Significance of Metabolite Ratios in the Interpretation of Segmental Hair Testing Results—Differentiation of Single from Chronic Morphine Use in a Case Series

Abstract

In morphine intoxication cases, forensic toxicologists are frequently confronted with the question of if the individual was opioid-tolerant or opioid-naïve, which can be investigated by hair analysis. However, interpretation of results can be challenging. Here, we report on hair testing for morphine and its metabolite hydromorphone following morphine intoxication without tolerance and upon chronic use. Two consecutive hair samples were collected after a non-fatal intoxication. Analysis comprised short hair segments and their initial wash water solutions. In the intoxications, morphine and hydromorphone levels were 3.3 to 56 pg/mg and at maximum 9.8 pg/mg, respectively. Both levels and hydromorphone to morphine ratios were significantly lower compared to chronic morphine use. In the non-fatal intoxication, the highest hydromorphone to morphine ratio was obtained in the segment corresponding to the time of intoxication. Morphine ratios of wash to hair were significantly higher in the intoxications compared to chronic use, being indicative of sweat/sebum contamination. We recommend including the analysis of hydromorphone and the initial wash solution in cases of morphine intoxications. Our study demonstrates that hydromorphone to morphine ratios can help in distinguishing single from chronic morphine use and in estimating the period of exposure when a consecutive hair sample can be collected in survived intoxications.

Interpretation of hair and nails findings in an infant death case related to maternal addiction to tramadol

“…This criterion is based on the principle that the oldest (most distal, most concentrated) hair segments have been in contact with a contaminated environment for a longer period. Nevertheless, contribution of sweat/sebum during the agony phase to the hair concentration pattern cannot be ruled out as a morphine concentration increase from proximal to distal has been also described (in two out of the three reported cases) in segmented hair analysis due to recent sweat contamination during the phase of agony in opioid‐related intoxication with well‐documented opioid abstinence before death 18 . Anyway, the hypothesis of external contamination (rather than repeated administrations of TR in the weeks before death) of the infant's hair is supported by the low MRs (<0.1), similar to MR ranges previously observed in hair of employees of a pharmaceutical company producing TR (working within the production site or in production control laboratories) 28,29 …”

“…The question of the “in between” situation arises when concentrations in hair and wash baths are of similar magnitude. In our practice, the second dichloromethane wash solution is analyzed and the results obtained in the wash residue are compared with those observed in the hair samples: When the wash/hair ratio is higher than 0.1, the possibility of external contamination is considered (without distinguishing between recent and acute contamination, e.g., by sweat/sebum during the agony phase in case of acute intoxication 18 and repeated external contamination including contamination by powder residues in environment or transfer of drugs by sweat from other) although it is not possible to be definitive 19 …”