The term "opiates" refers to a group of physiologically active substances (alkaloids) isolated from opium, which is a hardened milky juice flowing from incisions made on the mature heads of the opium poppy (Papaver somniferum). Opium (opium resin, or raw opium) is a complex mixture of proteins, lipids, resins, waxes, sugars and other substances, including more than 50 alkaloids that make up 10-20% of the total mass of this material.

Opiates include the following drugs:

• opium,
• heroin,
• ethylmorphine (dionine*),
• codeine,
• morphine,
• thebaine.

The most important opium alkaloids are morphine, codeine, papaverine and thebaine. Morphine and codeine are used as medicines, but often they are used for non-medical purposes (as drugs). Papaverine does not have narcotic properties, but finds wide application as a medicine. Thebaine is used mainly as a raw material for the production of other medicines.

Heroin (3,6-diacetylmorphine) is the most well-known and widely used semi-synthetic opiate.

Pharmacological action: analgesic, narcotic.

Toxic effect: psychotropic, neurotoxic, due to the effect on the central nervous system, a depressing effect on the thalamic regions, a decrease in the excitability of the respiratory and cough centers, and excitation of the center of the vagus nerves.

Morphine

With intravenous administration of morphine, the maximum pharmacological effect develops after a few minutes, with subcutaneous and intramuscular administration - after 15 minutes. AT further content morphine in the blood drops sharply. Morphine is excreted from the body mainly in the urine within 36-48 hours. Up to 80% of the administered morphine can be excreted during the first 8-10 hours after administration, with only less than 3% unchanged. After 72-80 hours, only traces of morphine can be determined in the urine, even when examined by the most sensitive methods. However, a certain part of the injected morphine is fixed in the hair and nails.

When morphine is taken orally, its conjugates with glucuronic and sulfuric acids are found in the urine, and glucuronides (morphine-3- and morphine-6-glucuronide) are much more than sulfate conjugates. Of the two isomeric monoglucuronides, morphine-3-glucuronide does not have narcotic properties, while morphine-6-glucuronide exhibits significant activity. Small amounts of normorphine are also found in the urine.

Codeine

Codeine has a significant less active compared to morphine. It is rapidly absorbed after parenteral administration and is metabolized in the liver via O- and N-demethylation to morphine or norcodeine, respectively. About 80% of codeine taken orally is excreted in the urine as free codeine (5-17%), codeine conjugates with glucuronic and sulfuric acids (32-64%), norcodeine conjugates (10-21%), morphine conjugates (5- 13%). AT initial period excretion of codeine in the urine, mainly codeine conjugates are found, after 20-40 hours they are replaced by morphine conjugates.

Heroin

Heroin, when administered intravenously, is rapidly, within 3-7 minutes, metabolized to 6-monoacetylmorphine (6-MAM), which is then slowly deacetylated to morphine over several hours. Due to its high lipid solubility, heroin, unlike morphine, easily crosses the blood-brain barrier, which causes its powerful narcotic effect. Further, the formed morphine is relatively slowly converted into glucuronides. To prove heroin use, it is necessary to identify its metabolite 6-monoacetylmorphine, since other opiates do not form it.

Symptoms of opiate poisoning

The following signs are characteristic:

• significant constriction of the pupils with a weakening of the reaction to light,
• skin hyperemia,
• muscle hypertonicity,
• sometimes clonic-tonic convulsions.

In severe cases, there is often a violation of the respiratory system and asphyxia, characterized by a sharp cyanosis of the mucous membranes, dilated pupils, bradycardia, collapse, hypothermia.

In severe poisoning with codeine, respiratory disorders are possible with the patient's consciousness preserved, as well as a significant drop in blood pressure.

Urgent care

Repeated gastric lavage (in case of taking the drug inside), the appointment of activated charcoal, saline laxative. Alkalinization of the blood is shown, the introduction of 400 ml of a 0.06% solution of sodium hypochlorite intravenously through a catheter.

Subcutaneously and intravenously injected 1-2 ml of 0.1% atropine solution, 2 ml of 10% caffeine solution, 2 ml of cordiamine, 3 ml of 5% thiamine solution intravenously repeatedly. It is necessary to warm the patient, oxygen inhalation is indicated.

Specific (antidote) therapy

The antidote naloxone is included in the list of vital drugs (Order of the Ministry of Health of the Russian Federation No. 157 of July 28, 1994) and in the "List of antidotes and other drugs used in acute poisoning as a means of specific pharmacotherapy."

Naloxone- a product of chemical modification of the morphine molecule, a specific pure antagonist of opiates (morphine, etc.) and opioids (fentanyl, dextropropoxyphene, methadone, buprenorphine, nalbuphine), used to completely or partially eliminate their effects, and also used to diagnose acute overdose these compounds. It has no effect on respiratory depression due to other causes.

When administered intravenously, naloxone is rapidly metabolized, metabolism is carried out in the enterohepatic cycle: dealkylation with the reduction of the 6-keto group, glucuronidation with the formation of 2-naloxone-glucuronide. Eliminated in the urine in pure form and in the form of metabolites (70% within 72 hours). The action of naloxone with intravenous administration begins after 30 seconds (3 minutes), with intramuscular or subcutaneous administration - after 3 minutes,

The half-life is from 45 to 90 minutes. The duration of action of naloxone with intravenous administration is from 20 to 30 minutes, with intramuscular or subcutaneous - from 2.5 to 3 hours. It penetrates well through the blood-brain ( maximum concentration in the structures of the brain is reached after 15 minutes) and placental barriers.

As an initial dose, 0.4-2 mg of the drug is administered intravenously. Mandatory reaction to the introduction of naloxone in case of poisoning with opiates is at least a short-term increase in breathing, dilated pupils, and a decrease in the degree of depression of consciousness. If the desired degree of antagonization and improvement of respiratory functions is not achieved immediately after intravenous administration, it can be repeated at intervals of 2-3 minutes. The lack of effect after 2-3 injections calls into question the diagnosis of opiate poisoning. After intravenous jet administration of the initial dose of naloxone, its intravenous drip is recommended at a dose of up to 2.4 mg in 500 ml of 5% glucose solution or isotonic sodium chloride solution. The infusion rate is determined by the patient's response (recommended rate of administration is 0.4 mg over 30 minutes).

The effect of the administration of naloxone is short-lived (30-45 minutes), therefore, due to the risk of remorphinization (repeated depression of consciousness and breathing), even after the restoration of consciousness, it is necessary to monitor the patient (monitoring of breathing and consciousness) for 6-12 hours. For prolonged administration, it is recommended "titration" of naloxone - 1 ml (0.4 mg) is diluted in 4 ml of isotonic sodium chloride solution and administered intravenously at a rate of 1 ml / min.

