The attempt to explain the pathophysiology of deaths from intravenously administered narcotics has been hindered in the past because of the small number of fatal cases reported annually in most areas of the United States and relatively insensitive toxicological methods. A sudden and dramatic increase in deaths attributed to intravenously administered narcotics together with improved and sensitive methods for the identification and quantitation of the major metabolite of heroin in tissues have provided the forensic pathologist with the necessary tools to re-evaluate this type of fatality.

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