Identifying cases of heroin toxicity where 6-acetylmorphine (6-AM) is not detected by toxicological analyses

Autor: Gregory G. Davis, Ashley D. Ellis, Daniel W. Dye, Gerald McGwin
Jazyk: angličtina
Předmět:
Pharmacology
01 natural sciences
Forensic pathology
Heroin
Toxicology
Drug user
chemistry.chemical_compound
0302 clinical medicine
030212 general & internal medicine
Substance Abuse
Intravenous
Drug paraphernalia
Morphine
Heroin Dependence
Heroin toxicity
General Medicine
Substance abuse
Substance Abuse Detection
Anesthesia
Toxicity
Original Article
6-Monoacetylmorphine
medicine.drug
Half-Life
Narcotics
Drug abuse
Gas Chromatography-Mass Spectrometry
Pathology and Forensic Medicine
03 medical and health sciences
Forensic Toxicology
Death certification
Heroin dependence
Codeine toxicity
medicine
Humans
030216 legal & forensic medicine
Retrospective Studies
Morphine Derivatives
business.industry
Codeine
010401 analytical chemistry
Forensic toxicology
Morphine toxicity
medicine.disease
0104 chemical sciences
chemistry
Postmortem Changes
Gas chromatography–mass spectrometry
business
Zdroj: Forensic Science, Medicine, and Pathology
ISSN: 1547-769X
DOI: 10.1007/s12024-016-9780-2
Popis: Purpose Heroin has a half-life of 2–6 min and is metabolized too quickly to be detected in autopsy samples. The presence of 6-acetylmophine (6-AM) in urine, blood, or other samples is convincing evidence of heroin use by a decedent, but 6-AM itself has a half-life of 6–25 min before it is hydrolyzed to morphine, so 6-AM may not be present in sufficient concentration to detect in postmortem samples. Codeine is often present in heroin preparations as an impurity and is not a metabolite of heroin. Studies report that a ratio of morphine to codeine greater than one indicates heroin use. We hypothesize that the ratio of morphine to codeine in our decedents abusing drugs intravenously will be no different in individuals with 6-AM present than in individuals where no 6-AM is detected, and we report our study of this hypothesis. Methods All accidental deaths investigated by the Jefferson County Coroner/Medical Examiner Office from 2010 to 2013 with morphine detected in blood samples collected at autopsy were reviewed. Five deaths where trauma caused or contributed to death were excluded from the review. The presence or absence of 6-AM and the concentrations of morphine and codeine were recorded for each case. The ratio of morphine to codeine was calculated for all decedents. Any individual in whom no morphine or codeine was detected in a postmortem sample was excluded from further study. Absence or presence of drug paraphernalia or evidence of intravascular (IV) drug use was documented in each case to identify IV drug users. The proportion of the IV drug users with and without 6-AM present in a postmortem sample was compared to the M/C ratio for the individuals. Results Of the 230 deaths included in the analysis, 103 IV drug users with quantifiable morphine and codeine in a postmortem sample were identified allowing for calculation of an M/C ratio. In these IV drug users, the M/C ratio was greater than 1 in 98 % of decedents. When controlling for the absence or presence of 6-AM there was no statistically significant difference in the proportion of IV drug users when compared to non IV drug users with an M/C ratio of greater than 1 (p = 1.000). Conclusion The M/C ratio in IV drug users, if greater than 1, is seen in deaths due to heroin toxicity where 6-AM is detected in a postmortem sample. This study provides evidence that a M/C ratio greater than one in an IV drug user is evidence of a death due to heroin toxicity even if 6-AM is not detected in the blood. Using the M/C ratio, in addition to scene and autopsy findings, provides sufficient evidence to show heroin is the source of the morphine and codeine. Listing heroin as a cause or contributing factor in deaths with evidence of IV drug abuse and where the M/C ratio exceeds 1 will improve identification of heroin fatalities, which will allow better allocation of resources for public health initiatives.
Databáze: OpenAIRE
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