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- W4253953536 abstract "Authors' reply Sir—Bruce Trathen and Sue Byers point out that the absence of 6-acetylmorphine could not exclude the use of heroin by the baker. 6-acetylmorphine is not always detected in the urine of heroin users, although it is found in more than 60% of cases with an assay of sufficient sensitivity. We excluded heroin use because of the absence of the heroin metabolite in three specimens, the history provided by the baker, and the results of the analysis of the tea. They also note that a blood concentration of morphine of 3 mg/L could indicate habitual heroin use. This concentration may be achieved initially with a high dose of intravenous heroin, but is unlikely to be sustained given the short half-life of morphine. Such concentrations are not seen even in heroin-related deaths of habitual users tolerant to the drug. Their comment that 3 mg/L morphine is surprisingly high for a supposed oral intake of 280 mg morphine, ignores the fact that non-linear absorption and kinetics will apply in high doses and lead to a non-linear increase in blood concentrations with dose, and that there is a wide individual variation in plasma concentrations after administration of standard doses.1Selavka CM Poppy seed ingestion as a contributing factor to opiate-positive urinalysis results: the Pacific perspective.J Forensic Sci. 1991; 36: 685-696PubMed Google Scholar Rainer Nowack is presumably not aware of the published research that shows substantial concentrations of morphine can be found in poppy seed, or that ingestion of poppy seed in cakes and buns can lead to a false conclusion of heroin use.2Pelders MG Ros JJW Poppy seeds: differences in morphine and codeine content and variation in inter- and intra-individual excretion.J Forensic Sci. 1996; 41: 209-212PubMed Google Scholar, 3Lo DST Chua TH Poppy seeds: implications of consumption.Med Sci Law. 1992; 32: 296-302PubMed Google Scholar We stand by our original letter and are now aware of a further two cases of morphine addiction from poppy tea. Drug use was not suspected at first and urine was not screened. The patient did not use cocaine, amphetamines, alcohol, or benzodiazepines; over several years, all urine screens were negative. One-off use of another convulsant drug is unlikely. Poppy tea and the baker's first seizureIn their report on the consumption of poppy-seed tea by a baker, Mark King and co-workers (Sept 6, p 716)1 make an error in their interpretation of the data when they state “the use of heroin was excluded by the absence of its distinguishing metabolite, 6-acetylmorphine”. The non-detection of 6-acetylmorphine does not exclude the use of heroin. Full-Text PDF Poppy tea and the baker' first seizureMark King and colleagues'1 report on poppy seed as a source of morphine intoxication contrasts with current knowledge on the opioid content of ripe poppy seed. Full-Text PDF Poppy tea and the baker' first seizureThe relation between the patient's poppy habit and his seizure is not established based on the available data in Mark King and colleagues' report1. Although experimental models in which morphine is microinjected into various brain regions of animals show a proconvulsant effect,2 convulsant effects of opiates are not consistently seen in human beings. When noted, they are generally related to hypoxia or cerebral oedema, which are themselves due to respiratory depression or pulmonary oedema.3 Indeed, clinical experience reflects this since seizures are rare even after large intravenous overdose. Full-Text PDF" @default.
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- W4253953536 date "1997-12-01" @default.
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- W4253953536 title "Poppy tea and the baker' first seizure" @default.
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