The lack of a sufficient effect of the administration of naloxone may be due to severe hypoxic brain damage.

Despite the lack of a proven causal relationship, it has been noted that too rapid administration of naloxone to patients with heart disease can lead to arterial hypotension, pulmonary edema, ventricular tachycardia and fibrillation, and cardiac arrest.

For children, the usual starting dose of naloxone is 0.01 mg/kg IV, continued as needed. There is a special dosage form for newborns (Narcan neonatal) containing 0.02 mg active ingredient in 1 ml of the drug.

Naltrexone (antaxone) is a specific opioid receptor antagonist. Competitively binds to all types of opioid receptors. Similar to naloxone but longer lasting. The half-life of naltrexone is 4 hours, its metabolite 6-naltrexone is 13 hours. At a dose of 50 mg, naltrexone blocks the pharmacological effects caused by intravenous administration of 25 mg of heroin for 24 hours, at a dose of 100 mg this action is extended to 48 hours, at a dose of 150 mg - up to 72 hours. Naltrexone is used mainly for the treatment of opioid dependence in order to maintain the patient's condition in which opioids cannot have a characteristic effect.

Nalorfin on chemical structure close to morphine. Modification of the structure led to the production of a compound that is an agonist (analgesic effect) and an antagonist in relation to opiate receptors (weakens respiratory depression caused by opiates and lowers blood pressure, cardiac arrhythmias). It is rarely used as an antidote: it has been replaced by naloxone. In the absence of opiates in the body, it can cause depression of consciousness and respiration. Intravenously administered 1-2 ml of 0.5% solution. If the effect is insufficient, the injections are repeated after 10-15 minutes; the total dose should not exceed 8 ml.

Oxygen therapy

Artificial respiration with a mask or Ambu bag, tracheal intubation, artificial lung ventilation, hyperbaric oxygenation.

Pathogenetic therapy

The use of respiratory analeptics (etimizol *, lobelin) is not indicated. With blockade of the respiratory tract, tracheal intubation, artificial lung ventilation (ALV) are necessary, in a coma, intravenous drip of glucose *, cytoflavin *, mexidol *, thiamine, pyridoxine, ascorbic acid, sodium hydroxybutyrate is advisable.

Detoxification therapy

Forced diuresis is shown. After ingestion, a second gastric lavage is recommended (after breathing is restored, very carefully due to the risk of damage to the esophagus, which is in hypertonicity), activated charcoal, enterosorbent, and saline laxative are prescribed. In case of poisoning with a mixture of psychotropic substances, codeine, methadone *, detoxification hemosorption is used.

Syndromic therapy

Assign vasoactive agents, antishock therapy, glucocorticoids. Treat non-cardiogenic pulmonary edema. Antibiotic therapy with broad-spectrum drugs is indicated, starting from the early toxicogenic stage: treatment of positional tissue compression. Hemosorption, plasmapheresis, hemodiafiltration, HD are effective.

Laboratory diagnostics for opiates

When screening biofluids for the presence of opiates, immune methods are used (ICA, IFA, PFIA, RIA). They do not require sample preparation; they are used to determine both free substances (morphine, codeine) and their conjugates with glucuronic acid. Due to cross-reaction, naloxone, nalorphine, and other substances in plasma at a concentration many times higher than the level of working concentrations of the method can give a positive result.

Given that opiates are excreted in the urine mainly in the form of conjugates, hydrolysis (acidic or enzymatic), extraction of hydrolysis products and analysis according to accepted standard methods are carried out before chromatographic examination. To establish the fact of heroin use, which is confirmed by the presence of the first active metabolite of heroin - 6-monoacetylmorphine hydrolysis of urine samples is not carried out. AT qualitative analysis TLC, GLC, HPLC, GC-MS are used. Quantifying carried out by GLC or HPLC.

To increase the sensitivity of the method in the determination of opiates, to improve their chromatographic properties, the structure of opiates is transformed before GLC using special reagents to form so-called derivatives.

Morphine and codeine are found in the urine during the day, their glucuronides - within 3 days.

Symptoms of acute poisoning:
1. Euphoria, pallor.
2. Nausea and vomiting.
3. Constriction of the pupils after a while.
4. Pupil dilation.
5. Respiratory depression.
6. Violation of the activity of the heart and circulatory system.
7. Coma.
8. Constipation.
9. Disorders of urination.
10. Violations of consciousness.

Addiction and overdose.
With a pathological addiction to opiates, the dose of these substances is gradually increased, which leads to their accumulation in the body. As a result, an overdose (the dose that causes intoxication may vary) causes poisoning, one of the symptoms is respiratory paralysis.

Causes of opiate poisoning.
There is only one cause of opiate poisoning - drug overdose. In this case, opiates act through the so-called opioid receptors - specific nerve endings brain neurons. When opioids bind to receptors, functions are impaired nervous system- this also explains the analgesic effect of opiates, and the poisoning they cause.

Treatment of opiate poisoning.
For severe opiate poisoning the main task- provide artificial ventilation of the patient's lungs, thus preventing possible violations caused by respiratory paralysis. There is also an antidote - naloxone, which displaces opiates from specific receptors. If the drugs were taken orally, then gastric lavage and bladder catheterization are performed.

How to help yourself?
In case of poisoning, it is too late to do anything on your own. Having noticed the first symptoms of poisoning, it is necessary to call the medical service.
In what cases should you consult a doctor?
Most often, opiate poisoning is the result of a pathological addiction to them. Therefore, as soon as the first signs appear drug addiction, you need to immediately contact a narcologist. Poisoning with opiates most often indicates drug addiction. The consequences of this addiction are extremely hard on the health and social well-being of a person.
If the doctor eliminates the life-threatening symptoms of poisoning, and the patient's condition improves, then he is referred to a narcologist, who in turn (if possible, the patient's own desire is necessary) begins drug addiction treatment.

Is opiate poisoning dangerous?
Almost always, opiate poisoning is the last stage of drug addiction, which leads to spiritual, physical and social degradation of a person, and even death.
Course of the disease.
In case of poisoning with opiates, severe nausea immediately begins, persistent vomiting, pupils constrict, the skin turns pale and acquires a bluish tint.
Breathing becomes shallow, pulse filiform. Then there is respiratory depression, disruption of the heart and circulatory system, dilated pupils, and, finally, coma.

