Historique
Article de Périodique
Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin users (2003)
(Utilisation des données de detection sanguine de la morphine et de la 6-monoacétylmorphine pour évaluer les facteurs de risques possibles de mort subite chez 192 usagers d'héroïne.)
Auteur(s) :
FUGELSTAD, A. ;
AHLNER, J. ;
BRANDT, L. ;
CEDER, G. ;
EKSBORG, S. ;
RAJS, J. ;
BECK, O.
Année :
2003
Page(s) :
463-470
Langue(s) :
Anglais
Refs biblio. :
37
Domaine :
Drogues illicites / Illicit drugs
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus mots-clés
HEROINE
;
MORT
;
FACTEUR DE RISQUE
;
ALCOOL
;
BENZODIAZEPINES
;
ETUDE RETROSPECTIVE
Thésaurus géographique
SUEDE
Résumé :
FRANÇAIS :
Les dossiers de médecine légale de 192 usagers d'héroïne, signalés comme présentant dans le sang de la morphine ou de la 6-MAM, ont été étudiés. La codéine a été détectée chez 96% des sujets. Dans la plupart des cas une polyconsommation est observée, principalement avec de l'alcool et des benzodiazépines. Aucun lien entre la pathologie cardiaque et la concentration sanguine en morphine ou 6-MAM n'est noté.
ENGLISH :
Aims: To detect risk factors for sudden death from heroin injection. Design: Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order toselect heroin intoxication cases. Setting: Stockholm, Sweden. Measurements: Autopsy investigation andtoxicological analysis of blood and urine; and police reports. Findings: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from50 to 7 200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations werefound. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. Conclusions: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
Les dossiers de médecine légale de 192 usagers d'héroïne, signalés comme présentant dans le sang de la morphine ou de la 6-MAM, ont été étudiés. La codéine a été détectée chez 96% des sujets. Dans la plupart des cas une polyconsommation est observée, principalement avec de l'alcool et des benzodiazépines. Aucun lien entre la pathologie cardiaque et la concentration sanguine en morphine ou 6-MAM n'est noté.
ENGLISH :
Aims: To detect risk factors for sudden death from heroin injection. Design: Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order toselect heroin intoxication cases. Setting: Stockholm, Sweden. Measurements: Autopsy investigation andtoxicological analysis of blood and urine; and police reports. Findings: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from50 to 7 200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations werefound. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. Conclusions: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
Affiliation :
Dept Clin. Pharmacol., Karolinska Hosp., SE-171 76.
Suède. Sweden.
Suède. Sweden.