Heroin‐related Deaths from the Hennepin County Medical Examiner's Office from 2004 Through 2015

Over the past two decades, prescription and illicit opioid use has led to changes in public health policy to address the increasing number of opioid‐related deaths. The purpose of this study was to review cases from Hennepin County Medical Examiner's Office between 2004 through 2015 where heroin was listed as a significant contributor or as the cause of death. We identified 322 heroin‐related deaths, which were predominantly male (255; 79%). 6‐Monoacetylmorphine (6‐MAM) median (range) concentrations were as follows: blood (n = 7), 0.010 (0.006–0.078) mg/L; urine (n = 30), 0.359 (0.009–1.75) mg/L; and vitreous humor (n = 31), 0.034 (0.004–0.24) mg/L. Free morphine was measurable in 273 cases and the percent free morphine (range), when grouped by COD, was opioid (n = 124), 28% (2.2%–92%), and mixed drug toxicity (n = 135), 35.3% (1.5%–100%); (p < 0.01). Quantitation of 6‐MAM in blood and vitreous humor, along with a free to total morphine ratio >26%, was useful in establishing heroin‐related deaths.