Nadezhda Osipova: Normative acts alone cannot solve the problem of narcotic painkillers

In July 2014, the famous Russian anesthesiologist Nadezhda Osipova resigned from the P.A. Herzen Cancer Institute in protest against the situation with anesthesia. Her frank became the starting point for changes in this area. In October 2014, a Krasnoyarsk court acquitted a doctor who had been under threat of criminal prosecution for three years. In December 2014, the Duma voted for an amendment to the Federal Law "On Narcotic Drugs and Psychotropic Substances", establishing the principle availability of narcotic drugs and psychotropic substances to citizens who need them for medical purposes. In April 2015, the Ministry of Health approved the procedures for providing palliative care to adults and children. Does this mean that the problem of anesthesia in Russia has been solved?

- Nadezhda Anatolyevna, do you think that enough has been done in Russia to solve the problem of anesthesia?

– In the legislative amendment on the availability of narcotic and psychotropic substances for medical use, a principle was formulated on which I myself had insisted for many years. The procedures for providing palliative care are also generally developed correctly. But the question remains how it will be implemented. Officials have this approach: we have issued regulations, now doctors will prescribe narcotic analgesics more often and in large doses.

Isn't that what they fought for?

– Fight for the right of patients to adequate pain relief. Unfortunately, in the current state of affairs, this is far from the case. Firstly, the doctor must know what exactly to prescribe to the patient, in what dosage and in what combination. Otherwise, the effect of anesthesia will not be optimal. I will give one example. I recently had a fracture. The pain was hellish. The paramedics offered to give an anesthetic injection. Of course, I asked what they would anesthetize with. It turned out that in their styling they only had fentanyl - a drug many times stronger than morphine. It should not be used without equipment to support vital functions. The patient may, for example, stop breathing. Of course, an ordinary ambulance does not have such capabilities. In general, I refused anesthesia. Then she called her colleague, who is in charge of emergency issues at the Russian Medical Academy of Postgraduate Education. I say: how did you admit that fentanyl is used in an ambulance? Why didn't they recommend promedol, which is safer under these conditions, for this? He says: well, the Ministry of Health has decided so ... Unfortunately, in our realities we constantly encounter examples of such bureaucratic attitude. Like, fentanyl costs a penny, it removes pain effectively. And the fact that it works for only 20-30 minutes, during which the patient cannot be taken to the hospital, and, moreover, can cause respiratory arrest, did not occur to representatives of the vertical of power. I'm afraid now the same situation will be with injectable morphine. Doctors will be forced to prescribe this cheap drug to all patients who need pain relief, including long-term pain relief, like cancer patients. Simply because nothing else will be available. I repeat all the time: professionals should decide how and with what to treat patients. But we don't have it yet.

What's wrong with injectable morphine?

– You need to understand the essence of the mechanism of action of an injectable drug or the so-called “short” pills. They gave the patient an injection, he took a "short" pill. After 4 hours, the pain relief will completely stop, and you need to take the drug again. 5-6 injections are required per day. The patient's whole life is broken into pieces, including a night's sleep - filled with fear that the pain is about to return. But that's not all. Very quickly comes tolerance - the resistance of receptors to the action of the drug. He occupied the receptor, activated it, caused pain relief, and then the effect ends and the pain returns abruptly. Time after time, ever-increasing doses of painkillers are required. Quite a different picture with pain relief with long-acting drugs. Morphine tablets are available for both 12-hour and 24-hour use. There are transdermal systems - a thin patch is glued to the chest for 72 hours. There is a continuous dosed supply of the drug. After 3 days the patch is changed. This is a completely different quality of life for an incurable cancer patient. On my shelf is a book by a famous biologist "Genetic Processes in Populations" with a dedicatory inscription. In the last year of his life, thanks to the fact that he received adequate pain relief, he managed to complete his work. On the cover of another book - our monograph on chronic pain - I took out a picture of an artist who, despite lung cancer, experienced a creative take-off in the last 11 months of his life and created a lot of work. He left without suffering. Don't other patients deserve it?

- Why do you think that for the majority of those who need pain relief, everything will end with injectable morphine?

