Narcotic poisoning of children (1) through accidental ingestion of methadone and (2) in utero

Narcotics have been known to man since prehistoric times, and they continue to be among the most used analgesics in the practice of medicine. They comprise a group of drugs whose analgesic effect is coupled with euphoria and somnolence. In addition, their spasmogenic effect on smooth muscle has made them useful agents in the alleviation of certain gastrointestinal tract symptoms. For most narcotics, therapeutic dosage does not produce serious untoward effects. Unfortunately, they have a depressant effect on respiration by directly influencing the respiratory center of the brain. This may be life threatening when recommended dosages are exceeded. Narcotics have been abused since the recognition that they can induce euphoria and a feeling of well being. Tolerance and physical and psychological dependence result from their repeated use. The occurrence of withdrawal symptomatology in humans using these drugs repeatedly helps to produce a pattern of drug dependence; an individual has but to repeat a dose of drug in order to prevent withdrawal symptoms. Abuse liability is thus great. All narcotics share this addiction potential. Those most frequently prescribed in clinical medicine are morphine, trieperidine, codeine and methadone. Heroin (diacetylmorphine), the most commonly abused narcotic, available only illicitly, is not prescribed in clinical practice. After injection, it is hydrolyzed to morphine which produces its pharmacological action. While morphine and heroin are absorbed only following parenteral administration, some narcotics are absorbed readily from the gastrointestinal tract as well as after injection (methadone, codeine, meperidine). Regardless of the mode of administration, narcotics taken by a pregnant addict readily pass the placental barrier and are capable of producing effects on the infant in utero and after birth.