Morphine to codeine concentration ratio in blood and urine as a marker of illicit heroin use in forensic autopsy samples

• Published in: Forensic science international Vol. 217; no. 1; pp. 216 - 221
• Main Authors: Konstantinova, Svetlana V, Normann, Per T, Arnestad, Marianne, Karinen, Ritva, Christophersen, Asbjørg S, Mørland, Jørg
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 10.04.2012; Elsevier; Elsevier Limited; Elsevier Sequoia S.A
• Subjects: 6-Monoacetyl morphine; Adolescent; Adult; Analogies; Autopsies; Biological and medical sciences; Blood; Codeine - blood; Codeine - urine; Comparative analysis; Drug testing; Drug use; Female; Forensic autopsy; Forensic medicine; Forensic science; Forensic sciences; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Gender; General aspects; Generalized linear models; Heroin; Heroin Dependence - diagnosis; Humans; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Male; Markers; Medical sciences; Metabolites; Middle Aged; Morphine; Morphine - blood; Morphine - urine; Morphine Derivatives - blood; Morphine Derivatives - urine; Morphine to codeine ratio; Narcotics; Narcotics - blood; Narcotics - urine; Pathology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Ratios; Studies; Substance Abuse Detection; Toxicology; Unity; Urine; Young Adult; Forensic autopsy; Toxicology; Heroin; 6-Monoacetyl morphine; Morphine to codeine ratio; Consumption; Urine; Forensic science; Illicit drug; Legal medicine; Sample; Biological marker; Opiates; Morphine; Antitussive agent; Forensic aspect; Concentration; Narcotic analgesic; Blood; Autopsy; Ratio; Drug of abuse
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2011.11.007

Abstract A morphine to codeine ratio greater than unity (M/C > 1) has been suggested as an indicator of heroin use in living individuals. The aim of this study was to examine the morphine to codeine ratio in a large population ( N = 2438) of forensically examined autopsy cases positive for 6-monoacetylmorphine (6-MAM) and/or morphine in blood and/or urine. Blood and urine concentrations of 6-MAM, morphine and codeine were examined using GC–MS and LC–MS/MS methods. In 6-MAM positive samples, the M/C ratio was greater than unity in 98% ( N = 917) of the blood samples and 96% ( N = 665) of the urine samples. Stratification of 6-MAM negative cases by M/C above or below unity revealed similarities in morphine and codeine concentrations in cases where M/C > 1 and 6-MAM positive cases. Median blood and urine morphine concentrations were 8–10 times greater than codeine for both groups. Similarly to 6-MAM positive cases, 25–44 year-old men prevailed in the M/C > 1 group. In comparison to cases where M/C ≤ 1, the M/C ratio was a hundred times higher in both 6-MAM positive and M/C > 1 cases. The range of morphine concentration between the lowest and the highest quintile of codeine in M/C > 1 cases was similar to that in 6-MAM positive cases. This range was much higher than for M/C ≤ 1 cases. Moreover, linear regression analyses, adjusted for age and gender, revealed a strong positive association between morphine and codeine in 6-MAM positive and M/C > 1 cases. The M/C ratio appeared to be a good marker of heroin use in post-mortem cases. Both blood and urine M/C > 1 can be used to separate heroin users from other cases positive for morphine and codeine.