In Heroin-Related Fatalities, Testing for 6-Acetylmorphine in Vitreous Humor Seems to Be of Higher Sensitivity than in Blood or Urine

Nassibou, Shanti; Richeval, Camille; Wiart, Jean-François; Hakim, Florian; Allorge, Delphine; Gaulier, Jean‐Michel

doi:10.1093/jat/bkaa116

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…Different results have been obtained for urine samples because low free morphine concentrations should be expected due to morphine-conjugated formation before excretion into urine [ 53 , 54 ]. Heroin biomarkers were more stable in vitreous fluid than in blood [ 55 ], which is supported by the detection of high 6-MAM in vitreous humor in cases with a longer PMI, whereas 6-MAM was negative or found at a low level in BNaF samples. The probability of obtaining a vitreous humor specimen for testing decreases with an increase in the time between death and body discovery.…”

Section: Discussionmentioning

confidence: 95%

Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018

Al-Asmari

Alharbi

Al-Zahrani

et al. 2023

Toxics

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To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21–30 age group. In addition, 61% of cases were classified as “rapid deaths,” while 24% were classified as “delayed deaths.” The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.

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Section: Discussionmentioning

confidence: 95%

Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018

Al-Asmari

Alharbi

Al-Zahrani

et al. 2023

Toxics

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Assessment of urine drug screen utility at autopsy to predict laboratory postmortem blood toxicology

Arndt,

Huestis,

Jarvis

et al. 2024

Journal of Forensic Sciences

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When faced with increasing drug‐related deaths and decline in practicing forensic pathologists, the need to quickly identify toxicology‐related deaths is evident in order to appropriately triage cases and expedite turnaround times. Lateral flow immunoassays conducted pre‐autopsy offer quick urine drug screen (UDS) results in minutes and are used to inform the need for autopsy. Over 1000 medicolegal cases were reviewed to compare UDS results to laboratory enzyme‐linked immunosorbent assay (ELISA) blood results to evaluate how well autopsy UDS predicted laboratory findings. Mass spectral analysis was performed on ELISA‐positive specimens and these data were used to investigate UDS false‐negative (FN) results when possible. Five different UDS devices (STAT One Step Drug of Abuse dip card and cassette, Premiere Biotech multi‐drug and fentanyl dip cards and ATTEST 6‐acetylmorphine (6‐AM) dip card) were tested encompassing 11 drug classes: 6‐AM, amphetamine/methamphetamine, benzodiazepines, benzoylecgonine, fentanyl, methadone, opioids, phencyclidine, and delta‐9‐tetrahydrocannabinol. Sensitivity, specificity, efficiency, and positive and negative predictive values >80% indicated that UDS was useful for predicting cases involving benzoylecgonine, methadone, methamphetamine, and phencyclidine. UDS was unreliable in predicting amphetamine, benzodiazepines, fentanyl, and opiates‐related cases due to a high percentage of FN (up to 11.2%, 8.0%, 12.4%, and 5.5%, respectively) when compared to ELISA blood results. For the later analytes, sensitivities were as low as 57.5%, 60.0%, 72.2%, and 66.7%, respectively. Overall results support that UDS cannot replace laboratory testing. Because UDS is subject to false‐positive and FN results users must understand the limitations of using UDS for triage or decision‐making purposes.

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In Heroin-Related Fatalities, Testing for 6-Acetylmorphine in Vitreous Humor Seems to Be of Higher Sensitivity than in Blood or Urine

Cited by 2 publications

References 8 publications

Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018

Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018

Assessment of urine drug screen utility at autopsy to predict laboratory postmortem blood toxicology

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