title: Unexpected variation of the codeine/morphine ratio following fatal heroin overdose.
abstract: Postmortem samples from 14 cases of suspected heroin overdose were subjected to a preliminary systematic toxicological analysis in order to highlight the presence of unknown exogenous compounds (e.g., drugs of abuse, alcohol) that may have played a role in the mechanism of death. This analysis unveiled histories of poly-drug use in seven of the cases under investigation. Moreover, the concentrations of morphine and codeine in the brain were also investigated, and the results were compared with the data obtained from the blood specimens. The concentration of morphine in blood ranged from 33 to 688 ng/mL, while the concentration of codeine ranged from 0 to 193 ng/mL. However, in the brain, the concentration of morphine was found to be between 85 and 396 ng/g, while the levels of codeine ranged from 11 to 160 ng/g. The codeine/morphine ratio in the blood ranged from 0.043 to 0.619; however, in the brain, the same ratio was found to be between 0.129 and 0.552. In most cases, a significantly higher codeine/morphine ratio was found in the brain, suggesting the accumulation of codeine in brain tissue due its high lipophilicity as compared with morphine.
authors.affiliation: 1Dipartimento di Scienze Farmaceutiche, Università degli Studi di Milano, Via Mangiagalli n.25, Milano 20133, Italy.
authors.forename: Veniero
authors.initials: V
authors.lastname: Gambaro
authors.forename: Antonella
authors.initials: A
authors.lastname: Argo
authors.forename: Marta
authors.initials: M
authors.lastname: Cippitelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Dell'Acqua
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Farè
authors.forename: Rino
authors.initials: R
authors.lastname: Froldi
authors.forename: Katia
authors.initials: K
authors.lastname: Guerrini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Roda
authors.forename: Chiara
authors.initials: C
authors.lastname: Rusconi
authors.forename: Paolo
authors.initials: P
authors.lastname: Procaccianti
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism; D003061:Codeine / Q000032:analysis* / Q000097:blood; D062787:Drug Overdose; D003932:Heroin / Q000493:pharmacokinetics* / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000032:analysis* / Q000097:blood; D014018:Tissue Distribution
chemical_list: D003932:Heroin; D009020:Morphine; D003061:Codeine