– In Russia, there are research institutions and enterprises that own the technologies for the synthesis of substances and the production of dosage forms of all major drugs used in medicine. But the state does not allocate funds for this. Moreover, only it can be the main customer. In addition to injectable morphine, we do not produce much. There is fentanyl, there is promedol, which is not intended for long-term treatment. There is a scanty amount of the modern drug prosedol. Almost all long-acting analgesics that provide an acceptable quality of life are purchased abroad. An amendment made to the law “On Narcotic Drugs and Psychotropic Substances” in April 2016 testifies to how things really are in Russia with narcotic painkillers. It involves the use of painkillers without licensing in the event of the outbreak of hostilities.

- That is, with painkillers we are very bad?

- Exactly.

– Is this the main problem?

– Even if the average Russian doctor had at his disposal the entire range of modern drugs for pain relief, he still would not be able to make the right choice. He does not have enough knowledge, so he is afraid to use narcotic painkillers. These are potent drugs that, at the slightest overdose, can act depressingly on the vital centers of the brain: respiratory, vascular. And the doctor, in principle, is rightly afraid. After all, he needs to understand what processes occur in the brain during pain, what molecular genetic mechanisms operate, what mediators, what affects what. In addition, one drug is not enough - the modern approach involves the use of additional adjuvant and symptomatic therapy, which improves pain relief, reduces the need for opioid analgesics, and corrects side effects. This is a whole science, which, unfortunately, is not taught in Russian medical universities. By the way, in Europe and in the USA, students are also not taught these things in universities. But doctors undergo mandatory training in the problem of pain and pain relief after graduating from a higher educational institution, including the rules for the use of narcotic and psychotropic drugs. Without a certificate of such training, no doctor has the right to start practical activities. After all, pain happens in all areas of medicine, and it must be able to remove it. We should have it too.

– What prevents such certification?

- No system. The certificate is given when there is a specialty. So far, there is no specialty “palliative medicine” in Russia. I hope the situation will change. My student Georgy Novikov, who has been the head of the Russian Association of Palliative Medicine for many years, took the initiative - with the support of Oleg Yanushevich, Rector of the Moscow State University of Medicine and Dentistry. A.I. Evdokimov, in this university they organized the Department of Palliative Medicine on the basis of the Russian Center for Palliative Medicine for 200 beds. Educational cycles are continuously going on at this department - they train 70 doctors a month: they teach to determine the physiological mechanisms of pain, its types, to select methods and means of treatment. The corresponding training cycles for doctors have also been launched at the Russian Medical Academy of Postgraduate Education - for this I have developed a modular training program on the theoretical and practical aspects of pain and its treatment, approved by the Ministry of Health. While this is a drop in the ocean. But we must strive to ensure that all doctors, upon graduation from the institute, take such courses.

Morphine - what is it? You will find the answer to the question below. In addition, we will talk about what this drug is used for, how it is used, etc.

Morphine - what is it?

In its pure form, the drug "Morphine" is a crystalline white powder. By the way, "Morphine" is its outdated name. It should be especially noted that the name of this substance comes from the name of the Greek god Morpheus, who commanded dreams. Morphine is a medicine that is an opium alkaloid. It is made from the dried juice of the opium poppy. In addition, such a substance can be found in the composition of such herbs as stephania, moonseed, synomenium, etc.

History reference

Morphine - what is it? It is a drug with analgesic, sedative and hypnotic effect. A drug made on the basis of such a substance was actively used in medical practice as early as 1805. Not a single hospital could do without it during the American Civil War. As a strong analgesic drug, it was administered to wounded soldiers intravenously and intramuscularly after surgical interventions. This greatly eased their suffering. However, it should be noted that such a remedy quickly became addictive. Soon, the condition to which the patient was subjected after prolonged use of the medication received such a name as "soldier's disease."

As you know, at the beginning of the last century, morphine was used not only by the military, but also by doctors who, with the help of it, wanted to get rid of the feeling of fatigue.

Release form of the medicinal product

The drug "Morphine" is available in the form of tablets of 0.01 g, a 1% solution in ampoules and in a 1 ml syringe-tube.

Drug properties

Describing morphine (medicine), we can note its following features:

• This drug is produced in the form of white needle-shaped crystals or a white crystalline powder, which turns slightly yellow or gray during storage.
• Such an agent is slowly soluble in water and sparingly soluble in alcohol. It is incompatible with alkalis. The prepared solution must be sterilized at 100°C for half an hour. For stabilization, add
• The melting point of this preparation is 254°C.
• The specific rotation of the solution is 2%.
• Ignites at 261°C.
• Self-ignition occurs at 349°C.

