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

Abstract

AimsThe main intention of this retrospective study was to investigate whether chronic illicit drug abuse, especially the intravenous use of opioids (heroin), could potentially trigger the development of myocardial fibrosis in drug addicts.DesignA retrospective case–control study was performed using myocardial tissue samples from both drug-related deaths (DRD) with verifiable opioid abuse and non-drug-related deaths in the same age group.SettingDepartment of Forensic Medicine, Medical University of Vienna, Austria (1993–94).ParticipantsMyocardial specimens were retrieved from 76 deceased intravenous opioid users and compared to those of 23 deceased non-drug users.MeasurementsDrug quantification was carried out using the enzyme-multiplied immunoassay technique (EMIT), followed by [gas chromatography–mass spectrometry (GC–MS), MAT 112®], and analysed using the Integrator 3390A by Hewlett Packard® and LABCOM.1 computer (MSS-G.G.). The amount of fibrous connective tissue (FCT) in the myocardium was determined by using the morphometric software LUCIA Net version 1.16.2©, Laboratory Imaging, with NIS Elements 3.0®.FindingsDrug analysis revealed that 67.11% were polydrug users and the same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM)—32.89% were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63% consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum and 275.52 ng/g in the medulla oblongata, respectively. Morphometric analysis exhibited a strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT content in the drug group was 7.6 ± 2.9% (females: 6.30 ± 2.19%; males: 7.91 ± 3.01%) in contrast to 5.2 ± 1.7% (females: 4.45 ± 1.23%; males: 5.50 ± 1.78%) in the control group, indicating a significant difference (P = 0.0012), and a significant difference in the amount of FCT between females and males (P = 0.0383). There was no significant interaction of age and FCT (P = 0.8472).ConclusionsThere is a long-term risk of cardiac dysfunction following chronic illicit drug abuse with opioids as a principal component. Regular cardiological examination of patients receiving substitution treatment with morphine is strongly recommended.

Recent Insights Into Cardiovascular Disease (CVD) Risk Among HIV-Infected Adults

“…[41] This can lead to cardiomyocyte dysfunction and increased stiffness, and eventuate in heightened interstitial fibrosis. [42] Apart from pro-inflammatory insults from HIV and co-infections, illicit drugs, such as cocaine, [43] opiates [44] and alcohol, [45] can play a major role.…”

Density and Mineral Content Dynamics of Bone Tissue Against the Background of Opioid Influence

“…Discussion. the results of the study show that, on the backdrop of prolonged use of opioid drugs, expressed changes occur not only in the tissues of the brain, liver, pancreas, myocardium, kidneys and other internal organs [1,3,4,6,14,15,17 ], as described in numerous literary sources, but also in bone tissue -in particular, in its mineral component, which must be taken into account in the medicine prescriptions and conducting the treatment courses, using drugs of this group [20].…”

Accumulation of Highly Stable ΔFosB-Isoforms and Its Targets inside the Reward System of Chronic Drug Abusers - A Source of Dependence-Memory and High Relapse Rate?

“…All of the deceased underwent drug testing using two different, validated methods as described before [16][17][18]. The concentration of morphine was determined in the medulla oblongata, the cerebellum and, if available, in the blood, the hair and the urine.…”