Postmortem tissue distribution of morphine and its metabolites in a series of heroin-related deaths.
Peter D MaskellNathan E WilsonL Nitin SeetohulMegan L CrichtonLewis J BeerGail DrummondGiorgia De PaoliPublished in: Drug testing and analysis (2018)
The abuse of heroin (diamorphine) and heroin-related deaths are increasing around the world. The interpretation of the toxicological results from suspected heroin-related deaths is notoriously difficult, especially in cases where there may be limited samples. 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 liquid chromatography-tandem mass spectrometry (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 four cases in muscle (three cases in bone marrow) no morphine, M3G, or M6G were 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.
Keyphrases
- liquid chromatography tandem mass spectrometry
- solid phase extraction
- bone marrow
- skeletal muscle
- ms ms
- healthcare
- simultaneous determination
- high performance liquid chromatography
- mesenchymal stem cells
- heart failure
- primary care
- type diabetes
- tandem mass spectrometry
- mass spectrometry
- pulmonary embolism
- atrial fibrillation
- adipose tissue
- multiple sclerosis
- brain injury
- gas chromatography
- ultra high performance liquid chromatography
- drug induced
- gas chromatography mass spectrometry
- functional connectivity