How to avoid opiate poisoning?
First of all, you need to get rid of drug addiction. The main thing is that a person realizes in time what danger threatens him and consults a doctor. The main stages of drug addiction are summarized below:
1. Pathological craving for the use of narcotic substances, their acquisition at any cost.
2. The emergence of a constant need to increase the dose.
3. The emergence of physical and mental dependence.
4. Complete degradation of a person as a person.

Opiates are natural alkaloids, the result of a special processing of the opium poppy. Opiate poisoning is an acute intoxication that occurs when an overdose of a narcotic substance. Mostly this happens by accident, less often - as a result of a deliberate suicide attempt. The diagnosis is made on the basis of a specific clinical picture. Typical signs of opiate poisoning are depression of consciousness (up to coma), cyanosis and a sharp narrowing of the pupils. What dose can cause an overdose is unknown. It depends on the characteristics of the body, the type of drug and the concentration of the opiate.

The effect of opiates on the body

Entering the body, opiates act on opiate receptors, which contributes to a pronounced analgesic effect. The most powerful opiate drug is heroin. It instantly crosses the blood-brain barrier. Due to this, its effect on the central nervous system is significantly enhanced. All opiates affect the psyche, causing a feeling of relaxation, euphoria, intoxication.

The first phase - "arrival" - occurs 25-30 seconds after the use of the drug. Characterized by:

• flushing of the skin in the face, neck;
• dry mouth;
• constriction of the pupil;
• distortion of perception of the surrounding world;
• retardation of consciousness: thoughts are absent, the addict experiences a state of "high", euphoria.

The duration of the phase is about five minutes. The second phase is called "nirvana", it is characterized by a feeling of calm bliss. A person after taking an opiate does not pay attention to the people around him, inadequate reactions are noted. This stage lasts for several hours.

The total duration of drug exposure is 7-9 hours. After that, the addict needs the next dose of the opiate. The longer the experience, the higher the tolerance to the drug and the shorter the duration of its action. The need to increase the dose often leads to such a consequence as opiate poisoning.

Causes of poisoning

Opiates are rapidly addictive. A drug addict who systematically takes opiate drugs develops tolerance to them. The effect of taking the next dose decreases. To achieve the desired “high”, the drug addict is forced to constantly increase the dosage of the substance. And this is one of the main reasons why acute opiate poisoning can occur. Most often, this situation occurs after a temporary withdrawal from opiates, and then the subsequent resumption of their use.

Cancer patients who take opioid analgesics to reduce the severity of pain can also be poisoned. If the usual dose does not help well, the person seeks to increase the amount of medication without consulting a doctor. There are rare cases of poisoning by opioid drugs during their illegal transportation in the stomach or rectum.

How does intoxication manifest itself at different stages

Action of opiates: the face turns red, there is a feeling of warmth in the lumbar region and abdomen, the addict is focused on his fantasies. In acute poisoning with opium drugs, the sensations are different. The toxicogenic stage is manifested by a triad of characteristic signs: depression of consciousness (stupor), pronounced constriction of the pupils, respiratory failure (bradypnea). Other symptoms quickly follow:

• decrease in temperature;
• vomiting (dangerous aspiration of vomit);
• convulsions;
• violation of urination and defecation (delay);
• rhabdomyolysis (impaired muscle function);
• pyrogenic reactions (fever, chills, headache).

External manifestations of poisoning are accompanied by serious disturbances in the activity of the central nervous system and the brain. Encephalopathy develops, possibly the formation of toxic cerebral edema, pulmonary edema. Myocardial damage associated with hypoxia provokes cardiovascular failure up to cardiac arrest. There are 4 phases of acute opiate poisoning:

• 1st stage (degree of poisoning is mild).

The patient is in contact, but is in a state of stun, speech is inhibited. The reaction to light is reduced or absent, oculomotor disorders (nystagmus, ptosis) are noted. There is a violation of breathing, pain sensitivity is weakened, the pulse is rare.

• Stage 2 (state of moderate severity) - the phase of superficial coma.

It is characterized by the absence of consciousness in the patient. Pale skin, reaction to light and external stimuli absent, tendon reflexes are preserved. Cyanosis, respiratory depression of the central type), a drop in blood pressure, convulsions are noted.

• 3rd stage (very severe condition) - the phase of deep coma.

Consciousness, reactions, sensitivity, reflexes are absent. Severe respiratory depression, cyanosis, hemodynamic disturbances. Cerebral edema develops, respiratory arrest is possible. Without timely assistance, about 80% of patients die after 5-10 hours.

• Stage 4 - the patient comes out of a coma.

This phase occurs with a slight excess of the dosage of opiates or with chronic intoxication. The functions of the body are restored independently: breathing is normalized, blood circulation is restored, consciousness returns.

Withdrawal symptoms

After the onset of the somatogenic stage (when toxins are removed from the body), the patient may experience signs of withdrawal, that is, withdrawal symptoms. Signs of withdrawal and their severity depend on the "experience" of drug addiction and on how long the addict has been deprived of the usual dose of opium preparations.

The first phase develops 10-12 hours after the "overdose". It is characterized by manifestations of physical dependence, as well as vegetative signs: dilated pupils are noted, the patient often yawns, his eyes are watery. Appetite is absent, sleep is disturbed. In the second phase, chills, sweating, a feeling of heat, tears and salivation appear. The muscles are tense, painful, the patient yawns intensely, sneezes.

By the end of the second day of opium withdrawal, the third phase begins - it is characterized by severe muscle pain, convulsions. A person is tense, cannot sit still, depression appears. The fourth phase develops the next day: dyspepsia, vomiting, skin itching, the temperature rises, the pulse is very quickened to the listed manifestations.

Diagnostics

Diagnosis of acute poisoning with opium preparations is based on the history (if possible), the specificity of the clinical picture, as well as laboratory data. Thanks to the tests, the doctor can determine which drug provoked the poisoning. If 6-mono-acetylmorphine is determined in the blood, this indicates the use of such an opiate as heroin. Morphine can be detected in the urine after two days, codeine - within three days.

In the diagnosis of opiate poisoning, an antidote is often used - usually Naloxone, an opiate antagonist. The doctor analyzes the patient's condition (the size of the pupils, how much consciousness is depressed, what is the respiratory rate) before and after the use of the antidote. If there was a reaction to the administration of the drug, this speaks in favor of poisoning with opium preparations. All changes and results of toxico-chemical studies should be recorded in detail in the medical history. This is important both for making the correct diagnosis and for determining the effectiveness of therapy for poisoning.

