Table IV.
Blood and Urine Results from Rapid and Delayed Death Heroin Cases
| Case | MoD | Age | Hx | Blood concentrationµg/g | Urine Concentrationµg/mL | Metabolite ratio | Case details | Other drugs in femoral blood | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6-MAM | MOR | COD | 6-MAM | MOR | M3G | M6G | NMOR | COD | C6G | NCOD | M3G/MOR | ||||||
| R.1 | A | 41 | – | 0.02 | 0.25 | 0.02 | 0.06 | 0.77 | 25.7 | 5.15 | 0.12 | 3.80 | 33.5 | Injection | ALP, AMP, BE, BUP, DZP, GBP, OXY, TZP | ||
| R.2 | U | 42 | – | 0.01 | 0.35 | 0.02 | 0.03 | 2.09 | 25.7 | 4.75 | 0.05 | 0.10 | 0.86 | 12.3 | Injection | ALP, BUP | |
| R.3 | A | 29 | Y | 0.02 | 0.36 | 0.02 | 0.61 | 11.2 | 89.9 | 18.9 | 0.16 | 0.52 | 5.12 | 8.03 | Injection, RR-rehab | – | |
| R.4 | U | 30 | – | 0.02 | 0.89 | 0.06 | 0.25 | 0.58 | 1.29 | 0.22 | 0.04 | 2.24 | Injection, Syringe in right thigh, drugs | ALP, EtOH, THC | |||
| R.5 | U | 42 | Y | 0.03 | 0.24 | 0.01 | 0.90 | 1.22 | 11.00 | 2.55 | 0.08 | 0.47 | 9.03 | Injection, Syringe in left arm, RR-prison | ALP | ||
| R.6 | A | 35 | – | 0.006 | 0.13 | 0.01 | 0.32 | 1.38 | 12.6 | 2.02 | 0.14 | 0.71 | 9.13 | Injection | ALP, AMZ | ||
| R.7 | A | 30 | Y | 0.02 | 0.51 | 0.03 | 0.17 | 0.60 | 0.81 | 0.04 | 1.35 | – | ALP, BE, DZP, MZP | ||||
| R.8 | U | 58 | Y | 0.03 | 0.36 | 0.03 | 0.44 | 1.58 | 23.8 | 4.88 | 0.03 | 0.18 | 2.51 | 0.06 | 15.1 | – | AMZ |
| R.9 | A | 60 | Y | 0.02 | 0.35 | 0.06 | 0.02 | 0.13 | 0.00 | Injection, crushed tablets beside body | AMZ, BUP, ZOP | ||||||
| R.10 | A | 19 | – | 0.02 | 0.08 | 0.006 | 0.15 | 0.15 | 0.00 | FU, CPR, died on scene | DHProp, EtOH | ||||||
| R.11 | A | 46 | Y | 0.006 | 0.11 | 0.01 | 0.31 | 0.52 | 2.57 | 0.31 | 0.05 | 4.93 | – | EtOH | |||
| R.12 | A | 31 | – | 0.02 | 0.62 | 0.03 | 0.05 | 0.09 | 0.00 | Injection, crushed medications | ALP, DZP, PRO | ||||||
| R.13 | A | 24 | Y | 0.005 | 0.15 | 0.007 | 0.07 | 0.04 | 0.00 | – | ALP, EtOH | ||||||
| R.14 | U | 26 | Y | 0.03 | 0.21 | 0.01 | 0.19 | 1.23 | 9.48 | 2.45 | 0.14 | 1.23 | 7.72 | – | AMZ, BPN, PGB, SER | ||
| R.15 | A | 60 | - | 0.006 | 0.76 | 0.12 | 1.73 | 13.0 | 127 | 20.1 | 2.32 | 22.2 | 0.19 | 9.77 | FU, injection, expires at ER (1h) | ALP, BUP, PGB, ZOP | |
| D.1 | A | 43 | Y | 0.09 | 0.007 | 0.08 | 0.66 | 4.76 | 1.12 | 0.05 | 0.21 | 7.18 | Injection, relapsed after long sobriety | ALP, EtOH, THC | |||
| D.2 | A | 40 | – | 0.47 | 0.07 | 2.11 | 28.7 | 134 | 28.2 | 0.13 | 2.02 | 7.23 | 0.16 | 4.67 | FU, injection, CPR, dies at hospital | ALP, AMZ, BUP, DZP, PGB | |
| D.3 | A | 28 | Y | 0.34 | 0.03 | 0.87 | 67.3 | 0.67 | 3.81 | 0.07 | 0.00 | Injection | DZP, TRA | ||||
| D.4 | A | 36 | – | 0.12 | 0.01 | 0.19 | 0.11 | 0.21 | 2.02 | Heroin powder and a rolled bill | EtOH | ||||||
| D.5 | U | 29 | Y | 0.02 | 0.50 | 2.54 | 28.0 | 4.11 | 0.13 | 0.47 | 4.68 | 0.48 | 11.0 | Powders/tablets, & paraphernalia | AMP, BE, DXN, DZP, TRA | ||
| D.6 | A | 33 | – | 0.25 | 0.02 | 1.39 | 4.65 | 22.6 | 4.20 | 0.38 | 0.25 | 1.46 | 4.86 | FU, CPR, dies at hospital | ALP, EtOH, PGB, THC | ||
| D.7 | U | 27 | Y | 0.02 | 1.16 | 7.15 | 45.6 | 11.4 | 0.19 | 1.13 | 7.04 | 0.13 | 6.38 | – | COC, BE, PZN, ZPX | ||
