the application of external heat.
Various cardiac and respiratory stimulants are given hypodermically; atropine is a physiological antagonist to the action of opium on respiration, being the most active known respiratory stimulant; but it is necessary to regulate the amount given with great precision and with a thorough understanding of the entire physiological relation of one to the other. Lacking this, it would probably be given rashly, and atropine poisoning be added to the opium narcosis. For this reason the administration of atropine should not be undertaken except under directions from a physician.
There are usually no sequels to opium poisoning. The amount which may cause death varies greatly with idiosyncrasy or the habits of the patient. Recovery has taken place after 55 grains of solid opium and again after 6 ounces of laudanum had been taken, while 4 grains of crude opium have caused death.
Idiosyncrasies are very common in regard to opium, especially among delicate nervous women. Severe depression sometimes follows ordinary doses, marked especially by excessive vomiting. In these cases, nausea is not felt while the patient is lying down, but recommences on rising. Delirium sometimes follows, or retention of urine. A common result, noticed when the effects of a dose are wearing off, is an itching, sometimes general, sometimes confined to the face and especially the nose; and erythema - red stains or blotches - appears on the face. Children and old people bear opium badly. With children this is accounted for by the disproportionately large size of brain; and women are more susceptible to its action than men.
In conditions where there is severe suffering, much larger doses than ordinary can be safely taken, for the power of the drug then seems to be spent in overcoming the pain.