First aid for overdose and treatment features

In acute opiate poisoning, it is important to provide emergency care to the patient in time. You should not take any measures on your own, you must wait for the emergency doctor or take the patient to the clinic. When assisting a patient with poisoning, a strict algorithm is used. The first and main stage of treatment is specific therapy using an antidote. Naloxone hydrochloride usually acts as an antagonist. The drug is used to neutralize the effects of opiates.

The initial dose is 0.5–2 mg intravenously. In case of poisoning with substances of the opiate group, the condition immediately improves, at least for a short time. Then the patient is given a dropper with Naloxone diluted in 0.9% sodium chloride solution or 5% glucose solution. The drug has a short-term effect, so the patient's condition must be monitored for 8-12 hours.

Symptomatic therapy consists in combating respiratory dysfunction: tracheal intubation, artificial lung ventilation, artificial respiration using an Ambu bag. As a pathogenetic treatment, analeptics are prescribed (Lobelin, Etimizol IV, IM, subcutaneously), as well as droppers with Mexidol, Cytoflavin. If the poisoning was caused by a mixture of methadone, codeine and psychotropic substances, hemosorption should be applied. An increase in blood pressure is an indication for the introduction of Diazepam, if there is no effect, an infusion of Nitroglycerin is prescribed (pressure control is required!).

Detoxification measures include forced diuresis, as well as gastric lavage. The victim is assigned Activated carbon, saline laxatives, enterosorbents. Syndromic therapy involves the use of glucocorticosteroids, vasoactive drugs, antibiotics.

In the future, the patient needs anti-shock therapy, prevention of cardiogenic shock. It is important to eliminate the compositional compression of tissues in a timely manner. For maximum cleansing of the body of toxins, procedures such as plasmapheresis, hemodialysis, hemodiafiltration are carried out.

The prognosis for recovery depends on general condition the patient, the extent of the opiate overdose, and how timely the help was. The risk of death in case of delay increases significantly, so it is important not to overlook the danger.

Morphine-opiates belong to the class of anesthetic drugs and are widely used by physicians to eliminate chronic, acute and other types of pain. Currently, technologies have been developed for taking opiates in any convenient way (orally, injections, droppers, etc.)

Opiates are extracted from a special variety of plants - the opium poppy. The substance itself belongs to the group of natural alkaloids. All opium painkillers are based on morphine and codeine.

At the same time, the term opiates is also used to refer to a variety of drugs that can interact with opium receptors in the body and have similar effects.

Opiates act on the central nervous system. The increased dose capable of causing intoxication varies widely and depends on the individual characteristics of a particular individual. Meru toxic effects also determine the method of administration of the drug and the body's tolerance to similar substances. Since there is no data on exactly how much of an opiate is an overdose, cases of intoxication with these substances are not uncommon.

Today, medicine widely uses not only natural alkaloids. Widespread and semi-synthesized on molecular level derivatives of morphine and codeine.

The effect of opiate drugs on the human body

Among opium addicts, the first phase of the action of opium is called the "arrival" and begins after 20-30 seconds. after taking.

At the physiological level, the following happens:

• An increase in heat in the abdominal cavity and lumbar region, which systematically rises up the whole body,
• redness of the skin of the face,
• constricted, immobile pupils,
• Thirst, feeling of dryness in the mouth,
• Itching in the lower part of the face.

On a psycho-emotional level:

• A person feels as if he "has seen the light", "saw the essence of all things",
• The surrounding world is refracted and seems ideal, "sparkling",
• Absence of thoughts, a state of meditation, bliss in the head,
• Consciousness perceives only the “high” of physical sensations.

The first phase lasts about 5 minutes. With prolonged use of opiates, the body's tolerance to them increases, and therefore the time of the first phase is reduced.

The second phase in the relevant areas is called "nirvana". The addict experiences a state of bliss and languor, true bliss and joyful peace. Physiologically, he seems to freeze, his limbs become heavy. A person ceases to pay attention to surrounding objects and events or reacts inadequately. In the imagination, “unearthly fantasies”, dreams and dreams are replaced one after another.

Codeine in action is somewhat different from morphine in the second phase: when it is taken, psychological hyperactivity and motor, speech is fast, but incoherent, thoughts are inconsistent.

The second phase lasts on average about 3-4 hours.

The third phase is a phase of very sensitive sleep, which can be disturbed even by the slightest rustles and sounds. It also lasts about 3-4 hours.

Phase 4 is not found in everyone and depends on the individual characteristics of the organism. Characterized by headaches and increased anxiety, melancholy, attacks of vomiting, a tremor can be observed.

In general, including all phases, the effect of opium exposure lasts 6-10 hours.

Causes of opium poisoning

Opiate intoxication occurs with an overdose of the drug. An overdose can be intentional or accidental, and also happens in chronic opium addiction (addiction), when larger and larger doses are required each time to achieve a “high”. Often drug addicts deliberately increase the doses in an attempt to commit suicide or kill a friend. Childhood cases of intoxication may occur due to the lack of quality control of the substance. There are also cases of childhood poisoning with common cough medicines.

When taking opium for medical purposes, an overdose can occur during preparation for general anesthesia (premedication); in patients suffering from chronic pain and taking opiates on an ongoing basis (usually can occur with hepatic, renal insufficiency). Also, intoxication is possible in individual cases with the rapid introduction of the drug into a vein (bolus).

Symptoms of acute opium poisoning.

Acute intoxication can develop regardless of how the opiate is taken. It is characterized by the following features:

• confused mind,
• There is a coma
• Strongly constricted pupils, regardless of the amount taken,
• Paleness and blueness of the skin (cyanosis),
• Encephalopathy (toxic and hypoxic types),
• Respiratory failure.

If timely assistance is not provided, this is fraught with more serious consequences, such as:

• swelling of the brain,
• Acute respiratory failure when opium is taken orally or inhaled,
• stop breathing,
• dilated pupils,
• immobility of the eyeball
• Pneumonia,
• Arrhythmias, heart failure
• muscle dysfunction (rhabdomyolysis),
• Mendelssohn's syndrome (impaired swallowing function and, as a result, a lung burn hydrochloric acid from stomach)
• changes in body temperature,
• Vomit.

Opiate intoxication is fraught with serious complications. Some of them may become irreversible. Among them:

• Paresis,
• Paralysis of various nature,
• polyneuropathy,
• Withdrawal syndrome, psychosis, personality disorder,
• Chronic impairment of respiratory function up to respiratory arrest,
• The development of a psycho-organic syndrome - memory and intelligence decrease, a person becomes uncontrollable in a state of passion,
• Renal failure.

For poisoning with opium drugs, withdrawal symptoms (mental disorders) are also characteristic, as well as a withdrawal syndrome.

