Fatal intoxication by alcohol and heroin

Abstract

At the recent time, in Split– Dalmatia County, drug abuse with alcohol consumption is in increase. We reported two cases of three deaths due to fatal combination of heroin and alcohol. The first case was a couple, 30-year-old man and 28-year-old woman, with a history of drug use which families claimed that they were in treatment program. They were found in a car surrounded by cans from different alcohol drinks. A numerous needles were beside the bodies. The second case was a 29-year-old man, found dead in an old house, who attempted suicide recently. Three fresh injection marks were found on his right arm, and two needles were near his body. Multiple samples were collected and stored at 4 oC until analysis in order to establish drug distribution. Solid-phase extraction was performed using Amberlite XAD-2, polyaromatic adsorbent resin (Supelco ; SIGMA ALDRICH, Taufkirchen, Germany). The analysis was performed using a Shimadzu GC-2010, with ion trap mass spectrometer. Blood-alcohol concentration (BAC) was measured by Shimadzu GC-2010 with headspace and flame ionization detector (FID). Absorbancies at 541, 560 and 576 nm were measured by spectrophotometer (Ultrospec 2000. Pharmacia Biotech (Biochrom) Ltd. Cambridge, England) to evaluate the amount of carboxyhemoglobin (COHb). CASE 1 Blood alcohol and urine concentration in man was 1.60 and 2.93 g/kg respectively. Concentration of blood alcohol in woman was 1.81 while urine alcohol concentration was 2.48 g/kg. Heroin, meconin, papaverine and caffeine were found in both syringes. Meconin was detected in all samples. Monoacetylmorphine was found only in woman’ s urine, bile and hair, while in the man’ s hair noscapine was found. In the samples of man and woman blood the amount of COHb was 25% that could contribute to their death. CASE 2 Blood alcohol concentration was 1.67 and urine alcohol concentration was 2.03 g/kg. Heroin, theophyline, meconin, acetaminophen, 3-acetyl-morphine, 6-acetyl-morphine, codeine, noscapine, papaverine and caffeine were detected in syringes. Meconin was found in blood, urine and bile samples. There was presence of 3-acetyl-morphine, 6-acetyl-morphine and codeine in the blood. Concentrations of morphine were much higher in tissue samples from 3 injection marks than in any other samples. Ethanol in the blood together with morphine drastically augments the risk of rapid death due to respiration failure. It can also lead to a relatively high risk of overdosage in experienced drug abusers.