Pharmacodynamics

Morphine is a drug that is a member of the group of opioid analgesics. It causes euphoria, reduces pain symptoms, causes a feeling of peace of mind, improves mood, gives bright prospects, regardless of the real state of affairs. It is these properties of this drug that contribute to the formation of physical and mental dependence.

In high doses, this drug has a rather strong hypnotic effect. In addition, morphine inhibits all conditioned reflexes, causes miosis and reduces the excitability of the cough center. By increasing the tone of the muscles of the internal organs, it contributes to spasms of the sphincter of Oddi and the biliary tract. In addition, such a drug significantly weakens intestinal motility, but at the same time accelerates emptying and increases gastric motility.

Pharmacokinetics

Most often, morphine (pain reliever) is prescribed intravenously, subcutaneously and intramuscularly. However, rectal, oral, epidural or intrathecal use is also possible. This drug is absorbed fairly quickly. About 20-40% of the drug binds to plasma proteins. The drug "Morphine" crosses the placenta and can cause respiratory failure in the fetus. It should also be noted that this drug is determined in breast milk.

With intramuscular injection, the effect of morphine develops after about 15-26 minutes. The maximum distribution in the bloodstream is achieved after 35-45 minutes and lasts about 3-5 hours.

The drug "Morphine": application

The drug "Morphine" is used as an analgesic for various diseases and injuries, which are accompanied by quite strong pain. In addition, it is used during preparation for surgery, as well as in the postoperative period. Often it is prescribed for insomnia, severe coughing and shortness of breath, which is caused by acute

Sometimes the remedy "Morphine" is used in x-ray practice during the study of the stomach, gallbladder and 12-colon. This is due to the fact that the introduction of this drug helps to increase the tone of the muscles of the stomach, increase its peristalsis and accelerate emptying. Thanks to this effect, it becomes much easier for specialists to identify ulcers and tumors of internal organs.

Indications for use

As you know, morphine in cancer contributes to the rapid elimination of pain, which greatly facilitates the patient's condition. In this regard, it should be noted that this tool:

• suppresses a pronounced pain syndrome in injuries, malignant neoplasms, myocardial infarction and;
• used as an additional drug to local or during surgery;
• sometimes used for childbirth, cough (if other means are ineffective) and pulmonary edema;
• is prescribed before an x-ray examination of the stomach, duodenum and gallbladder.

Contraindications for use

Such a drug is not recommended for use with hypersensitivity to the components, depression of the respiratory center (for example, against the background of drug or alcohol poisoning) and the central nervous system, as well as with paralytic ileus. In addition, morphine cannot be used for spinal and epidural anesthesia.

Use with extreme caution

Use this remedy with extreme caution should be for abdominal pain for an unknown reason, attacks of bronchial asthma, arrhythmia, convulsions, drug addiction, alcoholism, suicidal tendencies, cholelithiasis, as well as during surgical intervention on the urinary system and the digestive tract. In addition, such a drug should be carefully used for brain injuries, prostatic hyperplasia, liver or kidney failure, urethral stricture, hypothyroidism, severe inflammatory bowel disease, epileptic syndrome, pregnancy, lactation and after surgery on the biliary tract. Morphine should also be used with extreme caution in severe condition of patients, in the elderly and in childhood.

Dosage

Having answered the question about what morphine is, what it is, you should also talk about its dosages.

For oral administration, the patient should always consult a doctor. After all, treatment should be selected depending on the individual sensitivity and severity of the pain syndrome. A single dose of this drug is 10-20 mg for adults and 0.2-0.8 mg/kg for children.

For long-acting capsules, a single dosage should be 10-100 mg twice a day. For subcutaneous injection - 1 mg, and for intramuscular and intravenous - 10 mg each. The maximum daily dose is 50 mg. If the patient needs rectal administration, then the intestines should be cleaned first. For adults, suppositories are prescribed in an amount of 30 mg every 13 hours.

Overdose

With improper use of this tool, the patient may experience the following side effects:

• cold and clammy sweat;
• confusion;
• fatigue;
• miosis;
• drowsiness;
• intracranial hypertension;
• bradycardia;
• nervousness;
• severe weakness;
• hypothermia;
• slow;
• dry mouth;
• anxiety;
• delirious psychosis;
• dizziness;
• lowering blood pressure;
• hallucinations;
• convulsions;
• muscle rigidity, etc.