Stages of acute opium poisoning

In general, doctors divide the development of poisoning into 4 stages.

Stage 1 - the patient is still conscious and can be contacted, despite the fact that he is inhibited, half asleep and stunned. At the level of neurology are characteristic: constricted pupils that do not respond to light stimulus, nystagmus - involuntary, rhythmic movements eye muscle, the tone of the muscles of the body decreases, there is no reflex contraction of muscles and tendons. The heart rate drops to only 30-50 beats per minute, breathing is disturbed, and cyanosis of the skin (cyanosis) appears.

Stage 2 - a person falls into a superficial coma, a coma state, there is no consciousness. The above symptoms are also present, the pressure is greatly reduced. There is no response to pain. Convulsions are typical.

Stage 3 - deep coma. The patient does not respond to pain and any external influences. Due to muscle atony, the patient loses the ability to swallow, cough, does not close the eyelid when the cornea is irritated. Impaired respiratory function can lead to cerebral edema. If at the third stage you do not take measures to provide medical care, then a fatal outcome is possible due to a violation of the respiratory function.

Stage 4 - the patient comes out of a coma, regains consciousness. The fourth stage is possible if the dose of the drug is not too high or the body was able to cope with the poisoning on its own. First, the respiratory function returns, then the blood circulation normalizes, after which the patient regains consciousness. At the same time, the motor ability of the eye muscle is limited, emotional instability, hyperactivity and insomnia are noted. A withdrawal syndrome (or withdrawal) is possible if the patient has been injected with an opiate antidote. After leaving the coma, complications are also possible - pulmonary edema, heart attack, aspiration, muscle necrosis.

Diagnosis of intoxication

Diagnosis is carried out by the method of complex laboratory research of the biomaterial. It makes it possible to determine the presence of opiate substances in the blood many days after they have been taken.

Only by combining laboratory research and analysis clinical symptoms patient, opiate poisoning can be diagnosed. Naloxone, an opiate antagonist, is also widely used in diagnostics. The doctor analyzes the body's reaction to it and makes a diagnosis.

Treatment for poisoning

In case of opium poisoning, medical assistance should be provided immediately.

Those who discovered the patient are forbidden to take any action and must wait for the arrival of doctors.

The main treatment for opiate poisoning is the introduction of an opiate antagonist, naloxone, into the body. This substance completely neutralizes their action. If the respiratory arrest is not caused by opium, but by other causes, there will be no reaction in the body to naloxone. Here its introduction is widely used as a way to diagnose an overdose of opium.

With the introduction of naloxone, the doctor observes the patient for an hour to avoid remorphinization - the withdrawal syndrome. Naloxone is usually administered intramuscularly.

Symptomatic treatment methods are also used, such as artificial respiration or tracheal intubation and connecting the patient to an artificial lung ventilation system.

Drug therapy includes a drip with saline and glucose, pyridoxine, neurometabolic stimulants, B vitamins, ethylmethylhydroxypyridine succinate, and some other drugs.

Physiotherapeutic methods include washing the stomach and intestines, introducing adsorbent substances into the gastrointestinal tract.

Currently, analgesics based on morphine or codeine are widely used in medical practice. This type includes natural and semi-synthetic alkaloids that effectively eliminate pain. Assigned orally, drip, injection. The raw material for production is the opium poppy.

The action is directed to the central nervous system. At the same time, it is impossible to predict when intoxication will develop, the properties appear depending on individual qualities patient.

Coming

Begins 10-20 seconds after ingestion. Heat appears in the lower back and abdomen, which slowly rises through the body. You can identify by the following symptoms:

• red face;
• constricted pupils;
• dry mouth;
• sometimes itching in the nose and chin.

Sometimes there is a feeling of insight, but soon thoughts are completely focused on sensations. The duration rarely exceeds 5 minutes. When an opiate is used by an experienced addict, the severity decreases.

Nirvana

If morphine is introduced, the exposure algorithm is as follows:

• languor;
• pleasure;
• peace;
• dreams;
• inadequate response to irritants.

The limbs become heavy, the person practically does not move.

When codeine is used, the clinical picture changes:

• mental arousal;
• high physical activity;
• speech is fast and incoherent.

In this state, the patient is 3-4 hours.

Duration 3-4 hours. There is no deep immersion, light irritants are capable of waking up.

Effects

It does not appear to everyone. Characteristic features:

• anxiety;
• headache;
• depression;
• bouts of nausea;
• tremor.

In general, the duration of the 4 phases is 6-10 hours.

Upon entering the body, opiates primarily bind to specific receptors (opiate receptors) in the structures of the nervous system. This leads to a pronounced analgesic effect (central anesthesia by blocking the processing of pain impulses in the cerebral cortex).

They also affect the psyche, leading to a feeling of pronounced euphoria, relaxation. With the systematic use of compounds of this group (morphine and morphine-like compounds), physical and mental dependence develops, which is the basis of drug addiction.

Chemically synthesized derivatives used in medicine have a pronounced analgesic effect with a minimal narcotic effect.

Acute toxemia

An overdose of opiates can be intentional or unintentional. There are several contributing factors:

1. Addiction. Human, addicted, loses orientation and may inject an excessive amount of, for example, heroin, which leads to poisoning.
2. Suicide attempt.
3. Bad control. In medicine, there are cases when drugs were stored improperly due to the negligent attitude of the management. As a result, both patients and doctors could use them.
4. If opiates are used at home, try the taste and the child is able.
5. In preparation for general anesthesia, an incorrect calculation was made.
6. Significantly increases the risk of concomitant use with ethyl alcohol. Ethanol enhances respiratory suppression.
7. For analgesic effect, codeine is introduced into the composition of some antitussive drugs. Therefore, you can face intoxication with an overdose of a seemingly safe medication.

This course is observed with any method of administration.

Characteristic signs:

• confused mind;
• coma;
• constriction of the pupils;
• cyanosis of breath;
• hypoxic and toxic encephalopathy;
• cyanosis skin;
• apnea.

Upon admission to the hospital, a thorough examination is necessary, since an overdose of a narcotic drug can be confused with hypothermia, benzodiazepine poisoning, hypoglycemia, and hypoxia.

The program includes pathogenesis, observation of the clinical picture and laboratory tests:

1. study biological material. In samples, the presence of opiates can be detected several days after intoxication.
2. Perform a reaction with nalaxone - an antagonist of a narcotic substance.

However, the main diagnostic methods require time, which is not available in acute poisoning. Therefore, treatment begins immediately after the patient arrives.

