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Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation

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Abstract

This study undertook a multiparameter evaluation of the death of a 21-year-old woman known to be an abuser of heroin and cocaine. The toxicological analysis of multiple postmortem specimens such as blood and hair was carried out using liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The blood specimens of the deceased showed the presence of opium components such as morphine and its glucuronides together with cocaine and benzoylecgonine. The detected xenobiotic levels probably explained the cause of her death resulting from combined action of unintentional illicit drug overdose. By analysis of four 2-cm long hair segments, a heroin-cocaine addiction for at least 8 months antemortem was able to be documented; the presence of 6-monoacetylmorphine (6-MAM), cocaine, and benzoylecgonine was demonstrated. The histopathological findings of lesions of the internal organs of the deceased were consistent with long heroin and cocaine abuse. The use of multiple parameters, such as blood and hair segments as matrices and drug metabolites such as 6-MAM, morphine, glucuronides, and benzoylecgonine as target compounds, gave a well-defined outline of her death.

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References

  1. Preti A, Miotto P, De Coppi M (2002) Deaths by unintentional illicit drug overdose in Italy, 1984–2000. Drug Alcohol Depend 66:275–282

    Article  PubMed  CAS  Google Scholar 

  2. Darke S, Zador D (1996) Fatal heroin “overdose”. Addiction 91:1765–1772

    Article  PubMed  CAS  Google Scholar 

  3. White JM, Irvine RJ (1999) Mechanisms of fatal opioid overdose. Addiction 94:961–972

    Article  PubMed  CAS  Google Scholar 

  4. Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K (2003) Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98. Addiction 98:739–747

    Article  PubMed  Google Scholar 

  5. Marzuk PM, Tardiff K, Leon AC, Hirsch CS, Stajic M, Pertera L, Hartwell N (1997) Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study. Am J Drug Alcohol Abuse 23:221–228

    Article  PubMed  CAS  Google Scholar 

  6. Kronstrand R, Grundin R, Jonsson J (1998) Incidence of opiates, amphetamines, and cocaine in hair and blood in fatal cases of heroin overdose. Forensic Sci Int 92:29–38

    Article  PubMed  CAS  Google Scholar 

  7. Lachenmeier K, Musshoff F, Madea B (2006) Determination of opiates and cocaine in hair using automated enzyme immunoassay screening methodologies followed by gas chromatographic-mass spectrometric (GC-MS) confirmation. Forensic Sci Int 159:188–199

    Article  CAS  Google Scholar 

  8. Torralba L, Brugal MT, Villalbi JR, Tortosa MT, Toribio A, Valverde JL (1996) Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989–93. Addiction 91:419–426

    Article  PubMed  CAS  Google Scholar 

  9. Kłys M, Bystrowska B, Bujak-Giżycka B, Nowak G (2001) Significance of toxic interactions in medicolegal evidence. Complex fatal poisonings with drugs of abuse in the material of the Chair of Forensic Medicine, Collegium Medicum Jagiellonian University in Kraków. Pol J Pharmacol 53:653–658

    PubMed  Google Scholar 

  10. Kłys M, Rojek S, Kulikowska J, Bożek E, Ścisłowski M (2005) Usefulness of multiparameter opiate analysis in hair of drug users and victims of fatal poisonings. Przegl Lek 62:595–590

    Google Scholar 

  11. Kłys M, Rojek S, Kulikowska J, Bożek E, Ścisłowski M (2007) Usefulness of multi-parameter opiate analysis in hair of drug users for the evaluation of an abuse profile by means of tandem LC-APCI-MS-MS. J Chromatogr B 854:299–307

    Article  CAS  Google Scholar 

  12. Kłys M, Rojek S, Kulikowska J, Bożek E (2007) Usefulness of multiparameter opiate and amphetamine analysis of hair segments under methadone therapy using LC-APCI-MS-MS. Forensic Toxicol 25:69–75

    Article  CAS  Google Scholar 

  13. Baselt RC (2000) Disposition of toxic drugs and chemicals in man, 5th edn. Chemical Toxicology Institute, Foster City, pp 407–412

    Google Scholar 

  14. Winek CL, Wahba WW, Winek CL Jr, Balzer TW (2001) Drug and chemical blood-level data 2001. Forensic Sci Int 122:107–123

    Article  PubMed  CAS  Google Scholar 

  15. Uges DRA (1996) Therapeutic and toxic drug concentrations. Bull Int Assoc Forensic Toxicol 26:1–34

    Google Scholar 

  16. Bogusz MJ, Maier RD, Erkens M, Driessen S (1997) Determination of morphine and 3-and 6-glucuronides, codeine, codeine-glucuronide and 6-monoacetylmorphine in body fluids by liquid chromatography atmospheric pressure chemical ionization mass spectrometry. J Chromatogr B 703:115–127

    Article  CAS  Google Scholar 

  17. Bogusz MJ, Maier RD, Driessen S (1997) Morphine, morphine-3-glucuronide, morphine-6-glucuronide, and 6-monoacethylmorphine determined by means of atmospheric pressure chemical ionization-mass spectrometry-liquid chromatography in body fluids of heroin victims. J Anal Toxicol 21:346–355

    PubMed  CAS  Google Scholar 

  18. Aderjan R, Hofmann S, Schmitt G, Skopp G (1995) Morphine and morphine glucuronides in serum of heroin consumers and heroin-related deaths determined by HPLC with native fluorescence detection. J Anal Toxicol 19:163–168

    PubMed  CAS  Google Scholar 

  19. Goldberger BA, Cone EJ, Grant TM, Caplan YK, Levine BS, Smialek JL (1994) Disposition of heroin and its metabolites in heroin-related deaths. J Anal Toxicol 18:22–28

    PubMed  CAS  Google Scholar 

  20. Spieler VR, Reed D (1985) Brain concentrations of cocaine and benzoylecgonine in fatal cases. J Forensic Sci 30:1003–1011

    Google Scholar 

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Correspondence to Małgorzata Kłys.

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Kłys, M., Rojek, S., Kowalski, P. et al. Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation. Forensic Toxicol 26, 36–40 (2008). https://doi.org/10.1007/s11419-008-0042-1

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  • DOI: https://doi.org/10.1007/s11419-008-0042-1

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