Morphine was the first opium alkaloid isolated from it in its pure form by a twenty-year-old German pharmacist from Paderborn Friedrich Wilhelm Serturner in 1803. He not only isolated a new substance, but also studied its effect on animals and humans, and determined the dose. Thus began the history of morphine. The substance was named after the Greek god of sleep and dreams, Morpheus, since the hypnotic effect of the new drug was considered the main one. Almost simultaneously, in 1806, morphine was discovered by the French chemist Armand Seguin. At first, in medical practice, this substance was used very limitedly inside (powders with sugar and suppositories). Morphine received its use and distribution gradually, since in the first decade after its discovery it was stored only in the Kramer court pharmacy of Paderborn. Soon, having begun to spread, morphine became one of the most important pain-relieving medicines. However, its wider use began after its subcutaneous administration, which Wood proposed in 1853.

After the invention by Pravyaz in 1864 of the syringe, morphine began to be injected directly into the blood, which was universally recognized and widely used. Since that time, doctors have learned the shadow side associated with the use of this drug - drug addiction, which became apparent in the 70s of the XIX century. It was the second outbreak of drug addiction in Europe. It is associated with the Franco-Prussian War (1870-1871), when doctors for the first time widely used morphine injections for pain relief.

In the United States, this opium alkaloid was widely and uncontrollably used during the famous civil war of 1861-1865, which caused the appearance of many morphine addicts in the New World. Addiction to this narcotic substance in America was called "soldier's disease." This was the beginning of a new form of drug addiction known as morphinism. Subsequently, the drug is distributed not only among the military, but also among medical staff and people of other professions who use it as doping. Morphine was especially widespread among criminals, prostitutes, etc. At the end of XIX - beginning of XX century. there has been a widespread increase in the use of morphine along with other drugs.

The First World War was an additional impetus for the development of morphinism, especially among military personnel. The spread of morphinism was noted in large cities of pre-revolutionary Russia. During the Soviet period, the use of this narcotic substance decreased significantly - in the 30s, morphinism was quite rare.

The proportion of morphinism in the overall structure of initially diagnosed patients with various types of drug addiction is declining everywhere. Undoubtedly, this is connected not only with medical measures, but also with well-regulated control over the release and storage of morphine and its analogues at all stages of production and transportation, as well as with the improvement of legislative measures.

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Morphine is the most famous drug, an alkaloid of the opiate family. Do you remember Balabanov's famous film, based on Bulgakov's series of short stories "Doctor's Notes"? There, with documentary accuracy, all stages of the process of getting used to this remedy and the sad outcome are described.

Paying attention to modern hard drugs, we completely forgot about morphine. Meanwhile, they still exist, and the opium alkaloid is considered a more affordable drug than the same spice or hashish. What is morphine, how it can be useful and how to destroy a person - let's talk about it.

Morphine is one of the oldest and most dangerous drugs

"Gave" the world morphine (it is also called "morphine") at the beginning of the XVIII century, a young German pharmacist Friedrich Serturner. A twenty-year-old youth was able to isolate a pure alkaloid, a white crystalline substance, from poppy opium. The inquisitive pharmacist didn't just discover the new compound, he studied its effects in humans and experimental animals.

The ancestor of morphine was the German pharmacist Serturner

Morphine got its name from the Greek deity Morpheus, the god of dreams and astral adventures. After all, the main action of the new drug was considered a powerful hypnotic effect.

Almost simultaneously, with a difference of only three years, morphine was discovered by Serturner's colleague, a French chemist Armand Seguin. The newly appeared remedy gradually conquered the medical space. At first, it was used for medicinal purposes very limitedly.

Morphine is deadly to humans

But soon morphine broke out "into the people" and became one of the most popular and common painkillers. But a surge of active passion for morphine began after one of the doctors suggested injecting the drug into the body by injection, under the skin. The triumphant march of the drug began in 1855.

Morphine: what is it

Traditionally, this drug is obtained by technological distillation of the milky juice of an immature poppy plant. White powder of crystalline structure, opium alkaloid has poor dissolving power. In medicine, a morphine solution is used, which is injected into a person.

medicinal abilities

In small and harmless doses, this remedy has numerous healing effects. The main effect of morphine is a sedative effect. It becomes especially necessary when, due to a severe pain shock, the patient develops insomnia and the nervous system suffers.

