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Tuesday, August 26 Driving Under the Influence

Hodda A.E.
Division of Analytical Laboratories, Western Sydney Area Health Service, PO Box 162 Lidcombe NSW 2141, Australia

The forensic toxicologist has struggled to provide an adequate interpretation of the significance of blood morphine levels in deceased heroin addicts. The Division of Analytical Laboratories (DAL) is in a unique position of not only providing toxicological analysis for coronial purposes but also for the prosecution of drug intoxicated motor vehicle drivers. This presentation will compare blood morphine levels in deceased drug abusers, fatal motor vehicle accident drivers and living intoxicated drivers.

Methods. Analytical screening work on the intoxicated driver specimens was carried out by immunoassay and quantitation using mass spectrometry with deuterated internal standards in the extracts.

Results. Data were collected from over 1700 coronial cases involving morphine derivatives (especially heroin) use and over 600 intoxicated drivers who were using morphine derivatives. In the latter case, total morphine blood levels were analyzed at levels as high as 6.2 mg/L, in the case of motor vehicle fatalities morphine levels were as high as 1.6 mg/L and other drug related deaths had morphine levels up to 210 mg/L (although the median was well below 1 mg/L). Drug levels in blood, detected by the DAL, in a recently published survey of drug users living in Sydney, will also be referred to. Several of the motor vehicle related cases will be discussed in detail as well as driver behaviour: related to drug taking history.

Conclusions. The evidence from this study does not provide the key to interpreting blood morphine levels but reaffirms the need to be cautious. The degree of intoxication of motor vehicle drivers using morphine or its derivatives is clearly as difficult to interpret as fatal levels, especially with the overlap of levels demonstrated in this large study.

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