Acute pulmonary alveolitis in narcotics-related deaths

Abstract

Narcotic is a term used to describe in one word the polymorphic changes of all pulmonary compartments follwing abuse and intoxication with opiates. These changes include non-cardiogenic pulmonary edema, congestion, hemorrhage, acute and chronic inflammation, macrophage accumulation and adulterant-related lesions like foreign body granulomas. Intravenous administration of narcotics produces an acute inflammatory reaction in the alveolar wall accompanied by an exudation of fluids and cells into the alveolar space Acute alveolitis is less described in the literature, it frequently appears as a histopathological modification in heroin and methadone-related deaths. We retrospectively analized 35 cases of drug-related deaths with the aim to describe alveolar changes in relation to drug type and concentration. Acute alveolitis occured in 78% of the heroin-related deaths and in all deaths related to methadone. At morphine blood concentrations above 1000 ng/l the incidence of acute alveolitis was much higher than at lower concentrations (85.7% vs. 50%), on the other hand hemorrhagic and severe forms occured more often. The total average lung weight was 1526 g, similar to other reports in the literature. Microtrombosis was a rare finding, in 2 cases of methadone and 3 (11%) cases of heroin-related deaths.