Love Sara A, Lelinski Jessica, Kloss Julie, Middleton Owen, Apple Fred S
Department of Laboratory Medicine & Pathology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN.
Department of Laboratory Medicine & Pathology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN.
J Forensic Sci. 2018 Jan;63(1):191-194. doi: 10.1111/1556-4029.13511. Epub 2017 Apr 19.
Over the past two decades, prescription and illicit opioid use has led to changes in public health policy to address the increasing number of opioid-related deaths. The purpose of this study was to review cases from Hennepin County Medical Examiner's Office between 2004 through 2015 where heroin was listed as a significant contributor or as the cause of death. We identified 322 heroin-related deaths, which were predominantly male (255; 79%). 6-Monoacetylmorphine (6-MAM) median (range) concentrations were as follows: blood (n = 7), 0.010 (0.006-0.078) mg/L; urine (n = 30), 0.359 (0.009-1.75) mg/L; and vitreous humor (n = 31), 0.034 (0.004-0.24) mg/L. Free morphine was measurable in 273 cases and the percent free morphine (range), when grouped by COD, was opioid (n = 124), 28% (2.2%-92%), and mixed drug toxicity (n = 135), 35.3% (1.5%-100%); (p < 0.01). Quantitation of 6-MAM in blood and vitreous humor, along with a free to total morphine ratio >26%, was useful in establishing heroin-related deaths.
在过去二十年中，处方类和非法阿片类药物的使用促使公共卫生政策发生了变化，以应对与阿片类药物相关的死亡人数不断增加的问题。本研究的目的是回顾2004年至2015年间亨内平县法医办公室的案例，这些案例中 heroin 被列为主要死因或死亡原因。我们确定了322例与 heroin 相关的死亡案例，其中男性占主导（255例；79%）。6-单乙酰吗啡（6-MAM）的中位数（范围）浓度如下：血液（n = 7），0.010（0.006 - 0.078）mg/L；尿液（n = 30），0.359（0.009 - 1.75）mg/L；玻璃体液（n = 31），0.034（0.004 - 0.24）mg/L。在273例案例中可检测到游离吗啡，按死因分组时，游离吗啡百分比（范围）为：阿片类药物（n = 124），28%（2.2% - 92%），以及混合药物毒性（n = 135），35.3%（1.5% - 100%）；（p < 0.01）。血液和玻璃体液中6-MAM的定量分析，以及游离吗啡与总吗啡的比率>26%，有助于确定与 heroin 相关的死亡。
