Forensic Science, 9 (1977) 49 - 52 @ Elsevier Sequoia S.A., Lausanne - Printed in the Netherlands

0 CASES OF HEROIN-RELATED SUICIDE

DWIGHT REED

Forensic Toxicology Laboratory, Department of the Sheriff Coroner, County of Orange, Santa Ana, Calif., 92702 (U.S.A.)

VINA R. SPIEHLER

Department of Medical Pharmacology and Therapeutics, California School of Medicine, Irvine, Calif., 92717 (U.S.A.)

R. H. CRAVEY

Forensic Toxicology Laboratory, Department of the Sheriff Coroner, County of Orange. Santa Ana, Calif., 92702 (U.S.A.}

(Received September 27,1976; accepted November 11,1976)

SUMMAR.Y

This report studies 2 suicides where the death was due to heroin injection. The morphine concentrations in various tissues as determined by radio-immunoassay and fluorometry are presented.

INTRODUCTION

Although reports of heroin-induced and heroin-related. deaths are not rare in the literature, a search failed to reveal any case described as a suicide. It is unlikely that the 2 cases in this report are unique since heroin is readily available and abused, and consequently may have been the agent selected in many suicides. Unequivocal suicides, however, are rare and data from such cases may be helpful in interpreting concentrations in other fatal cases. Drug histories are usually difficult to obtain in any case involving an illicit drug.

CASE HISTORIES

Case 1

A 20 year old male suffered a period of depression following an arrest and oncoming trial for burglary. A friend indicated the decedent had related to several people his intent to kill himself by jumping from a building, or by.. heroin overdose. On the day of death still another friend phoned him and was told that he had just injected 5 “bags” of heroin in a suicide attempt.

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When police arrived at the scene, the decedent was found fully dressed on a bed. Injection site scarring was observed in both the right and left ante- cubital fossae and multiple injection sites were noted on each foot. Several syringes, cotton swabs and 2 spoons were found at bedside. Laboratory analysis of the residue in the spoons gave evidence of 12 mg heroin and 3 mg procaine in one spoon and 13 mg heroin and 4 mg procaine in the other.

Case II

Three days prior to death a 24 year old male told his estranged wife he was going to destroy himself. The decedent had been dependent on heroin in the past but was thought to have successfully discontinued the habit. His room-mate told authorities that he had recently begun using the opiate again during his period of depression over marital problems.

The body was found on a mattress in a bedroom. A syringe, spoon, cotton and burned matches were adjacent to the body. Laboratory analysis of the syringe and spoon revealed the presence of 1.1 mg heroin and 0.6 mg procaine in the syringe and 5 mg heroin and 3 mg procaine in the spoon residue. A suicide note was found on the desk as well as a holographic will. Three needle marks were observed in the antecubital space of the right arm and one in the left arm.

PATHOLOGY

In Case I, the lungs were found to be moderately congested and evidence was present of gastric aspiration. In Case II, moderate to markedly congested lungs were observed.

TOXICOLOGY

In both cases, blood, brain, lung, liver, kidney and urine were analyzed for morphine by radio-immunoassay using AbuscreenTM obtained from Roche Diagnostics, Hoffman-LaRoche, Inc., Nutley, N.J. 07110 and the supernatant counted on a Beckman BiogammaTM Gamma Counter (Beckman Instruments Inc., Irvine, Calif. 92664). The iodinated kit was used without modification according to the manufacturer’s suggestions for quantitative assay. Standards and blood samples were diluted as required with normal serum (Hyland Laboratories, Costa Mesa, Calif. 92626). Urine samples were diluted with drug-free normal urine provided in the AbuscreenTM kit.

Brain, lung, liver and kidney were homogenized in normal saline (1 g tissue with 1 ml saline).

