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Concentration ratios of free-morphine to free-codeine in femoral blood in heroin-related poisoning deaths
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
National Board for Forensic Medicine.
2011 (English)In: Legal Medicine, ISSN 1344-6223, E-ISSN 1873-4162, Vol. 13, no 4, 171-173 p.Article in journal (Refereed) Published
Abstract [en]

The concentrations of free-morphine (Mo), free-codeine (Co) and 6-monoacetyl morphine (6-MAM) were determined in femoral blood in N = 747 heroin-related deaths. The opiates were determined by isotope dilution gas chromatography-mass spectrometry after solid-phase extraction. The median blood concentrations of 6-MAM, free-morphine and free-codeine were 0.01 mg/L, 0.24 mg/L and 0.02 mg/L, respectively. The mean and median Mo/Co concentration ratios were 13.2 and 11.0, respectively with a range from 0.2 to 124. Despite the fact that all victims had taken heroin, there were eight cases (1.1%) with a Mo/Co ratio less than one and 18 cases (2.4%) with a ratio less than two. The free-morphine concentration in blood did not depend on the Mo/Co ratio; median 0.29 mg/L (Mo/Co less than 2.0) and median 0.25 mg/L (Mo/Co ratio greater than 2.0). By contrast, the concentration of free-codeine in blood was highly dependent on the Mo/Co ratio; median 0.75 mg/L (Mo/Co less than 1.0) and median 0.30 mg/L (Mo/Co ratio less than 2.0). A Mo/Co ratio in post-mortem (PM) femoral blood greater than1.0 is compelling evidence that the deceased had taken illicit heroin. However, finding a low Mo/Co ratio (less than1.0 or less than2.0) does not preclude use of heroin because such low ratios are possible if a person had co-ingested heroin along with use or abuse of codeine medication.

Place, publisher, year, edition, pages
Elsevier Science B.V., Amsterdam. , 2011. Vol. 13, no 4, 171-173 p.
Keyword [en]
Autopsy; Codeine; Heroin deaths; Morphine; Morphine/codeine ratio; Opiates
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-69841DOI: 10.1016/j.legalmed.2011.02.002ISI: 000291776000002OAI: diva2:433458
Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2014-06-11

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Jones, A Wayne
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ReferencesLink to record
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