Positivo a opiáceos en análisis de drogas de abuso en orina tras consumo de semillas de amapola. A propósito de un caso / Positive for opiates in urine drug of abuse test after poppy seed consumption. A case report

Antecedentes y objetivos: las semillas de amapola, cuyo consumo solas o contenidas en ciertos alimentos es considerado seguro en España desde el punto de vista toxicológico, presentan cierta cantidad de alcaloides opiáceos que pueden originar resultados «falsos positivos» en los análisis de drogas de abuso en muestras de orina, como los realizados de forma rutinaria, entre otros colectivos, al personal de las Fuerzas Armadas. A raíz de un caso detectado en el Instituto de Toxicología de la Defensa de resultado positivo a opiáceos en una persona que reportó el consumo de un pan con semillas de amapola, se propuso realizar un estudio de esta problemática y cómo abordarla desde el punto de vista analítico. Material y método: se estudió en dos voluntarios cómo afectó el consumo de dicho pan, analizándose muestras de orina, tanto por métodos de cribado como de confirmación, y se apoyó en una revisión bibliográfica empleando distintas bases de datos especializadas en referencia a la interferencia del consumo de semillas de amapola con las analíticas de drogas de abuso en muestras de orina. Resultados: aplicando el punto de corte de 300 ng/ml recomendado por la European Workplace Drug Testing Society (EWDTS) resultaron presuntamente positivos a opiáceos el 62,5% de los análisis de cribado. En ciertas muestras, el análisis de confirmación identificó codeína por encima del límite de detección establecido en la técnica analítica. La bibliografía apoyó estos resultados. Conclusiones: para abordar analíticamente esta problemática se ha propuesto incrementar, en la técnica analítica de confirmación, el punto de corte de confirmación y, asimismo, como otras posibles medidas a implementar se ha planteado la detección de tebaína como biomarcador específico del consumo de semillas de amapola y/o el incremento del punto de corte hasta los 2000 ng/ml. (AU)

Antecedents and objectives: Poppy seeds, whose consumption alone or contained in certain foods is considered safe in Spain from the toxicological point of view, have different amounts of opioid alkaloids that can cause «false positive» results in the analysis of drugs of abuse in urine samples, such as those routinely performed, among other groups, on Armed Forces personnel. Following a case detected at the Institute of Toxicology of the Defense of a positive result to opiates in a person who reported the consumption of a bread containing poppy seeds, it was proposed to carry out a study of this problem and how to approach it from the analytical point of view. Material and methods: We studied how the consumption of this bread affected to two volunteers, analyzing urine samples by both screening and confirmation methods, and was supported by a literature review using different specialized databases in reference to the interference of the consumption of poppy seeds and products containing them with the analysis of drugs of abuse in urine samples. Results: Using the 300 ng/ml cut-off point, 62% of the screening tests were presumably positive to opiates. In certain samples the confirmatory analysis identified codeine above the established detection limit. The literature supported these results. Conclusions: In order to deal with this problem analytically, it has been proposed to increase the confirmation cut-off level in the analytical confirmatory technique. In addition, the detection of thebaine as a specific biomarker for poppy seed consumption and/or the increase of the cut-off point to 2000 ng/ml has been proposed as other possible measures to be implemented. (AU)

Anaphylaxis in an 8-year-old boy following the consumption of poppy seed

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Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion.

Eating poppy seeds can cause a positive urine drug screen, but it is unknown whether ingesting large quantities can result in opiate intoxication or toxicity. A 54-year-old woman with intractable vomiting was found unresponsive at home and later pronounced dead. At autopsy, a cast-like large bowel obstruction composed of poppy seeds was identified. Postmortem blood morphine level was < 10 ng/mL. Cause of death was determined to be complications of a bowel obstruction secondary to poppy seed ingestion. Deaths related to eating poppy seeds have not been described in the literature. This case illustrates that consuming raw poppy seeds in large quantities did not cause lethal opiate toxicity. However, overdose deaths associated with ingesting poppy seed tea (PST) have been described. Poppy seed derivatives should be considered a potential source in cases of opiate toxicity without evidence of prescription or street drug abuse.

