title: Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers.
abstract: The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.
authors.affiliation: Department of Legal Medicine, Medical University of Luebeck, Kahlhorststrasse 31-35, D-23562 Luebeck, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meissner
authors.forename: Sabine
authors.initials: S
authors.lastname: Recker
authors.forename: Arthur
authors.initials: A
authors.lastname: Reiter
authors.forename: Hans Juergen
authors.initials: HJ
authors.lastname: Friedrich
authors.forename: Manfred
authors.initials: M
authors.lastname: Oehmichen
mesh_terms: D001334:Automobile Driving; D062787:Drug Overdose; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D009020:Morphine / Q000097:blood* / Q000506:poisoning*; D009294:Narcotics / Q000097:blood* / Q000506:poisoning*; D009293:Opioid-Related Disorders / Q000097:blood*
chemical_list: D009294:Narcotics; D009020:Morphine