Fatal versus non-fatal heroin “overdose”: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers
The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxi...
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| Veröffentlicht in: | Forensic science international 2002-11, Vol.130 (1), p.49-54 |
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| creator | Meissner, Christoph Recker, Sabine Reiter, Arthur Friedrich, Hans Juergen Oehmichen, Manfred |
| description | The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0–128
ng/ml, total morphine: 10–2110
ng/ml) and non-survivors (free morphine: 0–2800
ng/ml, total morphine: 33–5000
ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28–93
ng/ml, total morphine: 230–1451
ng/ml; non-survivors-free morphine: 0–2800
ng/ml, total morphine: 119–4660
ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (
N=207) was 0.293, for those that survived (
N=27) 0.135, in cases of intoxication only by morphine 0.250 (
N=87) and 0.080 (
N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200
ng/ml and more of free morphine displayed a fatal outcome. |
| doi_str_mv | 10.1016/S0379-0738(02)00343-2 |
| format | Article |
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ng/ml, total morphine: 10–2110
ng/ml) and non-survivors (free morphine: 0–2800
ng/ml, total morphine: 33–5000
ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28–93
ng/ml, total morphine: 230–1451
ng/ml; non-survivors-free morphine: 0–2800
ng/ml, total morphine: 119–4660
ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (
N=207) was 0.293, for those that survived (
N=27) 0.135, in cases of intoxication only by morphine 0.250 (
N=87) and 0.080 (
N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200
ng/ml and more of free morphine displayed a fatal outcome.</description><identifier>ISSN: 0379-0738</identifier><identifier>EISSN: 1872-6283</identifier><identifier>DOI: 10.1016/S0379-0738(02)00343-2</identifier><identifier>PMID: 12427450</identifier><identifier>CODEN: FSINDR</identifier><language>eng</language><publisher>Kidlington: Elsevier Ireland Ltd</publisher><subject>Addictive behaviors ; Adult and adolescent clinical studies ; Alcohol ; Automobile Driving ; Autopsies ; Biological and medical sciences ; Blood ; Blood levels ; Cocaine ; Drug addiction ; Drug dosages ; Drug Overdose ; Forensic Medicine - methods ; Free morphine ; Heroin ; Humans ; Intoxication ; Lethal intoxication ; Medical sciences ; Morphine ; Morphine - blood ; Morphine - poisoning ; Morphine concentrations ; Narcotics - blood ; Narcotics - poisoning ; Opioid-Related Disorders - blood ; Overdose ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Stimulants ; Survival ; Total morphine</subject><ispartof>Forensic science international, 2002-11, Vol.130 (1), p.49-54</ispartof><rights>2002 Elsevier Science Ireland Ltd</rights><rights>2003 INIST-CNRS</rights><rights>2002. Elsevier Science Ireland Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-1699007da346e3b3e5761866c55493535eabd7460124f39bcb87fda1a56957fe3</citedby><cites>FETCH-LOGICAL-c419t-1699007da346e3b3e5761866c55493535eabd7460124f39bcb87fda1a56957fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2900101073?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14012335$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12427450$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meissner, Christoph</creatorcontrib><creatorcontrib>Recker, Sabine</creatorcontrib><creatorcontrib>Reiter, Arthur</creatorcontrib><creatorcontrib>Friedrich, Hans Juergen</creatorcontrib><creatorcontrib>Oehmichen, Manfred</creatorcontrib><title>Fatal versus non-fatal heroin “overdose”: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers</title><title>Forensic science international</title><addtitle>Forensic Sci Int</addtitle><description>The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0–128
ng/ml, total morphine: 10–2110
ng/ml) and non-survivors (free morphine: 0–2800
ng/ml, total morphine: 33–5000
ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28–93
ng/ml, total morphine: 230–1451
ng/ml; non-survivors-free morphine: 0–2800
ng/ml, total morphine: 119–4660
ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (
N=207) was 0.293, for those that survived (
N=27) 0.135, in cases of intoxication only by morphine 0.250 (
N=87) and 0.080 (
N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200
ng/ml and more of free morphine displayed a fatal outcome.