Morphine Concentrations and Survival Periods in Acute Heroin Fatalities

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Abstract
Histopathological examination of the lung was used to separate 22 acute heroin fatalities according to the duration of survival after the last injection of drug, and the morphine concentrations in autopsy specimens were determined. The level of free morphine In the blood was found to correlate with the time of survival and ranged from 10 to 93 μg per 100 ml in the short-interval group (up to three hours). A small quantity (6 μg per 100 ml) was detected three days after the last injection in one case. These findings concur with the previously reported biphasic half-life of morphine in the blood. The presence of ethyl alcohol and other drugs was noted in 16 cases, whereas the role of adulterants, hypersensitivity and other factors in the lethal episode was not evident. Such observations support the concept of a toxic mechanism of death and the term "overdose" is probably an appropriate one. (N Engl J Med 289:1276–1278, 1973)