6-o-monoacetylmorphine and Morphine-Dependence

The interpretation of toxicological findings is critical for the thorough investigation of the use and abuse of psychoactive substances. A positive analytical result for a sample taken could usually result in criminal proceedings and a punitive outcome for the defendant whose sample was analysed. The detection of markers of illicit opiate misuse is important both in the management of substance misuse and in the postmortem identification of illicit opiate use. The aim of this study was to emphasise the role of opiate biomarkers available at the laboratory and in the clinical environment. Urine remains the biological tool of choice for qualitative detection of illicit drug use in a clinical setting, while quantitative accuracy remains strictly the domain of blood. Accurate interpretation of the screening tests within a clinical setting alongside other relevant information remains the key to the usefulness of any test. Moreover, the finding of a morphine/codeine concentration ratio in blood exceeding unity is a strong evidence that the person had used heroin, as opposed to having taken a prescription analgesic drug containing codeine.

Topics: Biomarkers; Humans; Morphine Dependence; Morphine Derivatives; Opiate Alkaloids; Opioid-Related Disorders; Pain; Substance Abuse Detection

Drugs contributing to overdose deaths are listed on death certificates, but their validity is rarely studied. To assess the accuracy of "morphine" and "codeine" listings on death certificates for unintentional overdose deaths in Allegheny County, PA, investigative and laboratory reports were reviewed. Deaths were reclassified as heroin-related if documentation showed 6-monoacetylmorphine in blood or urine, "stamp bags" or drug paraphernalia at scene, history of heroin use, or track marks. Deaths were considered morphine-related if notes indicated morphine use, prescription, or morphine at scene, or codeine-related if the codeine blood level exceeded morphine. Of 112 deaths with morphine but not heroin listed on the death certificate, 74 met heroin criteria and 21 morphine criteria. Of 20 deaths with both morphine and heroin listed, only one met morphine criteria. Of 34 deaths with codeine listed, only five were attributed to codeine. Consideration of patient history, death scene evidence, and expanded toxicology testing may improve the accuracy of death certificate drug listings.

Topics: Accidents; Codeine; Coroners and Medical Examiners; Death Certificates; Drug Contamination; Drug Overdose; Forensic Toxicology; Heroin Dependence; Humans; Morphine Dependence; Morphine Derivatives; Pennsylvania

A well-established possibility to treat opiate addiction is the participation in opiate maintenance treatment programmes. For this purpose the opioids methadone and buprenorphine have been evaluated and are used nowadays in many countries. However, since 1998 also the use of slow-release oral morphine (SROM) has been legally permitted in Austria. Our data show that these morphine preparations are frequently abused and are dominating the black market in the meantime. Especially the intravenous consumption of SROM goes along with highly dangerous side effects that exceed the risks of needle sharing alone. Special galenics are supposed to ensure a 24 h effect of the otherwise quickly metabolised morphine. If dissolved and injected, insoluble contents such as talcum cause microembolisms, leading to severe damages of the inner organs. Furthermore, SROM, i.e. a drug prescribed by physicians, has been proved to be the main responsible substance in most drug related deaths since its permission and has nearly replaced heroin. Forensic physicians play a major role in the profound examination of these cases, including extensive toxicological analyses and interpretation of results. For instance, a differentiation between a recent morphine and heroin consumption is certainly possible, provided appropriate methods are used. A reliable estimation of the current situation of drug abusing habits is a premise for adequate therapeutic offers and preventive measures. Thus, well-founded and comparable data have to be collected. To facilitate data report a standardized report form has been developed that includes an obligatory statement regarding morphine or heroin consumption. This should help to enlighten the ongoing discussion on the role of SRM in drug abuse cases. Our results indicate that the prescription of SROM in opiate maintenance therapy has to be handled very strictly and should be reserved for special patients only. A slackening of the Austrian law concerning SROM is therefore objected.

Topics: Administration, Oral; Austria; Brain; Cause of Death; Delayed-Action Preparations; Drug Overdose; Foreign-Body Reaction; Heroin Dependence; Humans; Lung; Microscopy, Polarization; Morphine; Morphine Dependence; Morphine Derivatives; Myocardium; Narcotics; Pulmonary Embolism; Substance Abuse Detection; Substance Abuse, Intravenous; Talc

To prepare anti-morphine vaccine antibody with high titer and good specificity and to identify its properties.. Chemically synthesized 6-succinylmorphine (M-6-S) was cross-linked to BSA in pH 9.0 carbonate buffer. After being purified by gel filtration and (NH4)2SO4 salting out, the immunogen was used to immunize BALB/c mice and SD rats. The titer and specificity of antisera were identified by ELISA and neutralization inhibition test, respectively. The effect of the immunization was examined by the radiant heat tail-flick (TF) reflex test.. The titers of antiserum from immunized BALB/c mice and SD rats were up to 1:200,000 and over 1:20,000, respectively. Neutralization inhibition test proved that the anti-morphine vaccine antibody had the cross-reactions to following drugs with analogous structure as morphine: 6-monoacetylmorphine, heroin and codeine. The TF reflex test showed: (1) TF reflexes were notable inhibited after intraperitoneal injection of 2 mg/kg morphine, and (2) percentage of the maximum possible effect (% MPE) reduced 74.7%, (3) the TF latency recovered to the baseline level much more rapidly compared with the control rats.. The M-6-S-BSA vaccine has been prepared successfully. The BALB/c mice and SD rats immunized with the vaccine can produce anti-morphine antibody with high titer and satisfactory specificity, which may significantly reduce rats' antinociception against morphine.

Topics: Animals; Antibody Specificity; Dose-Response Relationship, Immunologic; Immunization; Male; Mice; Mice, Inbred BALB C; Models, Animal; Morphine; Morphine Dependence; Morphine Derivatives; Rats; Rats, Sprague-Dawley; Serum Albumin, Bovine; Vaccines

Urine and blood concentrations of free and total morphin or 6-monoacetylmorphin were presented in fatal cases of morphin type opiates abuse. A solid phase extraction method was developed for isolation of drugs and their metabolities from biological material which used Separcol small columns with non-polar contents SI C 18T. Thin layer chromatography with densitometry anabled screening for quality evaluations. Resultes were compared with those obtained by fluoropolarizing immunodetection on Abbotts TDxFLx device. Possibility and cause of false positive results were discussed when using initial, screening, commercially available immunotests.

Topics: Adolescent; Adult; Chromatography, Thin Layer; Densitometry; Drug Overdose; Forensic Medicine; Humans; Male; Morphine; Morphine Dependence; Morphine Derivatives