Opium administration to infants in Peshawar region of Pakistan

Sections

Abstract
Introduction
Method
Results
Discussion

Details

Author: M. IMRAN, T.B. UPPAL
Pages: 69 to 75
Creation Date: 1979/01/01

Opium administration to infants in Peshawar region of Pakistan

M. IMRAN Professor, Department of Pediatrics, Khybar Medical College, Peshawar
T.B. UPPAL Professor, Department of Pathology, Khybar Medical College, Peshawar

Abstract

Use of opium for sedating infants in the North-West Frontier Province of Pakistan causes a grave public health problem. Among the infants hospitalized for opium overdosage, 22 were studied in detail, and their major clinical picture is presented in this paper. The effect of opium use on the nutritional status of these infants, or the relation of infant opium use to addiction in adult life, have not been assessed. It is, however, pointed out that opium overdosed of infants contributed to infant mortality. Despite emergency treatment, the lethality rate of opium overdosed infants was 40 per cent. It is emphasized that a preventive programme should be undertaken to educate parents who are ignorant of the dangers of opium administration to infants.

Introduction

Opium use has always been associated with distinct and, most important, aspects of health problems. Economic and social conditions, interests and priorities prevailing in a given society, as well as the environment in which people of that society live, exert either a direct or indirect impact on the existence and scope of the problem caused by opium or any other narcotic drug.

Opium use is very common in North-West Frontier Province (N.W.F.P.). This province is divided into 11 districts and is mainly an agricultural area. The soil and climate are favourable for the cultivation and growth of many agricultural crops, including plants containing psychoactive substances. Poppy (Papaver somniferum) is one of such plants. In recent years the cultivation of poppy has increased to such an extent that in some parts of the province, it has almost replaced the agricultural crops. The land which was previously under wheat cultivation, is now being cultivated with poppy as the farmer can earn more money through opium sale than through the sale of wheat. Such large scale opium production stimulates the abuse of opium by the local population to the extent that it has become a serious problem. Opium is used by many of the adult population, and also it is given to infants for various reasons, sometimes causing serious consequences, as is shown by this study.

Method

This study is based on the clinical assessment of opium overdose in 22 infants.

The subjects for the study were selected from the infants who were admitted to the local Lady Reading Hospital, Peshawar, and who were diagnosed as having an opium overdose. These infants were clinically studied in detail. Blood and urine specimens were collected and tested for the presence of opiates and other narcotic drugs. Opium overdosed infants were treated immediately with nalorphine, oxygen, intravenous fluids, hydrocortisone and other drugs for symptomatic treatment.

Results

This paper describes only the findings of 22 opium overdosed infants who were studied within a period of one year. About an equal number of infants could not be investigated because they had died soon after admission or because their clinical symptomatology was negative as the narcotic antagonist, nalorphine, had already been administered to them. Also, this study has not covered the opiate overdosed infants admitted to Khyber Hospital, another major hospital in the same town where the number of cases was approximately the same.

Sixteen of the 22 infants were younger than 12 months, and 6 were older. The youngest baby was only 3 weeks old.

Most of the mothers of the infants in this study were from the lower socio-economic group having no formal education, while the fathers usually had minimal formal education. However, there were some infants whose parents belonged to the middle and upper socio-economic groups. Infants of some well-educated parents were also included.

Addiction to opium was also common among the parents and grandparents of the infants in this study. Some fathers of these infants were addicted to smoking tobacco or using snuff orally.

Opium was given either in the raw form or combined with local herbs, honey, tea, water or mother's milk, as well as with cow or buffalo milk. Some of the poorer parents gave boiled extract of the poppy pod in tea, rather than using the more expensive raw opium.

The persons responsible for giving opium or for advising that it be administered, were the mothers themselves, elderly women living in the same house, other relatives, neighbours, and sometimes even the local general medical practitioner was involved. In older children, the opium overdose was due mainly to accidental ingestion of opium which had been kept at home for use by parents or grandparents.

The most common clinical picture was coma (50 per cent) followed by cyanosis (40 per cent), and restlessness (23 per cent). Respiratory depression, drowsiness and convulsions were also common. Infants with respiratory depression had a pulse rate as low as 30 per minute, with the respiratory rate as low as 8 per minute.

Despite emergency treatment, the lethality rate was 40 per cent. Morbidity, with regard to brain damage, secondary to prolonged convulsions, or hypoxia due to cyanosis, is not known, as the cases could not be followed up.

TABLE 1

Infants who were overdosed with opium

Subject No.

Age

Sex

Parents' background

Reasons for opium administration

Family history of addiction

1.
3 1/2 months
M
Labourer, illiterate
Sedation
Grandmother addicted to opium
2.
5 months
M
Labourer, mother illiterate
Chest pain and cough
-
3.
4 months
M
Driver, mother illiterate
Restlessness, chest pain, sedation
Father using snuff, smokes tobacco cigarettes
4.
4 months
M
Labourer, mother illiterate
Sedation
Father using snuff
5.
5 months
M
Farmer, mother illiterate
Sedation
Father using snuff
6.
21 days
M
Furniture contractor, mother a teacher
Warm baby after bath
Father smokes tobacco cigarettes
7.
5 months
F
Labourer, illiterate
Restlessness
-
8.
24 months
F
Government servant
Restlessness and pain
-
9.
3 months
M
Baker
Cough, restless- ness
Father smokes tobacco cigarettes
10.
3 months
F
Hawker
Cough, restless- ness
-
11.
8 months
F
Clerk
Restlessness
Father smokes tobacco cigarettes
12.
4 years
F
Hawker
Severe cough
-
13.
7 years
F
Farmer
Accidental
Father smokes tobacco
14.
12 months
M
Shopkeeper
Accidental
-
15.
18 months
M
Labourer
Restlessness
Father addicted to opium
16.
12 months
M
Labourer
Abdominal and chest pain, restlessness, cough, diarrhoea
Grandfather addicted to opium
17.
7 months
F
-
Cough, diarrhoea
-
18.
4 months
F
-
Diarrhoea
-
19.
18 months
F
-
Sedation
-
20.
12 months
M
-
Non-specific reason
Mother addicted to opium
21.
18 months
F
-
Cold
-
22.
3 months
M
-
Diarrhoea
-