Narcotic poisoning, which does not exclude a lethal outcome, can occur not only in an avid drug addict, but also in a person who takes it for the first time. Unintentional drug poisoning occurs more frequently in men. The age category with the highest incidence of death from overdose is 20-35 years.

The reasons

Drug poisoning does not necessarily occur when the norm is exceeded. Even the usual dose for a drug addict is provoking drug poisoning.

The reason for this may be:

• combined exposure to several types of drugs;
• excess of the norm caused by the formation of tolerance;
• increase in the frequency of administration or administration;
• the use of new species;
• drug use after a significant period of abstinence;
• somatic pathologies;
• suicide attempts.

External and characteristic symptoms

Drug intoxication is diagnosed based on an external examination and a survey, in which general signs of poisoning are revealed. Among them:

• apnea;
• miosis;
• glass look;
• hyperemia of the sclera;
• rapid breathing;
• dryness of the mucous membranes of the oral cavity;
• excessive appetite;
• abrupt change in blood pressure;
• muscle spasms;
• sudden loss of body weight.

Poisoning develops due to the ingestion of a high dose of these drugs. The main feature of the pharmacodynamics of these compounds is addiction.

This means that with the systematic intake of opiates into the body, the effect (narcotic and analgesic) decreases, which leads to the need to increase the dosage with each subsequent administration.

Therefore, poisoning often develops in drug addicts (especially after a temporary cessation of taking drugs with subsequent resumption) and cancer patients (to reduce the intensity of pain in the oncological process, a person constantly increases the dose of opiate painkillers).

Cases of acute opiate poisoning have been reported when drugs were transported in small plastic bags in the stomach. In the event of a rupture of the sachet, the narcotic compound was absorbed into the blood in large quantities.

There is acute and chronic poisoning. Chronic poisoning occurs in drug addicts (persons suffering from physical and mental addiction) with the systematic use of opiates (they are mainly administered intravenously), it is characterized by a number of symptoms:

• Pronounced personality disorders - such people are socially maladjusted, all mental activity is aimed at achieving one goal, namely the search for a new dose of the drug.
• Pronounced weight loss up to cachexia (exhaustion).
• Chronic constipation.

A significant constriction of the pupils makes it possible to suspect opiate poisoning even without clarifying the anamnesis (it is impossible to ask questions about taking or administering the compound in most cases, since consciousness is absent). Also, to diagnose this condition, traces of injections after the introduction of narcotic drugs, more often in the area of ​​​​the elbow bends, allow.

Symptoms of an overdose are determined directly by which psychoactive substance was taken. But regardless of the type of drug used, the brain, heart, liver and kidneys take the hit.

There are drugs that have a depressing effect on the nervous system. These are substances such as opiates (poppy straw, heroin, codeine, morphine), benzodiazepine tranquilizers (sibazon).

Symptoms of opiate poisoning are:

To suspect drug poisoning will allow the determination of traces of injections on the body.

Opiate overdose

With an overdose of opiates, a person is characterized by a sharp lethargy, his speech is slurred. Opioids depress the respiratory center, breathing gradually slows down and soon the person stops breathing altogether.

It is the leading cause of death in opiate overdose. In addition, against the background of an oppressed consciousness, a person can choke on vomit, which blocks the access of air to the lungs, and die from it.

Overdose of psychostimulants

Drugs such as amphetamines, ephedrine, screw, cocaine are classified as psychostimulants. These are substances that activate the nervous system.

The ambulance team that arrived at the call begins further treatment. In case of poisoning with opiate drugs, the patient is injected with their antagonist - Naloxone.

The use of this medicine allows you to eliminate the effect of opiates. However, the action of Naloxone is short-lived, therefore, constant medical monitoring of the patient is necessary for the timely detection of the return of symptoms of poisoning.

In case of poisoning with psychostimulants, sedative drugs can be used.

When breathing stops, the drug addict is given artificial ventilation of the lungs. Forced diuresis is prescribed as detoxification therapy. In the future, in a hospital, therapeutic measures are taken to normalize metabolic processes in the body. To eliminate drug addiction, the patient must undergo a course of rehabilitation.

Grigorova Valeria, medical commentator

Poisoning when using drugs occurs not only if the dose is exceeded. Sometimes the usual dose of a drug for a drug addict causes acute poisoning.

The reason is:

• combined action of several types of drugs;
• dose increase due to development of tolerance;
• increasing the frequency of administration;
• the use of a new type of narcotic substance;
• drug administration after abstinence;
• somatic pathologies;
• suicidal attempts.

The number of cases of acute drug poisoning is on the rise. So, for example, according to the results of epidemiological studies for 2005-2016. number of cases in Moscow, St. Petersburg and some other major cities Russia has grown 300-500 times. But even these data are not complete - out of 80% of drug poisonings, only in 27% of cases those present caused ambulance.

acute form poisoning occurs in response to a single use of the drug, which is explained by:

• cumulative effect - exceeding the maximum allowable dose of a narcotic substance;
• temporary factor - depends on the rate of administration and elimination of the drug from the patient's body.

Its toxic effect on a person depends on the amount and time of action of a narcotic substance.

In case of poisoning, several periods are distinguished:

1. The initial toxic effect of the drug on the patient's NS.
2. Progression of signs of intoxication, expressed in violation of the passage of signals of neuromuscular regulation, a decrease in respiratory functions, dysfunction of the gastrointestinal tract.
3. Absorption and evacuation, in which there is toxic damage to the liver, kidneys and lungs by active metabolites of the drug and endogenous toxins.

Traditionally, opiates have been thought to have an analgesic effect solely due to their effect on the brain, but in reality they appear to have an antinociceptive effect at the level of the brainstem, spinal cord, and nerve fibers.

Mu receptors located in the brain, spinal cord, and other organs and tissues (for example, in the joints) are responsible for this effect. Delta and k receptors also mediate the analgesic effects of opioids, but mostly at the level of the spinal cord.

They affect the transmission of impulses from pain receptors along the spinothalamic pathway to the thalamus and weaken the perception of pain in the central nervous system. Reluctance to use opiates for pain relief is often driven by fear of addiction or abuse.

However, despite numerous studies, this opinion has not been confirmed. In addition, opioids are generally easier to tolerate, safer, and less expensive than other analgesics (such as NSAIDs).

Euphoria occurs in the early stages of opiate poisoning. Many drugs induce feelings of pleasure by releasing dopamine in the mesolimbic system. All opioids have this effect.

Differential Diagnosis

Hypoglycemia, hypoxia, and hypothermia are common conditions with a clinical picture similar to opiate overdose. These conditions are easy to diagnose, but their presence does not rule out opiate poisoning.