IgE to Poppy Seed and Morphine Are Not Useful Tools to Diagnose Opiate Allergy.

BACKGROUND: Correct diagnosis of genuine IgE-mediated opiate allergy poses a significant challenge, mainly because of uncertainties associated with opiate skin testing and the unavailability of drug-specific IgE (sIgE) assays. Recently, it has been suggested that sIgE to poppy seed extract and morphine would be reliable in the diagnosis of opiate allergy. However, given the high prevalence of sIgE antibodies to these compounds in an allergic population, the predictive value of these tests leaves significant doubts. OBJECTIVE: This study aims at verifying the predictive value of positive poppy seed and morphine sIgE assays results. METHODS: A total of 22 individuals with a positive sIgE to poppy seed or morphine were selected. All had controlled drug challenges with increasing doses of morphine and/or codeine. Of these, 18 patients had an additional basophil activation test (BAT) with morphine and codeine. RESULTS: None of the 22 patients demonstrated objective or subjective symptoms on provocation with morphine and/or codeine. Regarding BAT with morphine and codeine, expression of CD63 on basophils from 14 opiate tolerant individuals remained comparable to spontaneous expression by resting cells. The remaining 4 patients were classified as nonresponders. CONCLUSION: Positive sIgE results to poppy seed and morphine are not per se predictive for genuine opiate allergy and should not be used in isolation to diagnose morphine or codeine allergy. To avoid overdiagnosis, for the time being, we propose to supplement serological diagnosis with an oral provocation test. Whether BAT might help to discriminate between clinical reactivity and sensitization remains to be confirmed in larger collaborative studies.

Hepatotoxicity associated with the ingestion of Papaver Rhoease.

Liver injury appears to be associated with the use of herbal products and wild plants.This paper presents what is to our knowledge the first case report in the world of acute liver toxicity caused by Papaver Rhoease. A 17-year- old woman from eastern Turkey ingested Papaver Rhoease which is known as "poppy flower" among the local inhabitants. Her liver function tests were initially 10- 15 fold higher than normal. She was hospitalised in intensive care unit and on day 2 of hospitalisation, the results of her liver function tests showed about a hundred-fold increase compared to the normal level. Her general status deteriorated and she was transferred to another medical centre for liver transplantation.

Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people.

BACKGROUND: The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. METHODS: We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. RESULTS: Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. CONCLUSIONS: Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.

Exposure of consumers to morphine from poppy seeds in Hungary.

Poppy seed-containing foods are popular dishes in Hungary and some other Central European countries. The alkaloids of poppy are used in the production of medicines. Poppy seeds used as food may also contain considerable amounts of alkaloids, which raises the question of food safety. Morphine, codeine, thebaine and noscapine concentrations of poppy seed samples from the period 2001-2010 and consumption data from two Hungarian surveys, carried out in 2003 and 2009, were evaluated. Exposure calculations were made for morphine intake by both point estimate and probabilistic methods, and the uncertainty of the calculated values was estimated. The point estimate for the acute consumer exposure, calculated using the 97.5th percentiles of morphine concentration and of poppy seed consumption and taking into account the reduction of morphine content by processing, was 78.64 µg (kg bw)⁻¹ day⁻¹ for adults, and 116.90 µg (kg bw)⁻¹ day⁻¹ for children. Based on probabilistic estimations, the 97.5th and 99th percentile exposures ranged between 18.3-25.4 and 25.6-47.4 µg (kg bw)⁻¹ day⁻¹ for adults, and between 32.9 and 66.4 µg (kg bw)⁻¹ day⁻¹ for children, respectively. As a no observed effect level (NOEL) had not been established, the significance of exposure could not be assessed.

Anaphylaxis to buckwheat in an atopic child: a risk factor for severe allergy to nuts and seeds?

