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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Monday 27th June 2011

Reports, in the last few days of a mother, in South Carolina USA, charged with homicide by child abuse after the death of her 6-week old baby from an overdose of morphine only give some of what looks to be a very interesting, though tragic, incident.

Several months after the death of Alexis Greene the authorities have decided that they have enough evidence to demonstrate that the baby died as a result of her mother, Stephanie, having used morphine pills and patches to such an extent that a lethal dose was passed to the child via her milk.

The accepted wisdom is that nursing mothers can have morphine because it does not readily pass into her milk so, for Alexis to have died of morphine poisoning, her mother must have been consuming huge amounts of the substance.

And, the additional 38 charges, of violating drug distribution laws by illegally obtaining supplies of morphine over a two-year period, suggest that Stephanie Greene had developed a serious problem.

I’m not going to try and second guess what may emerge at the trial but the case brought to mind three points. Although I didn’t write about it when I commented on the UNODC World Drugs Report 2011, last week, one area that UNODC says is of concern is the apparently growing number of problem drug users who had have nothing but prescribed medication. Back before the 1961 UN Single Convention on Narcotic Drugs, which gave rise to a criminal industry with a vested interest in promoting the use of substances such as heroin, the main route to morphine or heroin addiction was said to be the result of doctors prescribing the drug over long periods for patients with persistent pain. It would seem, according to the UNODC, that we are, again, seeing this as a substantial route to addiction. Of course, this time around, the numbers of people who become addicted by this route will be added to those addicted because of the profit motive of criminals.

Papaver somniferum, opium poppy

If someone is in constant pain, the possibility that their doctor will, unintentionally, overprescribe opioid medication is bound to exist. That may be what happened to Stephanie Greene but, the charges being brought, suggest that she may have invented a condition in order to obtain opioids. That calls to mind Marie Jeanneret, the Swiss nurse who, in 1868, was convicted of five murders using atropine, the active ingredient in Atropa belladonna.

Jeanneret developed, in childhood, an obsession with the effects of atropine on herself. Like many poisons, however, tolerance develops to atropine and she soon found she could not extract enough of the drug from the available plants to see any response. Atropine has a long history of being used to treat a number of eye conditions, because of its action in causing the pupils to dilate, and Marie faked such a condition in order to obtain supplies of atropine from her physician. Eventually, she developed tolerance to the point that she could not induce any symptoms in herself and that saw her become a nurse in order to use her patients as the subjects of her continuing experiments with her favourite substance.

We know very well, that morphine users also develop tolerance and need increasing amounts to achieve intoxication. There is plenty of scientific evidence of this but there is also an unusual anecdote. Thomas Edison, the American inventor, left notes of an unusual night time visitor to his Menlo Park laboratories.  ‘…there came into the laboratory a strange man in a most pitiful condition…[He] asked if I had any morphine…He poured out enough to kill two men…He said he had taken it for years, and it required a big dose to have any effect.’ (A fuller account of that story appears in Chapter 4 of ‘Is That Cat Dead?’)

More seriously, we know that released prisoners often do not realise that they have lost their tolerance to heroin and, in return to their pre-incarceration levels, administer themselves a fatal overdose.

I’m not sure that we shall ever hear the full detail of Ms Greene’s story. It seems to me that America has a tendency to punish failures and, if she simply did not seek help for her problem substance use, this young woman will be treated harshly. If, however, there is any suggestion that the system should have spotted her increasing drug use, I would expect a plea bargain to be agreed rather than have the possibility of the USA’s failure to treat substance misuse as a healthcare issue being aired in court.