| D.8 | A | 34 | – | 0.03 | 0.56 | 5.97 | 37.8 | 7.38 | 0.17 | 0.44 | 2.75 | 0.05 | 6.33 | – | ALP, BUP, PGB, THC | ||
| D.9 | U | 33 | Y | 0.25 | 0.02 | 0.55 | 5.08 | 26.4 | 4.69 | 0.04 | 0.38 | 1.20 | 5.19 | Injection | ALP, DZP, OZP | ||
| D.10 | A | 32 | Y | 0.38 | 0.03 | 0.43 | 1.92 | 9.93 | 1.91 | 0.13 | 0.63 | 5.17 | Injection, RR-treatment home | ALP, EtOH, THC, QZP | |||
| D.11 | A | 51 | – | 0.03 | 0.005 | 0.03 | 6.10 | 60.0 | 11.6 | 1.18 | 2.37 | 0.05 | 9.83 | FU, injection, CPR, expires at ER (1d) | ALP, AMP | ||
| D.12 | A | 35 | – | 0.1 | 0.01 | 0.70 | 3.98 | 50.9 | 11.5 | 0.40 | 5.54 | 12.8 | FU, injection, CPR, dies at scene | AMZ, BUP, LPZ, MZP | |||
| D.13 | A | 24 | – | 0.09 | 0.01 | 1.24 | 6.54 | 60.0 | 8.84 | 0.06 | 0.60 | 2.94 | 9.18 | Injection, RR-prison | ALP, BE, MZP | ||
| D.14 | A | 25 | – | 0.16 | 0.02 | 0.84 | 6.12 | 28.1 | 2.82 | 0.43 | 0.50 | 4.59 | Injection | ALP, DZP, MDA, MDMA, MGN, PGB | |||
| D.15 | A | 26 | – | 0.02 | 0.12 | 3.84 | 16.3 | 2.69 | 0.06 | 0.13 | 0.85 | 4.25 | Injection | ALP, AMP, THC | |||
| D.16 | A | 65 | Y | 0.37 | 0.04 | 1.46 | 17.9 | 77.5 | 11.2 | 0.09 | 1.20 | 2.80 | 4.33 | – | ALP | ||
| D.17 | A | 42 | Y | 0.23 | 0.02 | 0.69 | 6.03 | 46.6 | 7.12 | 0.10 | 0.52 | 3.05 | 7.73 | Paraphernalia for smoking heroin | EtOH, SER | ||
| D.18 | A | 39 | Y | 0.16 | 0.01 | 0.08 | 1.16 | 11.4 | 1.96 | 0.10 | 0.14 | 1.24 | 9.86 | – | ALP, BUP | ||
| D.19 | A | 59 | Y | 0.21 | 0.02 | 0.68 | 3.59 | 27.0 | 5.65 | 0.27 | 2.60 | 7.53 | Injection, other paraphernalia | AMP | |||
| D.20 | A | 45 | Y | 0.14 | 0.01 | 0.58 | 4.91 | 31.5 | 6.31 | 0.48 | 2.77 | 0.06 | 6.41 | Was trying heroin | COC, BE, SER, THC | ||
| Summary of rapid versus delayed deaths | |||||||||||||||||
| Blood Concentrationsµg/g | Urine Concentrationsµg/mL | Metabolite Ratio | |||||||||||||||
| 6-MAM | MOR | COD | 6-MAM | MOR | M3G | M6G | NMOR | COD | C6G | NCOD | M3G/MOR | ||||||
| R.1-R.15 | Median | 0.02 | 0.35 | 0.02 | 0.19 | 0.77 | 12.6 | 3.65 | 0.05 | 0.12 | 1.87 | N/A | 7.72 | ||||
| Range | 0.005–0.03 | 0.08–0.89 | 0.006–0.12 | 0.02–1.73 | 0.04–13.0 | 0.81–127 | 0.22–20.1 | 0.03–0.16 | 0.04–2.32 | 0.47–22.2 | 0.06–0.19 | 0.00–33.5 | |||||
| D.1-D.20 | Median | 0.13 | 0.02 | 0.63 | 5.00 | 28.1 | 5.98 | 0.12 | 0.44 | 2.68 | 0.07 | 6.36 | |||||
| Range | 0.02–0.47 | 0.005–0.07 | 0.03–2.11 | 0.11–67.3 | 0.21–134 | 1.12–28.2 | 0.04–0.67 | 0.05–3.81 | 0.21–7.23 | 0.05–0.48 | 0.00–12.8 | ||||||
D.# denotes delayed death case#; R.# denotes rapid death case#.
MoD denotes mode of death; Hx, known drug history; A, accidental; U, uncertain; 1d, one day; RR, recently released from; Injection, syringe was found at scene; FU, found unconscious.
ALP, alprazolam, AMP, amphetamine; AMZ, alimemazine; BE, benzoylecgonine; BPN, bupropion; BUP, buprenorphine; COC, cocaine; DXN, duloxetine; DZP, diazepam; EtOH, ethanol; GBP, gabapentin; LPZ, levomepromazine; MDA, methylenedioxyamphetamine; MDMA, 3,4-methylenedioxy-methamphetamine; MGN, mitragynine; MZP, mirtazapine; OXY, oxycodone; OZP, oxazepam; PGB, pregabalin; PRO, propranolol; PZN, perphenazine; SER, sertraline; THC, tetrahydrocannabinol; TRA, tramadol; TZP, temazepam; QTP, quetiapine; ZOP, zopiclone; ZPX, zuclopentixol.