Toxicologic assessments in acute heroin fatalities.

The recent improvements in analytic methods enable routine morphine detection in blood in microgram or nanogram quantities. It is now possible to assess acute death from heroin use by toxicologic analyses. A review of available data indicates a rapid distribution of morphine even in sudden fatalities, to the various organs of the body. Blood morphine levels in most acute heroin-involved deaths range from 0.1 to 1.0 microgram/ml, while morphine concentration in liver ranges from 0.1 to 10.0 microgram/gm. In rapid death, the blood to liver ratio is approximately 1:5. Blood and liver appear to be the specimens of choice in determining fatality due to heroin; however a distribution study that included other tissues such as brain, bile, and urine would afford a more meaningful evaluation in forensic investigation. The correlation of the survival periods of decedents to concentrations of morphine in tissues is discussed. Since morphine concentration decreases precipitously in antemortem blood immediately after administration of heroin, the assurance of detecting and determining morphine is greater in blood specimens from decedents who died within 1 hr after drug taking than from those who survived for a longer period. Blood levels of morphine also appear to be regulated by dosage. The role of ethanol and other drugs, including excipients in illicit heroin preparations, in acute narcotism is still poorly understood. Morphine is produced in the antemortem metabolism of codeine. A close evaluation of toxicologic data is necessary to determine whether the morphine detected, if a metabolite, is a conversion product of codeine, heroin, or both. In any event, the cause of death involving heroin is determined only after information from history and pathology, as well as toxicology, are carefully correlated.