Heroin‐related Deaths from the Hennepin County Medical Examiner's Office from 2004 Through 2015

Abstract

Over the past two decades, prescription and illicit opioid use has led to changes in public health policy to address the increasing number of opioid-related deaths. The purpose of this study was to review cases from Hennepin County Medical Examiner's Office between 2004 through 2015 where heroin was listed as a significant contributor or as the cause of death. We identified 322 heroin-related deaths, which were predominantly male (255; 79%). 6-Monoacetylmorphine (6-MAM) median (range) concentrations were as follows: blood (n = 7), 0.010 (0.006-0.078) mg/L; urine (n = 30), 0.359 (0.009-1.75) mg/L; and vitreous humor (n = 31), 0.034 (0.004-0.24) mg/L. Free morphine was measurable in 273 cases and the percent free morphine (range), when grouped by COD, was opioid (n = 124), 28% (2.2%-92%), and mixed drug toxicity (n = 135), 35.3% (1.5%-100%); (p < 0.01). Quantitation of 6-MAM in blood and vitreous humor, along with a free to total morphine ratio >26%, was useful in establishing heroin-related deaths.

A Novel Bioanalytical Method for the Determination of Opioids in Blood and Pericardial Fluid

“…The LOQs achieved in both matrices were 5 ng/mL for all substances (Figure 1A and B). Although in some previous studies lower values were achieved for LODs and LOQs much higher volumes of BL sample were used, between 1 and 3 mL (31,33,35,37,42,47,(56)(57)(58)(59)(60)(61). Related to PF, previous studies neither present values of LOD and LOQ using GC-MS, for codeine and morphine, nor the other compounds studied in this matrix, being impossible to make comparisons (18,20,23).…”

The impacts of governing agency: A comparison of resources in the patchwork of medicolegal death investigation systems

“…In the United States, medical examiner and coroner (MEC) offices are positioned at the crossroads of public health and public safety because they conduct formal medicolegal death investigations (MDIs) surrounding the circumstances of a death and determine the cause and manner [ 1 ]. As such, MDIs and their resulting data can inform a wide variety of relevant topics including the ongoing opioid overdose epidemic [ [2] , [3] , [4] , [5] , [6] ], COVID-19 and other pandemics [ [7] , [8] , [9] , [10] ], deaths in custody [ 11 ], deaths associated with natural [ 12 ] and artificial [ 13 ] disasters, families seeking answers about long-term missing loved ones [ 14 ], late-life suicide [ 15 ], preventable deaths from extremity wounds [ 16 ], and firearm-related deaths [ 17 ], among many other critical topics. Informing public health with autopsies and other MDI processes helps detect novel diseases, monitor the spread of infectious disease, register deaths related to epidemics reliably, correct clinical misdiagnoses, identify prognostic and risk factors, and identify target sites for infections and disease to enable better, more timely treatment [ 8 ].…”