Thiblin I, Eksborg S, Petersson A, Fugelstad A, Rajs J
Department of Forensic Medicine, Karolinska Institute, Retzius v 3, SE-171 77, Stockholm, Sweden.
Forensic Sci Int. 2004 Jan 28;139(2-3):241-7. doi: 10.1016/j.forsciint.2003.10.009.
In recent years we have noticed an increasing proportion of mortalities resulting from an overdose of heroin that involve routes of administration other than injection. Of 239 cases of fatal heroin intoxication examined at our department during the period 1997-2000, 18 deaths were associated with non-parental administration. Seven of these fatalities were experienced heroin users who had begun to use more sporadically, seven were recreational "party-users", while the remaining four persons had relapsed into heroin use following long periods of abstinence. The median blood morphine concentration of these non-injectors was 0.095 microg/g (range: 0.02-0.67 microg/g), significantly lower than that of the injectors. Concurrent use of alcohol, other illicit drugs and/or pharmaceutical preparations was observed in 17 of the 18 cases. However, there were no statistically significant differences between the victims of heroin intoxication by injection or by other routes with respect to the proportion who had simultaneously consumed alcohol or benzodiazepines. Pathological alterations like lung fibrosis, liver cirrhosis, endocarditis, etc. were not found to play a significant role in any of the 18 mortalities. We conclude that snorting or smoking heroin probably involves a reduced risk of obtaining high blood concentrations of morphine but still constitutes a considerable risk of lethal outcome due to high variability in blood concentrations. Furthermore, decreased tolerance resulting from periods of reduced or sporadic use appears to be an important risk factor in connection with heroin overdosing by snorting or smoking, which indicate that some heroin addicts may inaccurately assume that these routes of administration are safe when resuming their use of heroin after a period of abstinence.
近年来，我们注意到因海洛因过量致死的案例中，非注射给药途径导致的死亡比例在增加。在1997年至2000年期间，我们科室检查的239例致命海洛因中毒病例中，有18例死亡与非肠道给药有关。其中7例死亡者是有经验的海洛因使用者，他们开始减少用药频率；7例是娱乐性“派对使用者”；其余4人在长时间戒毒后复吸海洛因。这些非注射使用者的血液吗啡浓度中位数为0.095微克/克（范围：0.02 - 0.67微克/克），显著低于注射使用者。在18例病例中的17例中观察到同时使用了酒精、其他非法药物和/或药物制剂。然而，注射或其他途径导致的海洛因中毒受害者在同时饮酒或使用苯二氮䓬类药物的比例方面，没有统计学上的显著差异。在这18例死亡病例中，未发现肺纤维化、肝硬化、心内膜炎等病理改变起显著作用。我们得出结论，吸食或烫吸海洛因可能降低了获得高血药浓度吗啡的风险，但由于血药浓度变化很大，仍然构成相当大的致死风险。此外，减少或偶尔使用导致的耐受性下降似乎是与吸食或烫吸海洛因过量相关的一个重要风险因素，这表明一些海洛因成瘾者在戒毒一段时间后重新使用海洛因时，可能错误地认为这些给药途径是安全的。
