AIMS: To detect risk factors for sudden death from heroin injection. DESIGN: Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. SETTING: Stockholm, Sweden. MEASUREMENTS: Autopsy investigation and toxicological analysis of blood and urine; and police reports. FINDINGS: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. CONCLUSIONS: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
AIMS: To detect risk factors for sudden death from heroin injection. DESIGN: Evaluation of data from forensic investigations of all fatal cases of suspected heroindeath in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. SETTING: Stockholm, Sweden. MEASUREMENTS: Autopsy investigation and toxicological analysis of blood and urine; and police reports. FINDINGS: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. CONCLUSIONS: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
Authors: Frances Corrigan; Yue Wu; Jonathan Tuke; Janet K Coller; Kenner C Rice; Kerrilyn R Diener; John D Hayball; Linda R Watkins; Andrew A Somogyi; Mark R Hutchinson Journal: Brain Behav Immun Date: 2014-12-24 Impact factor: 7.217
Authors: Rob Hill; Abi Lyndon; Sarah Withey; Joanne Roberts; Yvonne Kershaw; John MacLachlan; Anne Lingford-Hughes; Eamonn Kelly; Chris Bailey; Matthew Hickman; Graeme Henderson Journal: Neuropsychopharmacology Date: 2015-07-14 Impact factor: 7.853
Authors: Gerd Jakobsson; Michael T Truver; Sonja A Wrobel; Henrik Gréen; Robert Kronstrand Journal: J Anal Toxicol Date: 2021-03-12 Impact factor: 3.367