Signs of morphine use in humans

About 100-120 years ago, morphine was prescribed in the treatment of delirium tremens, people suffering from mental illness and neuralgia.

Modern medicine has long dispensed with the use of opium alkaloid in the treatment of alcohol and other addictions. But, our pharmaceutics has not yet abandoned the old remedy. In pharmacies, you can find a lot of drugs created on the basis of this substance:

• Codeine;
• Skenan;
• Dionin;
• M-Eslon;
• Omnopon;
• Papaverine.

These drugs act on brain receptors and stop the centers responsible for creating pain impulses. A person is saved from unbearable pain after an injury, a complex fracture, a heart attack, or the growth of a cancerous tumor.

Although such drugs contain a minimum dosage of morphine, even a small dose of a substance can do a person a disservice and turn him into a morphine addict. It has been proven that the dependence of people taking morphine is much stronger and stronger than that of the same opium addict.

drug morphine

This remedy is very dangerous, because small doses of its intake can provoke a strong dependence in a person. Even at a low dosage, causing a deep and restful sleep, the opium alkaloid changes emotional reactions, distorting the perception of reality.

Morphine addiction used to be widespread

How is the effect of morphine manifested? When the alkaloid is administered in a minimal amount, the person experiences an elevated feeling of euphoria. His mood improves, the world is painted in iridescent and bright colors. Pleasant warmth is felt in the body. Wanting to experience a blissful sensation again, the person again seeks a new dose-prick and, imperceptibly for himself, gradually increases the dosage.

Morphine has one feature: if you stop taking it for a while (even a short one), then the addict will have to start again with a small dose of the alkaloid. Otherwise, morphine will not give bright emotions, but will bring serious discomfort and poisoning.

An overdose of morphine is very dangerous for humans. An excess of the drug causes severe intoxication of the body, accompanied by nausea and vomiting. When taking morphine in large quantities, the substance is fatal.

withdrawal syndrome

The drug morphine after its withdrawal from the patient responds with a mass of unpleasant side effects. The time when withdrawal begins is different for each person. On average, this period fits into 10-20 hours. For a morphine addict in withdrawal conditions, the following symptoms are characteristic:

• confusion of speech;
• increased sweating;
• increased salivation;
• loss of consciousness and general weakness;
• slowing down of thought processes;
• hysteria and irritability, tearfulness.

How does morphine work in the next stage, with a more serious overdose? The following, more dangerous syndromes are added to the initial symptoms:

1. Loss of consciousness, onset of hallucinations, delirium.
2. A person completely refuses to eat food.
3. The person has a strong tremor: trembling of the hands / feet.
4. The skin is covered with pimples, there is a feeling of chills.
5. The pupils of the eyes are greatly dilated, the addict is not able to visually assess the surrounding reality and understand where he is.

The effects of taking morphine are immediate.

After another 1.5-2 days, the person visits the last, most severe stage of the withdrawal syndrome. This period, if medical supportive measures are not taken, leads to the death of a person.. The following symptoms are observed:

• a sharp increase in blood pressure;
• severe tachycardia;
• aching muscles and joints, cramps;
• cutting pains in the abdomen;
• nausea leading to profuse vomiting.

The emotional state of the morphine addict of this period is far from the feeling of euphoria that he experienced when he first met the drug. Now morphine and morphine, the difference between which is absent, act on a person depressingly.

A person, in search of a new dose, stops at nothing. She becomes aggressive, hysterical and unpredictable. In a fit of anger, an inadequate person can harm others and even kill a person who prevents the morphine addict from getting another dose.

What does a morphine addict look like?

The portrait of a typical morphine addict is very far from looking like a healthy person. Now this is a thin, haggard and tired person. Sparse thin, greasy hair, wildly burning eyes. Puffy, edematous face with sallow skin, rotten diseased teeth. In a chronic morphine addict, due to frequent injections, the skin suffers greatly - it becomes covered with ulcers, abscesses and scars.

Ways to save a person from addiction

It is necessary to restore and return a person to a healthy life in the conditions of a drug treatment clinic. What is morphine - this is an evil that gradually destroys a person, leading to his complete degradation and final death. The process of detoxifying a morphine addict takes a long time.

With observed attacks of rage and aggression, the patient is prescribed psychotropic drugs and tranquilizers. The overall picture of therapy is complemented by therapeutic nutrition with a specially designed diet and a course of taking multivitamin supplements. Often used and psychotherapeutic effects.

