On the diagnosis of death from acute narcotism

Abstract

In the past the diagnosis of death from acute narcotism (principally heroin) presented the forensic pathologist with a problem as pathological criteria and adequate toxicological methods were not available. Each such case requires a thorough scene investigation, a complete autopsy, and adequate histological and toxicological studies. An adequate scene investigation can make a probable diagnosis in 75% of cases. Criteria established by autopsy and histological studies increased this to about 95%. These criteria included needle punctures, pulmonary changes, enlargement of hepatic and subpyloric lymph nodes and cellular infiltrate in portal triads. The newer toxicological methods permit a positive diagnosis ‘beyond a reasonable doubt’ in about 98% of cases. The higher sensitivity of the newer methods coupled with the widespread use of heroin has increased the problem of differential diagnosis. Since heroin metabolites (mainly morphine) can be detected in body fluids even 2 or 3 days after injection they may be present in those dying from other causes. Recent studies have shown that morphine is more difficult to detect in the decomposed body and that the histopathological changes in the lung, which can give an indication of the duration of survival after the last injection of the drug, can be correlated with the blood levels of morphine.