Common buckwheat (Fagopyrum esculentum) is known to cause severe anaphylactic reactions in adult individuals. However, type I allergy to buckwheat is rarely seen in children. We report on a 7-year-old boy who developed a grade III anaphylactic reaction after consumption of a cake containing buckwheat flour. Prior to this incident, the boy had developed severe allergic reactions to hazelnuts and suffered from an oral allergy syndrome to poppy seed. Analysis of the patient's IgE reactivity by immunoblotting experiments revealed that he was sensitized to members of the 2S albumin and 11S globulin protein families in buckwheat. Additionally, cross-reactivity was found between the 11S globulins in buckwheat, poppy and hazelnut. IgE inhibition experiments indicated that the 11S globulin in buckwheat was the initial sensitizing protein. We conclude that 11S globulins in buckwheat have the potential to induce IgE antibodies cross-reactive with 11S globulins in other, botanically unrelated foods and may induce anaphylactic reactions.

[Hepatopathies in concomitance of chronic drug and alcoholic intoxications].

Liver biopsy specimens were morphologically investigated in 87 patients, including 30 with drug (marijuana and poppy straw) addiction, 23 with chronic alcoholic intoxication, and 25 abused narcotics and alcohol concomitantly. All the patients were not found to be infected with viruses of hepatitis B, C, G, TTV, or CMN; the clinical manifestations and biochemical blood parameters were studied over time. In patients who simultaneously used drugs and alcohol, the specific features of hepathopathy were shown to be more pronounced and more rapidly progressive changes as fatty hepatosis and diffuse liver tissue fibrosis than in those used either drugs alone or alcohol alone. This is favored by chronic inflammation and cholestasis that is accompanied by bile duct proliferation. Concomitance of these processes leads to permanent liver tissue atrophy and death and to the relatively early development of hepatic monolobular cirrhosis. The mechanisms responsible for the patho- and morphogenesis of combined toxic hepatopathy are discussed.

Poppy seed allergy: a case report and review of the literature.

Seeds of the poppy plant are traditionally used in bakeries, e.g., for garnishing bread or making cakes. Reports of allergic type I sensitivity to poppy seed are rare. According to the literature, severe reactions may occur, affecting mainly patients with allergy to pollens or nuts. We report on a 16-year-old boy who has developed erythema and angioedema, conjunctivitis, and dyspnea due to inhalation of poppy seed. Skin-prick tests were positive for poppy seed, hazelnut, and chickpea. The concentration of specific IgE for poppy seed, hazelnut, and peanut were 3.36 kU/L (class 2), 1.5 kU/L (class 2), and 6.17 kU/L (class 3), respectively. Allergic reactions associated with inhalation of food allergens have been reported for some foods but not for poppy seed. This is the first report on inhalative allergy to the poppy seed. Although poppy seeds are not commonly used, we underline the possible importance of such rare and often hidden sources of allergens, especially in patients with nut allergy.

Cross-sensitization between poppy seed and buckwheat in a food-allergic patient with poppy seed anaphylaxis.

The opium poppy, Papaver somniferum L., is the source of both poppy seeds and opium. The commercially available seeds are widely used as ingredients for various kinds of food. IgE-mediated sensitization to poppy seeds is rare, but, if present, clinical symptoms are usually severe. Cross-sensitizations between poppy seeds and other food allergens have been described with sesame, hazelnut, rye grain and kiwi fruit. We report the case of a 17-year-old female with an apparently food-allergic reaction after ingestion of a poppy seed cake. Allergological workup revealed a poppy seed anaphylaxis and led to the identification of a novel cross-sensitization with buckwheat.

Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections.

