Duflou Johan, Darke Shane, Easson Jennifer
Department of Forensic Medicine, Sydney South West Area Health Service, NSW, Australia.
J Forensic Sci. 2009 Sep;54(5):1181-4. doi: 10.1111/j.1556-4029.2009.01123.x. Epub 2009 Aug 6.
Death caused by heroin overdose is almost always the result of intravenous injection of the drug in Australia. We briefly describe a case where a heroin overdose was initially thought to be the result of oral ingestion of the drug, primarily as a result of higher concentrations of morphine in stomach contents than in blood. During the subsequent criminal trial and investigation, however, the issue of the entero-hepatic circulation of morphine was raised as a possible reason for the presence of morphine in the stomach contents. In this study, we report on the distribution of opioids in blood, stomach contents, urine, liver, and bile in 29 deaths caused by intravenous heroin overdose. The mean total and free blood morphine concentrations were 0.60 and 0.32 mg/L, respectively, and the mean stomach contents total morphine concentration was 1.16 mg/kg. All cases had detectable morphine in the stomach contents, and 24 of 29 cases (83%) had higher concentrations of total morphine in stomach contents than in blood. The mean total morphine concentration in bile was c. 100 times that in blood, and the liver total morphine concentration averaged twice that of blood levels. We conclude that the entero-hepatic circulation of morphine and subsequent reflux of duodenal contents back into the stomach can result in the deposition of morphine in gastric contents. Consequently, the relative levels of opioids in blood and stomach contents cannot be used to determine the site of administration of the drug.
在澳大利亚，海洛因过量致死几乎总是静脉注射该药物所致。我们简要描述了一个案例，最初认为一起海洛因过量事件是口服该药物导致的，主要原因是胃内容物中吗啡浓度高于血液中的浓度。然而，在随后的刑事审判和调查中，吗啡的肠肝循环问题被提出，这可能是胃内容物中存在吗啡的原因。在本研究中，我们报告了29例因静脉注射海洛因过量致死案例中阿片类药物在血液、胃内容物、尿液、肝脏和胆汁中的分布情况。血液中吗啡的平均总浓度和游离浓度分别为0.60毫克/升和0.32毫克/升，胃内容物中吗啡的平均总浓度为1.16毫克/千克。所有案例的胃内容物中均检测到吗啡，29例中有24例（83%）胃内容物中吗啡的总浓度高于血液中的浓度。胆汁中吗啡的平均总浓度约为血液中的100倍，肝脏中吗啡的总浓度平均为血液水平的两倍。我们得出结论，吗啡的肠肝循环以及随后十二指肠内容物反流回胃中可导致吗啡在胃内容物中沉积。因此，血液和胃内容物中阿片类药物的相对水平不能用于确定药物的给药部位。