TABLE 2

Clinical features of opium-overdosed infants

 

Clinical manifestations

Suject No.
Form of opium
Person who Recommended Opium use
Main findings
Cyanosis
Temperature (°C)
Pulse per minute
Respiration Per minute
Results
1.
Poppy pod
Neighbour
Coma
+_
37 80
Irregular, shallow, gasping
Expired
2.
Opium (about 10 mg.)
Neighbour
Coma, Cough, diarrhea, fever
+
36.7 30
Deep, slow, 8
Recovered
3.
Poppy flower, boiled in water, 2 tsps.
Local G.P.
Coma dyspnoea, cough
+
37.2 120
Cough, chest wheezing, 50
Recovered
4.
Poppy pod
Grandmother
Coma, fever, restlessness
-
37.8 34
Shallow, irregular, chest full of crepitations, 34
Recovered
5.
Poppy pod, spices, sugar mixed with breast milk, 2 tsps TID for 24 hrs
Mother-in-law
Drowsiness, fever, cough, chest rest less retraction
-
39 140
Shallow, wheezing, crepitations, 60
Expired
6.
Poppy pod boiled
Sister, mother- in-low
Coma, cyanosis, difficult breathing
+
37.8 60
Shallow, irregular, 14
Recovered
7.
Opium
Relative
Coma, cough, breathlessness, fever
-
37 140
Shallow, 38
Recovered
8.
Opium
Mother
Fever, vomiting, cough, restlessness
-
37.8 180
Irregular, gasping, 10
Expired
10.
Opium
Mother
Restlessness, cough
-
37 120
Deep, bilateral crepitations, 30
Expired
11.
Opium
Grandmother
Restlessness, drowsi- ness
+
37 110
Shallow, bilateral crepitations, 20
Expired
12.
Opium powder, 1/4 tsp.
Mother
Cough, drowsiness
+
37.2 100
Shallow, bilateral crepitations, 28
Expired
13.
Opium
Accidental use
Abdominal pain, restlessness, drowsiness
+
37 100
Shallow, 18
Recovered
14.
Opium leaves
Accidental use
Drowsiness
-
37 115
Regular, 20
Recovered
15.
Opium with condi- ments
Mother
Coma, convulsions, fever
+
37.20 140
Regular, 70
Expired
16.
Opium pod, pea size
Parents
Coma, dyspnoea
+
40 110
Regular, 30
Recovered
17.
Opium, maize size
-
Coma, dyspnoea
+
37 120
Deep, 60
Recovered
18.
Opium extract in tea
Parents
Coma, dyspnoea
+
37 120
Shallow, 50
Recovered
19.
Opium
Mother
Fever, cough, drowsiness
-
39 120
Regular, bilateral crepitations
Recovered
20.
Opium
Mother
Fever, cough
-
39 120
Regular, bilateral crepitations
Recovered
21.
Opium, wheat grain
Grandmother
Corzya, cough, fever, restlessness, drowsiness
-
39 120
Regular
Recovered
22.
Opium
Mother
Coma, diarrhoea, convulsions
+
37 100
Depressed
Recovered

Discussion

Administration of opium to infants has become a critical problem in this part of the country. After incising the pods, the raw opium is collected with primitive instruments.

FIGURE I

(A) Poppy pods; (B) collection receptacle made of tin with a wooden handle; (C) small wedge shaped wooden instruments used for collecting opium; (D) crude opium in a match box.

Full size image: 15 kB, FIGURE I

FIGURE II

A malnourished infant whose mother routinely sedated him with opium to keep him from crying when he was hungry

Full size image: 46 kB, FIGURE II

FIGURE III

Above is a mother who is addicted to opium, but whose children were not given the drug

Full size image: 43 kB, FIGURE III

The cost of crude opium on the drug market is about Rs. 20/- (or 2 U.S. dollars) for one gram. Because this is expensive, some of the poorer people use the drug in a variety of forms such as the poppy pod itself which is boiled, and the extract then mixed with tea. In such a case, it is difficult to determine the dosage, as the opium content of the pod varies. Hence, the reason for the frequent overdosage of the drug.

The drug is given primarily to sedate infants when parents must work in the fields or elsewhere without being disturbed by the baby and without the necessity of employing a babysitter. The sedation of babies with opium is more common in some districts of the province than in others. Sometimes in upper class families, the drug is given by the maid or by the babysitter, who can rest while the baby is asleep.

Such a practice of unrestricted use of opium is, in our view, an important factor in the high rate of infant mortality. It is essential that an educational programme therefore be launched. In order to investigate all aspects of the opium use in infants, multidisciplinary and coordinated research is required.