</description><subject>Addictive behaviors</subject><subject>Adult and adolescent clinical studies</subject><subject>Alcohol</subject><subject>Automobile Driving</subject><subject>Autopsies</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Blood levels</subject><subject>Cocaine</subject><subject>Drug addiction</subject><subject>Drug dosages</subject><subject>Drug Overdose</subject><subject>Forensic Medicine - methods</subject><subject>Free morphine</subject><subject>Heroin</subject><subject>Humans</subject><subject>Intoxication</subject><subject>Lethal intoxication</subject><subject>Medical sciences</subject><subject>Morphine</subject><subject>Morphine - blood</subject><subject>Morphine - poisoning</subject><subject>Morphine concentrations</subject><subject>Narcotics - blood</subject><subject>Narcotics - poisoning</subject><subject>Opioid-Related Disorders - blood</subject><subject>Overdose</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Stimulants</subject><subject>Survival</subject><subject>Total morphine</subject><issn>0379-0738</issn><issn>1872-6283</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1uFDEQhS0EIsPAEUCWEBIsGvzTdnezQSgigBSJBbC23Ha1xtGMa7DdAXY5AEdILpeT4PkRWbIqyfXV86tXhDzl7DVnXL_5ymQ3NKyT_UsmXjEmW9mIe2TB-040WvTyPln8Q07Io5wvGGNKCf2QnHDRiq5VbEH-nNli1_QSUp4zjRibaf-wgoQh0tura6w9jxlur27e0nGN6OkG03YVIlCH0UEsyZaAMdOfoazoYR7n4nADtGrUurUpZIy0IC2rqkVxqp2Cv4KzBTz1KewcPCYPJrvO8ORYl-T72Ydvp5-a8y8fP5--P29cy4fScD0MjHXeylaDHCWoTvNea6dUO0glFdjRd61mdc1JDqMb-27yllulB9VNIJfk-UF3m_DHDLmYC5xTrF8aUZVrvjW0SqkD5RLmnGAy2xQ2Nv02nJndDcz-BmYXsGHC7G9gRJ17dlSfxw34u6lj6BV4cQRsdnY9JRtdyHdcW43LuseSvDtwULO4DJBMdgFq4j4kcMV4DP-x8hdM76bH</recordid><startdate>20021105</startdate><enddate>20021105</enddate><creator>Meissner, Christoph</creator><creator>Recker, Sabine</creator><creator>Reiter, Arthur</creator><creator>Friedrich, Hans Juergen</creator><creator>Oehmichen, Manfred</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>20021105</creationdate><title>Fatal versus non-fatal heroin “overdose”: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers</title><author>Meissner, Christoph ; Recker, Sabine ; Reiter, Arthur ; Friedrich, Hans Juergen ; Oehmichen, Manfred</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-1699007da346e3b3e5761866c55493535eabd7460124f39bcb87fda1a56957fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Addictive behaviors</topic><topic>Adult and adolescent clinical studies</topic><topic>Alcohol</topic><topic>Automobile Driving</topic><topic>Autopsies</topic><topic>Biological and medical sciences</topic><topic>Blood</topic><topic>Blood levels</topic><topic>Cocaine</topic><topic>Drug addiction</topic><topic>Drug dosages</topic><topic>Drug Overdose</topic><topic>Forensic Medicine - methods</topic><topic>Free morphine</topic><topic>Heroin</topic><topic>Humans</topic><topic>Intoxication</topic><topic>Lethal intoxication</topic><topic>Medical sciences</topic><topic>Morphine</topic><topic>Morphine - blood</topic><topic>Morphine - poisoning</topic><topic>Morphine concentrations</topic><topic>Narcotics - blood</topic><topic>Narcotics - poisoning</topic><topic>Opioid-Related Disorders - blood</topic><topic>Overdose</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Stimulants</topic><topic>Survival</topic><topic>Total morphine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meissner, Christoph</creatorcontrib><creatorcontrib>Recker, Sabine</creatorcontrib><creatorcontrib>Reiter, Arthur</creatorcontrib><creatorcontrib>Friedrich, Hans Juergen</creatorcontrib><creatorcontrib>Oehmichen, Manfred</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>Forensic science international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meissner, Christoph</au><au>Recker, Sabine</au><au>Reiter, Arthur</au><au>Friedrich, Hans Juergen</au><au>Oehmichen, Manfred</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fatal versus non-fatal heroin “overdose”: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers</atitle><jtitle>Forensic science international</jtitle><addtitle>Forensic Sci Int</addtitle><date>2002-11-05</date><risdate>2002</risdate><volume>130</volume><issue>1</issue><spage>49</spage><epage>54</epage><pages>49-54</pages><issn>0379-0738</issn><eissn>1872-6283</eissn><coden>FSINDR</coden><abstract>The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0–128
ng/ml, total morphine: 10–2110
ng/ml) and non-survivors (free morphine: 0–2800
ng/ml, total morphine: 33–5000
ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28–93
ng/ml, total morphine: 230–1451
ng/ml; non-survivors-free morphine: 0–2800
ng/ml, total morphine: 119–4660
ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (
N=207) was 0.293, for those that survived (
N=27) 0.135, in cases of intoxication only by morphine 0.250 (
N=87) and 0.080 (
N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200
ng/ml and more of free morphine displayed a fatal outcome.</abstract><cop>Kidlington</cop><pub>Elsevier Ireland Ltd</pub><pmid>12427450</pmid><doi>10.1016/S0379-0738(02)00343-2</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0379-0738 |
| ispartof | Forensic science international, 2002-11, Vol.130 (1), p.49-54 |
| issn | 0379-0738 1872-6283 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Addictive behaviors Adult and adolescent clinical studies Alcohol Automobile Driving Autopsies Biological and medical sciences Blood Blood levels Cocaine Drug addiction Drug dosages Drug Overdose Forensic Medicine - methods Free morphine Heroin Humans Intoxication Lethal intoxication Medical sciences Morphine Morphine - blood Morphine - poisoning Morphine concentrations Narcotics - blood Narcotics - poisoning Opioid-Related Disorders - blood Overdose Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Stimulants Survival Total morphine |
| title | Fatal versus non-fatal heroin “overdose”: blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers |
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