Illicit Drug Heroin Research Articles

Heroin Fatality in a Feline: A Case Report with Postmortem Liver Concentrations

A case of feline intoxication and fatality with the illicit drug heroin is described. A 5-year-old castrated male domestic shorthair cat was recently diagnosed with an active pneumonitis and left at home for a couple of days under the care of another resident. Upon return, the owner found his cat dead with strong suspicion of foul play. The cat was necropsied by a local veterinary clinic to retrieve the liver for diagnostic toxicology. The postmortem liver sample screened positive for 6-acetylmorphine and 6-acetylcodeine by gas chromatography mass spectrometry. Deconvolution techniques were applied to chromatograms, which revealed the additional presence of morphine and mirtazapine. Subsequent quantitation of mirtazapine, heroin, morphine, 6-acetylmorphine and 6-acetylcodeine was performed by gas chromatography--tandem quadrupole mass spectrometry. Although companion animal fatalities arising from toxicities are a likely consequence of drug abuse in a home, this is the first reported case of a malicious feline fatality resulting from heroin with quantitation of heroin metabolites.

Marijuana users are likely to report opioid misuse among adults over 50 years in representative sample of the United States (2002–2014)

Background: In the wake of the rising rate of prescription opioid misuse, there has been increased public health interest in the possibility that cannabis might help to curb or prevent opioid use disorder. Previous studies were limited to young adult marijuana use population. Little is known about whether in older adult population, marijuana use is associated with a different type of nonmedical use opioids. We examined the association between marijuana use and nonmedical prescription opioids dependence and use among older adults.Methods: The National Survey on Drug Use and Health is a nationally U.S. representative cross-sectional survey. We analyzed data for 75,949 adults aged ≥ 50 who participated in the year 2002–2014.Results: Within the overall population, 3.8% of the older adults reported past-year marijuana use (estimate 3.5 million older adults Americans). Past-year marijuana use was very common (25%–37%) among nonmedical opioid dependence respondents compared to those who did not report nonmedical opioid dependence and use (3.5%–3.7%). Past-year marijuana user was significantly associated with an increase in odds of reporting opioid dependence (AOR 9.6 95% CI = 5.8–15.7), and past-year nonmedical use opioids (AOR 6.4 95% CI = 5.2–7.8). Illicit drug heroin was the most prevalent nonmedical used opioid (AOR 6.3 95% CI = 5.0–7.9), compared to codeine (AOR 4.5 95% CI = 3.5–5.7), hydrocodone (AOR 4.9 95% CI = 3.8–6.4), methadone or tramadol (AOR 4.9 95% CI = 2.0–12.3).Conclusion: Policymakers and healthcare providers should remain mindful that older adult marijuana users regardless of initial legitimate medical needs are likely to report nonmedical opioid use including illicit drug heroin.

Driving Under the Influence of Opiates: Concentration Relationships Between Morphine, Codeine, 6-Acetyl Morphine, and Ethyl Morphine in Blood

Morphine and codeine are frequently identified in blood samples from impaired drivers. But whether these opiates reflect the use of prescription analgesics or abuse of the illicit drug heroin (diacetyl morphine) is not always obvious. Opiates, either alone or together with other drugs, were determined in 2,573 blood specimens from impaired drivers by sensitive and specific methods of analysis. The specific metabolite of heroin 6-acetyl morphine (6-AM) was quantifiable in only 52 cases (2%) at mean, median, and highest concentrations of 0.015, 0.010, and 0.10 mg/L, respectively. The mean, median, and highest concentrations of morphine were 0.046, 0.03, and 1.13 mg/L, respectively (N = 2,029). The corresponding concentrations of codeine (N = 1,391) were 0.047, 0.01, and 2.40 mg/L. Ethyl morphine was identified in 63 cases at a mean concentration of 0.055 mg/L (median 0.03 mg/L). When 6-AM was present in urine (N = 324), the mean morphine/codeine ratio in blood was 7.5 (median 6.7), and this important ratio was less than unity in only two cases. This study finds compelling evidence that approximately 90% of apprehended drivers in Sweden with morphine and codeine in their blood had used heroin.

Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine

Both the illicit drug heroin and the prescription drug codeine are metabolized to morphine, which tends to complicate interpretation of opiate-positive samples. We report here the concentrations of morphine and codeine, the morphine/codeine ratios, and 6-acetylmorphine (6-AM) in blood specimens from individuals arrested for driving under the influence of drugs (DUID) in Sweden. The results were compared with positive findings of 6-AM in urine as evidence of heroin intake. In 339 DUID suspects, both blood and urine specimens were available for toxicologic analysis. In another 882 cases, only blood was available. All specimens were initially analyzed by immunoassay, and the positive results were verified by isotope-dilution gas chromatography-mass spectrometry. In routine casework, the limits of quantification (LOQs) for unconjugated opiates were 5 ng/g for blood and 20 microg/L for urine. The median concentration of morphine in blood was 30 ng/g with 2.5 and 97.5 percentiles of 5 and 230 ng/g, respectively (n = 979). This compares with a median codeine concentration of 20 ng/g and 2.5 and 97.5 percentiles of 5 and 592 ng/g, respectively (n = 784). The specific metabolite of heroin, 6-AM, was identified in only 16 of 675 blood specimens (2.3%). This compares with positive findings of 6-AM in 212 of 339 urine samples (62%) from the same population of DUID suspects. When 6-AM was identified in urine, the morphine/codeine ratio in blood was always greater than unity (median, 6.0; range, 1-66). In 18 instances, 6-AM was present in urine, although morphine and codeine were below the LOQ in blood. The morphine/codeine ratio in blood was greater than unity in 85% of DUID cases when urine was not available (n = 506), and the median morphine and codeine concentrations were 70 ng/g and 10 ng/g, respectively. When morphine/codeine ratios in blood were less than unity (n = 76), the median morphine and codeine concentrations were 10 ng/g and 180 ng/g, respectively. Only 2.3% of opiate-positive DUID suspects were verified as heroin users on the basis of positive findings of 6-AM in blood. A much higher proportion (62%) were verified heroin users from 6-AM identified in urine. When urine was not available for analysis, finding a morphine/codeine concentration ratio in blood above unity suggests heroin use and not medication with codeine. This biomarker indicated that 85% of opiate-positive DUID blood samples were from heroin users.