Morphine to codeine concentration ratio in blood and urine as a marker of illicit heroin use in forensic autopsy samples
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-mono...
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Published in | Forensic science international Vol. 217; no. 1; pp. 216 - 221 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Kidlington
Elsevier Ireland Ltd
10.04.2012
Elsevier Elsevier Limited Elsevier Sequoia S.A |
Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 |
ISSN: | 0379-0738 1872-6283 |
DOI: | 10.1016/j.forsciint.2011.11.007 |