Maskell Peter D, Wilson Nathan E, Seetohul L Nitin, Crichton Megan L, Beer Lewis J, Drummond Gail, De Paoli Giorgia
School of Science, Engineering and Technology, Abertay University, Dundee, DD11HG, UK.
University of Dundee, Dundee, DD1 4HN, UK.
Drug Test Anal. 2019 Feb;11(2):292-304. doi: 10.1002/dta.2492. Epub 2018 Oct 18.
The abuse of heroin (diamorphine) and heroin-related deaths are increasing around the world. The interpretation of the toxicological results from suspected heroin-related deaths is notoriously difficult, especially in cases where there may be limited samples. To help forensic practitioners with heroin interpretation, we determined the concentration of morphine (M), morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) in blood (femoral and cardiac), brain (thalamus), liver (deep right lobe), bone marrow (sternum), skeletal muscle (psoas), and vitreous humor in 44 heroin-related deaths. The presence of 6-monoacetylmorphine (6-MAM) in any of the postmortem samples was used as confirmation of heroin use. Quantitation was carried out using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method with solid-phase extraction. We also determined the presence of papaverine, noscapine and codeine in the samples, substances often found in illicit heroin and that may help determine illicit heroin use. The results of this study show that vitreous is the best sample to detect 6-MAM (100% of cases), and thus heroin use. The results of the M, M3G, and M6G quantitation in this study allow a degree of interpretation when samples are limited. However in some cases it may not be possible to determine heroin/morphine use as in four cases in muscle (three cases in bone marrow) no morphine, M3G, or M6G were detected, even though they were detected in other case samples. As always, postmortem cases of suspected morphine/heroin intoxication should be interpreted with care and with as much case knowledge as possible.
海洛因（二乙酰吗啡）滥用及与海洛因相关的死亡在全球范围内呈上升趋势。对疑似与海洛因相关死亡案例的毒理学结果进行解读极为困难，尤其是在样本可能有限的情况下。为帮助法医从业者解读海洛因相关情况，我们测定了44例与海洛因相关死亡案例的血液（股动脉血和心脏血）、脑（丘脑）、肝脏（右叶深部）、骨髓（胸骨）、骨骼肌（腰大肌）和玻璃体液中吗啡（M）、吗啡 - 3 - 葡萄糖醛酸苷（M3G）和吗啡 - 6 - 葡萄糖醛酸苷（M6G）的浓度。任何死后样本中6 - 单乙酰吗啡（6 - MAM）的存在被用作使用海洛因的确认依据。采用经过验证的固相萃取液相色谱 - 串联质谱法（LC - MS/MS）进行定量分析。我们还测定了样本中罂粟碱、那可丁和可待因的存在情况，这些物质常在非法海洛因中发现，可能有助于确定是否使用了非法海洛因。本研究结果表明，玻璃体液是检测6 - MAM（100%的案例）进而确定是否使用海洛因的最佳样本。本研究中M、M3G和M6G的定量结果在样本有限时能提供一定程度的解读。然而，在某些情况下可能无法确定是否使用了海洛因/吗啡，如在肌肉中的4例（骨髓中的3例）案例中，未检测到吗啡、M3G或M6G，尽管在其他案例样本中检测到了。一如既往，对于疑似吗啡/海洛因中毒的死后案例，应谨慎解读，并尽可能了解更多案例相关信息。