A similar picture is observed in case of poisoning with clonidine, phencyclidine, phenothiazines, tranquilizers and hypnotics (especially benzodiazepines). It is especially difficult to distinguish poisoning from clonidine and other centrally acting antihypertensives from opiate overdose.

Finally, similar symptoms are observed in a variety of injuries, metabolic disorders and infectious diseases. Moreover, all these conditions can be observed simultaneously with opiate poisoning.

Laboratory research

Opioids can be detected in body fluids long after their effects have ceased, so laboratory results are only relevant when combined with the clinical picture.

The history and physical examination are usually sufficient to establish a diagnosis of opiate poisoning, sometimes a reaction to naloxone helps. In acute cases, laboratory tests are almost always useless due to waiting too long for results.

Cross reactions

Standard laboratory methods Diagnosis of opiate poisoning is based on determining the structure of the substance, so drugs that are similar in structure to opioids can give cross-reactions. The accuracy of the results depends on the sensitivity and specificity of the method, as well as on the serum concentration of the opioid.

Basic methods have been developed for the determination of morphine, so its derivatives and structurally similar drugs often give cross-reactions. On the other hand, these methods do not detect most semi-synthetic and synthetic analogues.

For example, fentanyl (a powerful opioid that often causes fatal complications) does not cross-react with morphine, so overdose may not be detected without additional research.

Acute opiate poisoning leads to CNS and respiratory depression. early start Mechanical ventilation (by means of a counterlung or tracheal intubation) and maintenance of oxygen is usually sufficient to prevent death, but the duration of mechanical ventilation can be significantly reduced by prescribing opioid receptor blockers.

These drugs, the most common of which is naloxone, competitively inhibit the binding of opioids to opiate receptors, allowing spontaneous breathing to be restored.

The purpose of administering naloxone for opiate poisoning is to restore spontaneous breathing, not consciousness. To reduce the risk of an unpredictable opioid withdrawal syndrome that can aggravate the patient's condition, start with a minimum dose of naloxone, and then increase it based on the clinical picture.

In most cases, the effect is observed with the on / in the introduction of 0.05 mg of naloxone, although the effect of the drug sometimes begins later than when using large doses, and it may be necessary to continue mechanical ventilation for some time.

This method avoids tracheal intubation and confirms or excludes opiate poisoning while minimizing the risk of withdrawal symptoms. With subcutaneous administration of naloxone, the patient's condition recovers more smoothly than with intravenous administration of large doses, but it is more difficult to control the onset of the drug.

The time of action of naloxone with s / c administration also increases, which can lead to withdrawal symptoms.

In the absence of a history and clinical evidence of opiate poisoning, cautious administration of naloxone is both diagnostic and medical event. But in opioid addiction, naloxone can cause side effects, especially opioid withdrawal syndrome.

One of its manifestations is vomiting, which can be especially dangerous in case of incomplete recovery of consciousness after the administration of naloxone (for example, while taking alcohol, tranquilizers or sleeping pills), since in the absence of tracheal intubation, the risk of aspiration of gastric contents is high.

To reduce the unjustified risk of withdrawal symptoms in opioid dependence, it is necessary to determine the likelihood of a positive effect of naloxone. It has been shown that the best result is given by the administration of naloxone to patients delivered to the intensive care unit in an unconscious state at a respiratory rate of 12 per minute or less.

However, it is impossible to determine the indications for the appointment of naloxone or mechanical ventilation, based only on the respiratory rate, since hypoventilation can be due to hypopnea, and bradypnea develops only after some time.

It is important to determine the indications for discharge after recovery of consciousness as a result of the administration of naloxone. The patient can be discharged with only mild signs of opiate overdose, stable condition within a few hours after naloxone administration, and no conditions requiring special attention(eg risk of suicide).

In most cases of opiate poisoning, the clinical picture can be predicted based on knowledge of the pharmacological properties of opiate receptors. However, some opiates cause atypical symptoms in overdose, so a thorough evaluation and, if indicated, individualized empiric treatment is always necessary.

Drug poisoning can occur various reasons. It has individual character manifestations for each person and depends on specific factors, in particular on the way the drug enters the body.

During intravenous injections, the drug instantly spreads through the bloodstream throughout the body, causing severe intoxication. In persons with chronic diseases, the first symptoms indicating drug poisoning proceed in a complicated form.

Most often, drug poisoning occurs for the following reasons:

• too much drug dosage;
• mixing various intoxicants;
• adding narcotic substances to alcoholic cocktails;
• taking drugs after a long break;
• intentional reception a large number drugs for the purpose of suicide.

In a hospital, the poisoned person will be prescribed rehabilitation therapy, which includes:

• long-term and intensive ventilation of the lungs;
• the use of antidotes, selected individually, because they have the ability to neutralize specific types drugs;
• restoration of indicators blood pressure by introducing (intravenously) adrenomimetics;
• cleansing the body of toxic products by thoroughly washing the stomach cavity or artificially increasing diuresis;
• the use of a 3% solution of sodium bicarbonate to alkalize the circulatory system;
• carrying out dehydration of the body using drugs such as Lasix and Mannitol;
• improvement of metabolic processes in the tissues of the central nervous system with the help of Piracetam and Actovegin;
• prevention of possible complications with the use of antibiotics.

Acute poisoning:

• Euphoria, pallor.
• Nausea and vomiting.
• Pupil constriction.
• Pupil dilation.
• Respiratory depression.
• Violation of the activity of the heart and circulatory system.
• Coma.

Chronic drug poisoning:

• Constipation.
• Urination disorders.
• Disturbances of consciousness.

When intoxicated with opiates, severe nausea immediately begins, persistent vomiting, pupils constrict, the skin turns pale and acquires a bluish tint. Breathing becomes shallow, pulse filiform. Then there is respiratory depression, disruption of the heart and circulatory system, dilated pupils, and, finally, coma.

There is only one cause of drug poisoning - an overdose. In this case, drugs act through the so-called opioid receptors - specific nerve endings of brain neurons. When opioids are attached to receptors, the functions of the nervous system are disrupted - this also explains the analgesic effect of opiates and the poisoning they cause.

The classic triad of opioid intoxication includes severe depression of respiratory function, depression of consciousness to the point of stupor or coma, and the development of bilateral miosis. Administration of opioids to opioid-intolerant individuals results in dose-dependent inhibition of all phases of respiratory activity, even when opioids are used at therapeutic doses.

Respiratory rate less than 12 per minute in a patient who is not in a state of physiological sleep is the most important sign of opioid intoxication. The probability of an event is greatly increased if respiratory depression is combined with depression of the function of consciousness.

