Postmortem tissue distribution of morphine and its metabolites in a series of heroin related deaths

Peter D. Maskell, Nathan E. Wilson, L. Nitin Seetohul, Megan L. Crichton, Lewis J. Beer, Gail Drummond, Giorgia De Paoli

Research output: Contribution to journalArticle

Abstract

The abuse of heroin (diamorphine) and heroin deaths are growing around the world. The interpretation of the toxicological results from suspected heroin deaths is notoriously difficult especially in cases where there may be limited samples. In order 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 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 4 cases in muscle (3 cases in bone marrow) no morphine, morphine‐3‐glucuronide or morphine‐6‐glucuronide was 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.
Original languageEnglish
Pages (from-to)292-304
Number of pages15
JournalDrug Testing and Analysis
Volume11
Issue number2
Early online date29 Aug 2018
DOIs
Publication statusPublished - 28 Feb 2019

Fingerprint

Heroin
Tissue Distribution
Metabolites
Morphine
bone
metabolite
muscle
Tissue
brain
blood
Muscle
Noscapine
distribution
tissue
Bone Marrow
Bone
Heroin Dependence
Vitreous Body
Codeine
Papaverine

Cite this

Maskell, P. D., Wilson, N. E., Seetohul, L. N., Crichton, M. L., Beer, L. J., Drummond, G., & De Paoli, G. (2019). Postmortem tissue distribution of morphine and its metabolites in a series of heroin related deaths. Drug Testing and Analysis, 11(2), 292-304. https://doi.org/10.1002/dta.2492
Maskell, Peter D. ; Wilson, Nathan E. ; Seetohul, L. Nitin ; Crichton, Megan L. ; Beer, Lewis J. ; Drummond, Gail ; De Paoli, Giorgia. / Postmortem tissue distribution of morphine and its metabolites in a series of heroin related deaths. In: Drug Testing and Analysis. 2019 ; Vol. 11, No. 2. pp. 292-304.
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Maskell, PD, Wilson, NE, Seetohul, LN, Crichton, ML, Beer, LJ, Drummond, G & De Paoli, G 2019, 'Postmortem tissue distribution of morphine and its metabolites in a series of heroin related deaths' Drug Testing and Analysis, vol. 11, no. 2, pp. 292-304. https://doi.org/10.1002/dta.2492

Postmortem tissue distribution of morphine and its metabolites in a series of heroin related deaths. / Maskell, Peter D.; Wilson, Nathan E.; Seetohul, L. Nitin; Crichton, Megan L.; Beer, Lewis J.; Drummond, Gail; De Paoli, Giorgia.

In: Drug Testing and Analysis, Vol. 11, No. 2, 28.02.2019, p. 292-304.

Research output: Contribution to journalArticle

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AB - The abuse of heroin (diamorphine) and heroin deaths are growing around the world. The interpretation of the toxicological results from suspected heroin deaths is notoriously difficult especially in cases where there may be limited samples. In order 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 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 4 cases in muscle (3 cases in bone marrow) no morphine, morphine‐3‐glucuronide or morphine‐6‐glucuronide was 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.

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