The toxicology of heroin-related death: estimating survival times
The toxicology of heroin-related death: estimating survival times
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DOI：
10.1111/add.13429
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发表时间：
2016-09-01
期刊：
影响因子：
6
通讯作者：
Duflou, Johan
中科院分区：
文献类型：
--
作者：
Darke, Shane;Duflou, Johan
背景和目的干预海洛因过量的可行性具有临床重要性。血液中存在 6-单乙酰吗啡 (6MAM) 表明服用海洛因后的存活时间少于 20-30 分钟。该研究旨在确定存在 6MAM 的病例比例，并按 6MAM 状态比较次级代谢物的浓度和死亡情况。设计分析 2013 年 1 月 1 日至 2014 年 12 月 12 日向悉尼法医学部提交的海洛因相关死亡病例。设置澳大利亚悉尼。病例总数 145 例。平均年龄为40.5岁，81%为男性。测量6MAM、游离吗啡、吗啡-3-葡萄糖醛酸(M3G)和吗啡-6-葡萄糖醛酸(M6G)的浓度。死亡情况包括支气管肺炎、明显的突然虚脱、位置和其他中枢神经系统 (CNS) 抑制剂。结果 6MAM 在 43% 的病例中检测到[置信区间 (CI)=35-51%]。 6MAM 阳性病例的中位游离吗啡浓度是无 6MAM 病例的两倍多（0.26 与 0.12mg/l）。 6MAM 阳性病例的其他主要海洛因代谢物浓度也较低：M3G（0.05 与 0.29mg/l）、M6G（0.02 与 0.05mg/l），M3G/吗啡（0.54 与 2.71）和 M6G/吗啡（0.05 与 0.50）比率相应较低。 6MAM 的显着独立相关性是较高的游离吗啡浓度 [比值比 (OR)=1.7]、较低的 M6G/游离吗啡比 (OR=0.5) 和明显崩溃迹象 (OR=6.7)。 结论 在 2013 年和 2014 年澳大利亚悉尼海洛因相关死亡中，不到一半的病例血液中存在 6-单乙酰吗啡，这表明少数病例服药过量后的存活时间少于20-30分钟。海洛因代谢物的毒理学和死亡情况与 6-单乙酰吗啡一致，可以作为更快死亡的指标。
Background and aimsThe feasibility of intervention in heroin overdose is of clinical importance. The presence of 6-monoacetyl morphine (6MAM) in the blood is suggestive of survival times of less than 20-30 minutes following heroin administration. The study aimed to determine the proportions of cases in which 6MAM was present, and compare concentrations of secondary metabolites and circumstances of death by 6MAM status.DesignAnalysis of cases of heroin-related death presenting to the Department of Forensic Medicine Sydney, 1 January 2013-12 December 2014.SettingSydney, Australia.CasesA total of 145 cases. The mean age was 40.5years and 81% were male.MeasurementsConcentrations of 6MAM, free morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). Circumstances of death included bronchopneumonia, apparent sudden collapse, location and other central nervous system (CNS) depressants.Findings6MAM was detected in 43% [confidence interval (CI)=35-51%] of cases. The median free morphine concentration of 6MAM-positive cases was more than twice that of cases without 6MAM (0.26 versus 0.12mg/l). 6MAM-positive cases also had lower concentrations of the other major heroin metabolites: M3G (0.05 versus 0.29mg/l), M6G (0.02 versus 0.05mg/l) with correspondingly lower M3G/morphine (0.54 versus 2.71) and M6G/morphine (0.05 versus 0.50) ratios. Significant independent correlates of 6MAM were a higher free morphine concentration [odds ratio (OR)=1.7], a lower M6G/free morphine ratio (OR=0.5) and signs of apparent collapse (OR=6.7).ConclusionsIn heroin-related deaths in Sydney, Australia during 2013 and 2014, 6- monoacetyl morphine was present in the blood in less than half of cases, suggesting that a minority of cases had survival times after overdose of less than 20-30 minutes. The toxicology of heroin metabolites and the circumstances of death were consistent with 6- monoacetyl morphine as a proxy for a more rapid death.