Miosis is not a mandatory symptom of opioid intoxication. Miosis is not characteristic of an overdose of meperidine, propoxyphene and tramadol.

In cases where opioid-induced respiratory depression provides adequate evacuation carbon dioxide from the body, but sufficient oxygenation is not provided, that is, arterial hypoxemia long time combined with normocapnia, there is a threat of developing hypoxemic pulmonary edema, similar to that which is characteristic of staying at high altitudes.

Other manifestations of opioid intoxication may be arterial hypotension, moderate bradycardia. In persons with total absence tolerance is vomiting. Rhabdomyolysis with the development of myoglobinuria and renal failure is caused by muscle ischemia from positional compression, when the victim is in a motionless unconscious state for a long time.

According to observations deposited by WHO, the most susceptible to overdose of opioids are:

• people who are opioid dependent, especially if they have completed detoxification therapy;
• just released from places of restriction of freedom;
• discontinued treatment;
• using the intravenous route of administration into the body;
• patients using high-dose prescribed opioids;
• persons taking opioids in conjunction with sedatives;
• patients with HIV, liver and respiratory failure;
• family members of patients receiving opioids.

First aid

If during an overdose there were relatives next to the person, it is necessary to call an ambulance and urgently perform the following procedures:

1. Stop access to opiates.
2. In case of cardiac arrest, perform indirect massage, perform artificial respiration.
3. If the lesion occurred due to ingestion, rinse the stomach, induce vomiting.
4. As an antidote, camphor oil can be injected subcutaneously.

The emergency team will arrive and administer nalaxone to the patient, which will restore lung function. Further treatment takes place in a hospital.

The algorithm for providing emergency care for opiate poisoning includes several main activities, which include:

• Ensuring the cessation of the flow of opiates into the body of the victim.
• If possible, it is necessary to ensure the normalization of breathing, in case of respiratory arrest and asystole (cardiac arrest), resuscitation measures (indirect heart massage and artificial respiration) are carried out.
• In the event that poisoning is the result of oral (oral) intake of opiates, a gastric lavage is mandatory (“restaurant” method, in which they give about 1 liter of clean water to drink, then reflexively stimulate vomiting, the procedure is repeated at least 5 times, or by inserting a probe ).
• Call for an ambulance.

Medical care for opiate poisoning primarily consists of administering an antidote, which is naloxone (0.8 mg intravenously until spontaneous breathing is restored). Also, in a medical hospital, detoxification infusion therapy is carried out (the introduction of a significant amount of saline solutions and glucose).

In chronic opiate poisoning, treatment is carried out taking into account possible development withdrawal syndrome.

Poisoning with opiates is a serious condition, since depression of the respiratory center can lead to respiratory arrest and death of the victim. Therefore, assistance must begin as quickly as possible.

Properly rendered first aid in case of drug poisoning will save a person's health and greatly facilitate the struggle for his life.

In case of severe intoxication with opium derivatives, the main task is to provide artificial ventilation of the patient's lungs, thus preventing possible disorders caused by respiratory paralysis. There is also an antidote for opiate poisoning - naloxone, which displaces toxins from specific receptors.

If the drugs were taken orally, then gastric lavage and bladder catheterization are performed.
.

With a drug overdose, it is very difficult to do anything on your own, often even too late. Noticing the first symptoms of poisoning, you need to call an ambulance.

Most often, an overdose of drugs is the result of a pathological addiction to them. Therefore, as soon as the first signs of drug addiction appear, you should immediately contact a narcologist. Poisoning with opium derivatives most often indicates drug dependence. The consequences of this addiction are extremely hard on the health and social well-being of a person.

After the doctor eliminates the life-threatening symptoms of intoxication, and the patient's condition improves, the patient is referred to a narcologist, who, in turn (if possible, the patient's desire is necessary), begins drug addiction treatment.

How to avoid drug poisoning?

Measures of emergency medical care (EMA) consist in ensuring the patency of the respiratory tract, carrying out artificial ventilation of the lungs by any available method, as well as in the introduction of naloxone.

Respiratory support is considered more important than the use of naloxone. Naloxone is ineffective unless the depression of consciousness and breathing is due to an opioid overdose. Naloxone can be administered intravenously, intramuscularly, subcutaneously, and intranasally.

The accumulated experience with the use of naloxone has led to a gradual increase in the dosage of the drug used for both diagnosis and detoxification, with official statements and recommendations for this use. In the USA in 2011-2012. 50,000 doses of naloxone prevented death from opioid overdose in about 10,000 patients.

In November 2015, the Food and Drug Administration (USA) approved the intranasal administration of naloxone for EMT for suspected opioid intoxication. The spray should provide a single dose of 0.4 mg of naloxone.

The doses of naloxone recommended for intravenous administration in Ukraine fully comply with modern international recommendations (0.4-2 mg for adults and 0.1 mg/kg for children). Intravenous drip administration of naloxone in isotonic sodium chloride solution and in 5% glucose solution is allowed.

Long-term infusions are usually used for methadone poisoning. The half-life of naloxone ranges from 20-60 minutes. The duration of action can be up to 2-3 hours, but most often it is much shorter - 40-45 minutes.

An overdose of naloxone leads to the manifestation of an abstinence syndrome, the severity of which can be different. To stop heroin intoxication, naloxone is often used together with buprenorphine, which very effectively displaces other opioid agonists from binding to opioid mu receptors, but by itself has weak analgesic activity, without causing severe dependence.

Routine use for EMT of opioid antagonists with long period elimination half-life (nalmefene, naltrexone) is not recommended.

Kursov S.V., Skoroplet S.M.

Possible consequences

The consequences of opiate poisoning are quite severe:

• paralysis and paresis;
• polyneuropathy;
• psychoses;
• withdrawal syndrome;
• personality disorder;
• decreased intelligence and memory;
• degradation;
• chronic renal failure.

It is not uncommon for a patient who has undergone poisoning to require further psychiatric help.

The main danger of a drug overdose is damage to the brain, heart, liver and kidneys, respiratory arrest and circulatory disorders. All these conditions can lead to the development of complications such as:

• pulmonary edema;
• swelling of the brain;
• toxic coma or shock;
• pneumonia or sepsis;
• thrombophlebitis and thrombosis;
• fatal outcome.

Drug poisoning is a deadly condition. It can lead to irreversible consequences, affecting vital organs. If symptoms of such a pathology are detected, one should not hesitate, it is urgent to call medical care! In a hospital, the poisoned person will be provided with needed help and prescribe therapy that helps to quickly remove drug intoxication.