Mexico has cultivated opium poppy since before the 1900's and has been an important transit route for South American cocaine for decades. However, only recently has drug use, particularly injection drug use, been documented as an important problem. Heroin is the most common drug used by Mexican injection drug users (IDUs). Increased cultivation of opium poppy in some Mexican states, lower prices for black tar heroin and increased security at U.S.-Mexican border crossings may be contributing factors to heroin use, especially in border cities. Risky practices among IDUs, including needle sharing and shooting gallery attendance are common, whereas perceived risk for acquiring blood borne infections is low. Although reported AIDS cases attributed to IDU in Mexico have been low, data from sentinel populations, such as pregnant women in the Mexican-U.S. border city of Tijuana, suggest an increase in HIV prevalence associated with drug use. Given widespread risk behaviors and rising numbers of blood borne infections among IDUs in Mexican-U.S. border cities, there is an urgent need for increased disease surveillance and culturally appropriate interventions to prevent potential epidemics of blood borne infections. We review available literature on the history of opium production in Mexico, recent trends in drug use and its implications, and the Mexican response, with special emphasis on the border cities of Ciudad Juarez and Tijuana.

Effects of poppy seed meal on egg production and hatching results in quail (Coturnix coturnix japonica).

This study was carried out to determine the effects of poppy seed meal (PSM) on the egg production and hatching of quail. Two experiments were undertaken. In the first experiment, 240 quail, reared under the same conditions, were divided into four groups of 60 birds each (which were, in turn, subdivided into four subgroups of 15 each for experimental replicates). The first, second, and third experimental groups were fed ratios containing 5%, 15%, and 25% PSM, respectively, over 12 weeks. The control group received no PSM. Feed and water were supplied ad libitum and artificial light was provided for 16 h a day. During the first experiment, egg production, egg weight, and feed conversion ratio (FCR) were measured. In the second experiment, 240 female and 48 male quail were divided into four groups, as in the preceding experiment, and the birds were housed in cages at a ratio of one male to five females. The diets and their presentation to the quails were the same as in the preceding experiment. The results of the two experiments showed that the addition of PSM to the feed ratios increased egg production, feed consumption, and feed conversion per kg of eggs and per dozen eggs. However, PSM addition at all percentages significantly reduced (P<0.001) hatchability, mainly because of increased infertility and embryonic deaths.

Drogas en el Perú / Drugs in Peru

Bajo el título de drogas en el Perú se presenta un apretado resumen de la farmacología de las drogas ilícitas de uso más extendido en el país. No se ha considerado pertinente presentar en esta oportunidad la gran familia de las drogas de las que se abusa frecuentemente pero que por razones epidemiológicas y de manejo de los aspectos preventivos se clasifican como drogas sociales, productos industriales o drogas folclóricas. El libro ha sido diseñado como un auxiliar práctico para público general, maestros y alumnos que requieran obtener información farmacológica acerca de las drogas en un lenguaje accesible al público general. Ramiro Castro de la Mata, médico farmacólogo especialista en drogas y miembro fundador de CEDRO, presenta en esta obra, una apretada síntesis de los principales aspectos de la farmacología de las principales drogas ilícitas cuyo consumo viene aquejando a la población peruana o de aquellas como el opio que amenazan a las futuras generaciones

WHO Expert Committee on Drug Dependence. Thirty-second report.

This report presents the recommendations of a WHO Expert Committee responsible for reviewing information on dependence-producing drugs to assess the need for their international control. The first part of the report contains a general discussion of the new guidelines for the review of dependence-producing psychoactive substances and their implications for the scheduling of ephedrine and of the guidelines that were drafted to clarify the scope of control of stereoisomers. A summary follows of the Committee's evaluations of six substances (4-bromo-2,5-dimethoxyphenethylamine (2C-B), 4-methylthioamphetamine (4-MTA), gamma-hydroxybutyric acid (GHB), N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MDBD), diazepam and zolpidem), four of which (2C-B, 4-MTA, GHB and zolpidem) were recommended for international control. The report also discusses the substances that were pre-reviewed by the Committee, five of which (amfepramone, amineptine, buprenorphine, dronabinol and tramadol) were recommended for critical review at a future meeting.