title: Postmortem blood free and total morphine concentrations in medical examiner cases.
abstract: This purpose of this study was to determine the relationships between postmortem free morphine and total morphine levels in a large series of medical examiner morphine and heroin related deaths. Free morphine, total morphine, and 6-monoacetylmorphine (6-MAM) concentrations were measured by gas chromatography-mass spectrometry (GC-MS) in 87 medical examiner cases over 20 months. The mean total morphine concentration, mean free morphine concentration, and mean percent free morphine for all cases were: 2.3 mg/L (SD 5.2 mg/L), 0.5 mg/L (SD 1.6 mg/L), and 19.4% (SD 22.8%); respectively. Regression analyses showed weak correlations between total and free morphine concentrations over the entire concentration range (0 to 36.6 m/L, r = 0.603, n = 91) and over a subset concentration range of 0 to 1.0 mg/L (r = 0.369, n = 54). Twenty-three out of 56 (41%) tested positive for 6-MAM, indicative heroin abuse cases. Lower total and free morphine concentrations and a higher percent free morphine were found in individuals with detectable 6-MAM. Comparing blood concentrations for cases with and without detectable 6-MAM demonstrated mean total morphine concentrations of 0.9 mg/L versus 2.1 mg/L (p = 0.05), mean free morphine concentrations of 0.3 mg/L versus 0.4 mg/L (p = 0.21), and mean percent free morphine of 34.7% versus 13.7% (p < 0.003), respectively. Our findings demonstrate higher free to total morphine ratios in individuals with detectable 6-MAM than in individuals without 6-MAM. The database established in this study may assist medical examiners in the evaluation of postmortem blood opiates regarding the cause of death in opiate related ingestion cases.
authors.affiliation: Hennepin County Medical Center, Clinical Laboratories, Minneapolis, MN 55415, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Burt
authors.forename: J
authors.initials: J
authors.lastname: Kloss
authors.forename: F S
authors.initials: FS
authors.lastname: Apple
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D016208:Databases, Factual; D005554:Forensic Medicine / Q000706:statistics & numerical data; D006801:Humans; D009020:Morphine / Q000097:blood*; D009294:Narcotics / Q000097:blood*; D012016:Reference Values; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D009294:Narcotics; D009020:Morphine