Evaluation of the role of abstinence in heroin overdose deaths using segmental hair analysis

In the body heroin is rapidly metabolized to 6-acetylmorphine and morphine. Victims of lethal heroin overdose often present with fairly low blood concentrations of morphine. Reduced tolerance due to abstinence has been proposed to account for this finding. The aim of the present study was to examine the role of abstinence in drug-related deaths by comparing recent and past exposure to opioids using segmental hair analysis with the postmortem blood morphine concentrations in deceased heroin users. The study included 60 deceased drug addicts in the Stockholm area, Sweden. In 32 cases, death was not related to heroin intake. In 18 of the 28 heroin fatalities, opioids were absent in the most recent hair segment, suggesting a reduced tolerance to opioids. However, the blood morphine levels were similar to those found in the 10 subjects that showed continuous opioid use. Hair and blood analysis disclosed an extensive use of additional drugs that directly or indirectly may influence the opioid system. The results suggest that abstinence is not a critical factor for heroin overdose death. Obviously tolerant subjects die after intake of similar doses. Other factors, particularly polydrug use, seem to be more causally important for these deaths.

Strandberg, Joakim J.Department of Forensic Medicine, Karolinska Institutet, Stockholm, Sweden (författare)
Alkass, KanarKarolinska Institutet (författare)
Nyström, IngridDepartment of Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden (författare)
Kugelberg, FredrikDepartment of Forensic Medicine, Karolinska Institutet, Stockholm, Sweden(Swepub:liu)freku57 (författare)
Kronstrand, RobertDepartment of Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden(Swepub:liu)robkr41 (författare)
Karolinska InstitutetDepartment of Forensic Medicine, Karolinska Institutet, Stockholm, Sweden (creator_code:org_t)

Ingår i:Forensic Science International: Elsevier BV168:2-3, s. 223-2260379-07381872-6283

Av författaren/redakt...: Druid, Henrik; Strandberg, Joak ...; Alkass, Kanar; Nyström, Ingrid; Kugelberg, Fredr ...; Kronstrand, Robe ...

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