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Monday, August 25 Postmortem Analysis and Drug Stability

Ruprah M.
Medical Toxicology Unit, Guy's & St Thomas' Hospital Trust, Avonley Road, London, SE 14 5ER, UK

Morphine and morphine-6-glucuronide conccntrations were measured in blood samples referred to the Medical Toxicology Laboratory from 34 cases of death following heroin injection. Blood and urine specimens from these cases were also screened for a wide range of other drugs. Blood morphine and morphine-6-glucuronide were quantified using high performance liquid chromatography with coulometric detection. Blood morphine was also measured by radioimmunoassay using the morphine specific Coat-A-Count kit (Diagnostic Products Corporation).

Blood morphine concentrations showed a large variation with a range of 40-675 µg/L. In 17 cases the blood morphine-6-glucuronide was <20 µg/L and in the remaining the concentrations ranged from 20-600 µg/L. Ten of the cases with morphine-6-glucuronide concentration less than 20 µg/L were reported as "sudden deaths". In contrast, of those cases with detectable concentrations of M6G, only 2 were described as "sudden". The blood morphine concentration always exceeded that of morphine-6-glucuronide except in 3 cases, one of whom was a subject with chronic renal failure. The blood morphine/morphine-6-glucuronide showed a large variation ranging from 0.7-10.5.

In conclusion, although blood morphine measurement alone can often provide sufficient evidence that death has resulted from heroin injection, it may be possible to obtain additional information relating to the survival time by measuring the morphine/morphine-6-glucuronide ratio.

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