In contact with

Cancer patients can get medicines from pharmacies free of charge. Here, morphine is prescribed not in its pure form, but in a mixture. There is no given prescription in list II of narcotic and psychotropic drugs, therefore it can be dispensed on prescription 148-1 / y-88 (l) or 148-1 / y-06 (l). 2) When issuing a prescription for an individual prescription containing a narcotic drug or psychotropic substance of Schedule II and other pharmacologically active substances in a dose not exceeding the highest single dose, and provided that this combination drug is not a narcotic drug or psychotropic substance List II, you should use the prescription form of form N 148-1 / y-88.

The prescription form is issued in 3 copies.

The necessary basic (mandatory) details are:

1) a stamp of the health facility indicating its name, address and telephone number;

3) date of issue of the prescription;

4) Name (in full) of the patient, date of birth.

5) surname and initials of the doctor;

6) personal seal of the doctor;

7) personal signature of the doctor;

8) prescription validity period.

Additional details are:

1) series and individual number;

2) printing of health care facilities "For prescriptions";

3) health facility code;

5) code of the nosological form of the disease;

6) the source of funding for the benefit;

7) type of benefit;

9) No. of the CHI insurance policy;

10) address or medical card number of the outpatient

sick;

11) doctor's code;

12) barcode (for form 148-1 / y-06 (l))

If some mandatory or additional requisite is missing, the prescription is canceled with the stamp “Recent is invalid” and an entry is made in the Journal of incorrectly issued prescriptions.

Morphine is on PKU. The recipe is underlined in red pencil. At the end, a selection of such prescriptions is made, a summary sheet is drawn up, how many drugs were dispensed per day at the PKU, and based on it, entries are made in the “Journal of Narcotic Substances”

5. Give a brief description of medicinal plants containing morphine and caffeine.

Capitapapaveris- boxespoppy

Poppy sleeping pills Papaver somniferu

family poppy (Papaveraceae)

Pharmacological group - narcotic analgesic

SeminaCqffeae arabicae - Arabian coffee tree seeds

Arabian coffee tree Coffee ardbica

family madder (rubiaceae)

infantry paraguariensis - Paraguayan holly (mate)

A plant from the family holly (Aquifoliaceae).

Paulinia cupana Kunth- Guarana (Paulinia Kupana)

A plant from the family sapindaceae (Sa- pindaceae).

Thea sinensis- teabush

A plant from the family teahouses (Theaceae).

Theobroma cacao L. - chocolatetree (cacao tree)

A plant from the family sterculian (Sterculiaceae).

Pharmacological group - psychostimulant

Qualitative reactions

General (sedimentary) reactions to alkaloids, allowing to establish the presence of alkaloids in MP

Color (specific) reactions - to detect a specific group or individual alkaloids

Chromatographic, luminescent and spectroscopic - for the identification of individual alkaloids

General sedimentary reactions

All these reactions are not very specific and allow only tentative conclusions about the presence of alkaloids.

Specific reaction to caffeine - "Murexide test"

Specific reactions to morphine - When iron (III) chloride is added to the residue containing morphine, a blue color is observed due to the free phenolic hydroxyl in position 3. When 1-2 drops of concentrated nitric acid are added to the residue, morphine gives a blood-red color, turning into orange-yellow. Part of the extract from the object is evaporated to a dry residue, which is dissolved in 1 ml of 10% sodium hydroxide solution. The resulting alkaline solution is carefully poured along the walls of the test tube into a solution of diazotized sulfanyl acid. A red color appears at the point of contact between the two solutions.

quantitation

The whole process of quantitative determination of alkaloids in plant materials can be divided into three main stages:

Extraction of alkaloids from raw materials

Purification of extracted alkaloids from related substances: resins, pigments, fats, pectin substances, etc.

Quantitative determination of isolated and purified alkaloids.

The extraction of alkaloids and their purification are based on the fact that almost all alkaloid bases are insoluble in water, but soluble in organic solvents. Salts of alkaloids are insoluble in organic solvents, but soluble in water.

Extraction of alkaloids from plants can be carried out in the form of salts and in the form of bases. More often, methods are used to extract alkaloids from raw materials in the form of a base.

Quantitative determination of caffeine and morphine - method of non-aqueous titration in non-aqueous solvents.