Poisoning In Medical Settings

Poisoning by Narcotics

Dr. Harold Shipman, a 51-year-old general practitioner and serial killer, is known as England's “Doctor Death.” He was sentenced to life in prison after his conviction of murdering 15 elderly patients by administering lethal doses of morphine. Morphine is a narcotic, and physiologic changes that normally occur in the elderly make it imperative that these drugs be administered with caution. Absorption and metabolism of drugs are altered in the elderly because of decreased liver, renal, and gastrointestinal function. As a result, drugs are not metabolized as quickly, and blood levels of the drug remain higher for a longer period, thus increasing susceptibility to depression of the nervous and respiratory system.

Morphine can be administered orally (tablets and syrup), intravenously (IV), subcutaneously (in the fatty tissue), and rectally (suppositories). When administered by IV, it should be given in small incremental doses (1–3 mg over 1–5 minutes) until the desired effect is achieved. If morphine is administered quickly in a single large dose, as with other narcotics, respiratory depression will occur. The recipient's normal drive to breathe is inhibited, and he or she soon dies from lack of oxygen. Because morphine causes peripheral dilation of the blood vessels, hypotension (low blood pressure) is a possible side effect. Long periods of hypotension decrease blood flow to the brain and other vital organs, causing permanent damage and possible death.

As a poison, morphine is a convenient drug because it is a common drug of choice for the treatment of pain and anxiety within the outpatient (Hospice) and clinical (hospital) settings. It is used preoperatively to provide a synergistic effect to that of the general anesthetics and postoperatively to provide pain relief. Pain relief is obtained by the inhibition of impulses that would be experienced as painful and by blocking their transmission in the brain and spinal cord. Morphine is also commonly used in cardiac units to relieve the pain of a myocardial infarction (heart attack) and for the sudden onset of pulmonary edema (fluid build-up in the lungs). In these instances, morphine temporarily relieves chest pain by dilating peripheral blood vessels. This dilation shunts blood and workload away from the dying, overworked heart muscle.

In June 2001, a public inquiry opened to examine more than 400 cases in which Dr. Shipman was suspected of murder. Depending on the outcome of this inquiry, “Dr. Shipman might prove to be Britain's—and the world's—most prolific serial killer” (McDowell, 2001).

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