Distribution of morphine in body fluids of heroin users.

Heroin (3,6-diacetylmorphine) is rapidly hydrolyzed to 6-monoacetylmorphine, which is further hydrolyzed to morphine (1). In this retrospective study, samples of biological fluids were analyzed for free morphine because it is the primary analyte found in biological samples obtained from victims of heroin fatalities (2). Of 1,175 cases reviewed, 29 heroin-induced fatalities were identified. Victims of heroin overdose were identified on the basis of history of chronic drug abuse and/or the presence of drug paraphernalia at the death scene. The autopsy findings revealed pulmonary congestion in 89.6% of the cases (N = 26) and fatty liver changes in 44.8% (N = 13). None of the fatalities reported were caused by abuse of prescribed or stolen morphine. Biological fluids analyzed were blood, urine, bile, vitreous humor (VH), and cerebrospinal fluid (CSF) whenever available. Morphine was first detected qualitatively in blood, urine, and/or bile by extraction followed by thin layer charomatography (3). Coat-A-Count serum morphine radioimmunoassay (RIA) kit (DPC, Los Angeles, CA) was used for quantitation of morphine in biological fluids. The gamma counter used was a Packard Multi Prias 1 Auto Gamma Counter, equipped with a scintillation detector, auto background subtract, data reduction, video display, and printer. This RIA method is highly specific for free morphine with low cross-reactivity to other narcotics and glucuronides of morphine. Methadone,