Is There a Relationship Between Street Heroin Purity and Drug‐Related Emergencies and/or Drug‐Related Deaths? An Analysis from Vienna, Austria*

Abstract

This study examines the quality of street heroin seized in Vienna in 1999 and whether there was a relationship between the purity of street heroin and the number of heroin-related emergencies as well as the number of heroin-related deaths. Street heroin confiscated by the Viennese police, run-sheets of drug-related emergencies, and postmortem reports of drug-related deaths in Vienna in 1999 were analyzed. A total of 415 retail samples with a total weight of 128.02 g contained a median percentage of 6.5% diacetylmorphine (range: 0.0-47.0%). All the samples contained a diluent, mainly lactose, as well as adulterants, such as caffeine and/or paracetamol. During the study period, 75 heroin-related deaths and 387 heroin-related emergencies were registered in Vienna. Time-series analysis revealed no statistically significant relationship between the rate of heroin-related incidents and the diacetylmorphine concentration of street heroin samples confiscated in Vienna in 1999. The widely held belief that the number of heroin-related deaths could be explained simply through fluctuations in the purity of street heroin could not be substantiated, even though the results of this study do not rule out an association between the purity of heroin and heroin-related deaths/emergencies.

Micromorphological changes in cardiac tissue of drug‐related deaths with emphasis on chronic illicit opioid abuse

“…However, all the cases used in this study were selected carefully from this specific period in the 1990s (1993–94), and the co-consumption of opioids and stimulant drugs such as cocaine could be excluded, on one hand, for empirical reasons, as stated by Risser et al . 8, and on the other hand could be verified clearly in our study (2.63%). Thirdly, in our study population, pure heroin-related death represented only about a third of the heroin-related deaths: in the other two-thirds, morphine derivatives in combination with another drug and/or alcohol could be detected.…”

“…Fourthly, the quality of heroin was not asserted in detail although the codeine detected in about three-quarters of the victims indicate a certain heroin impurity, as already described by Risser et al . 8. However, in an earlier study by Risser et al .…”

“…All DRD cases must be reported to the coroner and have to undergo forensic post-mortems by law 5. At the Department of Forensic Medicine in Vienna, in the 1990s heroin overdose was the main cause of DRD 7,8.…”

“…Due to the fact that, particularly during the 1990s, the co-consumption of opioids with stimulants such as cocaine was somewhat low (about 6% according to Risser et al . 8), all the cases used in this study were taken from the years 1993 and 1994 to obtain a sample of opioid users which were as free from stimulants as possible, and to avoid the potential influence of cocaine or other analeptic agents on fibrous connective tissue (FCT) development in the myocardium.…”

Heroin poisoning deaths with 6-acetylmorphine in blood: demographics of the victims, previous drug-related offences, polydrug use, and free morphine concentrations in femoral blood

“…Studies have shown that the purity of illicit heroin might impact on toxicity and increase the risk of an overdose death [3,18]. Moreover, street heroin contains other opiates, such as 6-acetylcodeine, which accounts for the presence of codeine in the blood of heroin users [19].…”