NCJ Number
228536
Journal
Journal of Forensic Sciences Volume: 54 Issue: 5 Dated: September 2009 Pages: 1181-1184
Date Published
September 2009
Length
4 pages
Annotation
After briefly describing a case in Australia in which a heroin overdose was initially thought to be the result of the drug's oral ingestion, which resulted from higher concentrations of morphine in stomach contents than in blood, this study reports on the distribution of opioids in blood, stomach contents, urine, liver, and bile in 29 deaths caused by intravenous heroin overdose.
Abstract
The study found that stomach morphine levels cannot be the basis for determining whether heroin has been consumed orally or intravenously. Given the large number of drugs and poisons that undergo entero-hepatic circulation, it is prudent not to draw a conclusion about the route of administration of such drugs without definitive evidence of oral ingestion of the drug, such as the observation of appropriate pill fragments. In many of the cases in this study, there was strong evidence of duodeno-gastric reflux, with resulting high levels of morphine in stomach contents. The study found that the mean stomach contents total morphine concentration was almost double the mean blood total morphine concentration in the cases examined. The findings suggest that reflux of morphine from the duodenum into the stomach is the norm for intravenous heroin use, at least after death. Also, it is likely that the gastro-duodinal sphincter is at best an incomplete barrier in death and is probably ineffective in preventing reflux of morphine rich, semi-digested material from the duodenum back into the stomach. The authors advise, however, that although the death-scene investigations and autopsy findings in all these cases strongly suggested the intravenous administration of heroin, the remote possibility that all or some of the drug was taken orally cannot be excluded. 1 table and 11 references