Confirmation of morphine was by thin-layer chromatography [l] . Selected tissues were also analyzed for morphine by fluorometry. The

urine and bile were acid hydrolyzed and filtered before saturating with

TABLE I

Morphine concentration in two intravenous heroin suicides (pg/g or ,ug/ml) _

Case I Case II

Procedures -

Radio-immunoassay Fluorometric Radio-immunoassay Fluorometric

Blood 0.41 0.64 0.38 0.63 Brain 0.35 0.69 0.25 0.50 Lung 0.97 0.21 0.14 0.27 Liver 0.66 NA 0.35 NA Kidney 1.51 NA 0.70 NA Urine 0.10 0.25 0.49 0 Rile NA 40.0 NA 0

NA = Not analyzed.

sodium bicarbonate. The blood, brain and lung were homogenized with 2 parts saturated sodium bicarbonate and the samples were then extracted as amphoterics and analyzed on Perkin-Elmer MPF-2A Fluorescence Spectro- photometer [ 11.

Blood, liver, urine and gastric contents were also screened for the presence of acidic, neutral and basic drugs. None were found in either case. Using gas chromatography [2] ethanol was found present in the blood in Case II, in the concentration of 180 mg/lOO ml.

Morphine concentrations found in the tissues of both cases are given in Table I. The radio-immunoassay values are reported as morphine equivalents. The fluorometric values are reported as “free” morphine for the blood, brain and lungs and total morphine for the urine and bile. Although there are differences in the values as determined by the 2 procedures, these are consis- tent with those discussed previously [l] .

DISCUSSION

These 2 cases have provided a unique opportunity to study the distribu- tion of morphine, the major metabolite of heroin, in 2 cases determined by history to be suicides. Previous studies have indicated a wide range of tissue concentrations following heroin injection [3-6] in cases not designated as suicides. In 22 cases reported by Garriott and Sturner [3] in which death occurred within 3 hours following the intravenous administration of heroin, the concentration of free morphine in the blood ranged from 0.01 ,ug/ml to 0.09 ,ugg/ml. Robinson and Williams [4] reported a free morphine bload range of 0.0 to 0.1 pg/ml in heroin-related deaths, and Johnson et al. [5] found a comparable range in a series of cases involving death in heroin addicts. More recently Richards et aZ. [6] studied 114 cases attributed to

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intravenous narcotism and found a morphine blood concentration range of O-2 @g/ml.

In 23 cases in which survival time was less than 2 hours a post-mortem blood morphine concentration ranged from 0.02 @/ml to 2.0 &ml [6].

Residual drugs found at the scene in both cases revealed the presence of both heroin and procaine. In the western United States procaine is almost always found in heroin. The pharmacological effect of heroin and procaine in combination has not been studied in man; consequently the effect is unknown. Procaine may be significant in many of the heroin-related deaths since small amounts have been found to cause a toxic reaction in hypersensitive subjects [ 71.

REFERENCES

1 V. R. Spiehler, D. Reed, R. H. Cravey, W. P. Wilcox, R. F. Shaw and S. Holland, Com- parison of results for quantitative determination of morphine by radio-immunoassay, and spectrofluorometry, J. Forensic Sci., 20 (1975) 647-655.

2 D. Reed and R. H. Cravey, A quantitative gas chromatographic method for alcohol determination, J. Forensic Sci. Sot., 11 (1971) 263-265.

3 J. C. Garriott and W. Q. Sturner, Morphine concentrations and survival periods in acute heroin fatalities, N. Eng. J. Med., 2389 (1973) 1276-1278.

4 A. E. Robinson and F. M. Williams, Post-mortem distribution of morphine in heroin addicts, Med. Sci. Law, 11 (1971) 135-138.

5 E. H. Johnson, L. R. Goldbaum and R. L. Whelton, Investigation of sudden deaths in addicts, Med. Ann. D.C., 38 (1969) 375-380.

6 R. G. Richards, D. Reed and R. H. Cravey, Death from intravenously administered narcotics: a study of 114 cases, J. Forensic Sci., 21 (1976) 467-482.

7 E. G. C. Clarke, The Isolation and Identification of Drugs, Pharmaceutical Press, London, 1969, p. 513.