Fatal poisonings in young drug addicts in the Nordic countries: a comparison between 1984–1985 and 1991

Fatal poisonings among young drug addicts (15–34 years) in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden in 1991 were investigated and compared to a similar investigation for 1984–1985 (Sweden for 1984 only). A common definition of ‘drug addict’ has been applied by the participating countries. In both investigations, the greatest number of drug addict deaths was seen in Denmark calculated per 10⁵ inhabitants, followed in descending order by Norway, Sweden, Finland and Iceland. An increased number of deaths was observed from 1984–1985 to 1991 in all five countries. The increase in Denmark and Sweden was small while the number of deaths was more than doubled in Norway and Finland. The increased number of cases in Norway and Sweden in 1991 is mainly due to a greater number of deaths in the age group 25–34 years. In Finland, the increased number was seen mainly in the age group 15–24 years. In the two investigations heroin/morphine caused most of the fatal poisonings in Norway and Sweden. In Denmark, heroin/morphine caused about half of the fatal poisonings only, and strong analgesics other than heroin/morphine caused about one third of the deaths. In 1984–1985 it was methadone, propoxyphene and ketobemidone and in 1991 mostly methadone. The number of heroin/morphine related deaths in Finland increased from 1984–1985 to 1991, but other drugs and poisons caused a much higher proportion of the deaths. Pentobarbital caused the only fatal poisoning in Iceland in 1991.     

Classification of Opium by UPLC‐Q‐TOF Analysis of Principal and Minor Alkaloids

Opium is the raw material for the production of heroin, and the characterization of opium seizures through laboratory analysis is a valuable tool for law enforcement agencies to trace clandestine opium production and trafficking. In this work, a method for opium profiling based on the relative content of five principal and 14 minor opium alkaloids was developed and validated. UPLC‐Q‐TOF was adopted in alkaloid analysis for its high selectivity and sensitivity, which facilitated the sample preparation and testing. The authentic sample set consisted of 100 “Myanmar” and 45 “Afghanistan” opium seizures; based on the data set of the 19 alkaloid variables in them, a partial least squares discriminant analysis classification model was successfully achieved. Minor alkaloids were found to be vitally important for opium profiling, although combined use of both principal and minor alkaloids resulted in the best geographical classification result. The developed method realized a simple and accurate way to differentiate opium from Myanmar and Afghanistan, which may find wide application in forensic laboratories.     

Heroin fatality due to penile injection

Death due to heroin overdose and/or rapid injection of heroin is a frequent occurrence among opioid addicts. We present an unusual case of heroin fatality due to the injection of the drug in the penis. Blood, urine, bile, and vitreous humor concentrations of morphine were 0.68, 0.49, 0.32 and 0.062 microg/ml, respectively. Ethanol was detected at concentrations of 104, 124, 106, and 94 mg/dl in the blood, urine, bile, and vitreous humor, respectively. The cause of death was determined to be due to heroin and ethanol intoxication.     

Fentanyl-related deaths: demographics, circumstances, and toxicology of 112 cases

Since 1979, the potent narcotic analgesic fentanyl and its analogs have been synthesized in clandestine laboratories and sold as heroin substitutes. At least 112 overdose deaths have been associated with their use. In this study, toxicology data, autopsy findings, and coroners' investigative reports were reviewed in order to construct a profile of the typical fentanyl overdose victim and to identify any factors that might heighten the risk of death from fentanyl use. The "typical" fentanyl overdose victim was 32.5 +/- 6.7 years of age (range, 19 to 57 years), male (78%, compared with 22% female), and Caucasian (50%, compared with 29% Hispanic, 20% Black, and 0.9% Asian). With the exception of his or her age, the typical fentanyl overdose victim is quite similar to the typical heroin user. Nearly all the deaths (94%) occurred in California, yet within the state they were widely distributed throughout 17 counties and 44 cities. Pulmonary edema and congestion and needle puncture sites were consistent postmortem findings. No preexisting medical conditions were identified as possible risk factors. Although most of the fentanyl victims had a prior history of intravenous drug use, morphine or codeine were not commonly found, which suggests that the victims had little or no opiate tolerance. Ethanol was present in 38% of the cases and is thought to be a significant risk factor. Mean fentanyl concentrations in the body fluids were quite low: 3.0 +/- 3.1 ng/mL (0.3 +/- 0.31 micrograms/dL) in blood and 3.9 +/- 4.3 ng/mL (0.39 +/- 0.43 micrograms/dL) in urine, measured by radioimmunoassay. Although the potency of the analogs and the purity of street samples varies considerably, it is probably the general availability of the drug rather than the potency of a particular analog that determines the incidence of overdose deaths.     

Chlorinated Opium Alkaloid Derivatives Produced by the Use of Aqueous Sodium Hypochlorite During the Clandestine Manufacture of Heroin

Abstract:  A clandestine chemist was observed producing heroin from crude morphine utilizing a solution of sodium hypochlorite during the process. Numerous chlorinated opium alkaloid derivatives were created when the morphine acetylation reaction was quenched and neutralized with a solution of sodium hypochlorite and ammonium hydroxide. Four of these compounds, 1-chloroheroin, 1-chloroacetylcodeine, 1-chloro-O⁶-monoacetylmorphine, and 2'-chloropapaverine, were characterized via preparative isolation, gas chromatography/mass spectrometry, nuclear magnetic resonance spectroscopy, and independent synthesis. These chlorinated derivatives were formed via electrophilic aromatic substitution with free chlorine during the illicit process. Although no illicit heroin exhibits containing these compounds have been observed in seizures to date, mass spectral data are provided for several of these compounds for their identification should they be seen within future seizures of illicit heroin.     

Evaluation of the role of abstinence in heroin overdose deaths using segmental hair analysis

In the body heroin is rapidly metabolized to 6-acetylmorphine and morphine. Victims of lethal heroin overdose often present with fairly low blood concentrations of morphine. Reduced tolerance due to abstinence has been proposed to account for this finding. The aim of the present study was to examine the role of abstinence in drug-related deaths by comparing recent and past exposure to opioids using segmental hair analysis with the postmortem blood morphine concentrations in deceased heroin users. The study included 60 deceased drug addicts in the Stockholm area, Sweden. In 32 cases, death was not related to heroin intake. In 18 of the 28 heroin fatalities, opioids were absent in the most recent hair segment, suggesting a reduced tolerance to opioids. However, the blood morphine levels were similar to those found in the 10 subjects that showed continuous opioid use. Hair and blood analysis disclosed an extensive use of additional drugs that directly or indirectly may influence the opioid system. The results suggest that abstinence is not a critical factor for heroin overdose death. Obviously tolerant subjects die after intake of similar doses. Other factors, particularly polydrug use, seem to be more causally important for these deaths.     

The Prevalence of Paraphernalia Found at the Scene of Drug‐Related Deaths

Many illicit drugs involve the use of paraphernalia, and the presence of paraphernalia found at the scene of death may suggest that the death is drug‐related. Few sources of objective data are available regarding the prevalence of drug paraphernalia found at the scene of drug‐related deaths or the likelihood of a death with drug paraphernalia found at the scene to be drug‐related. This study reviews the deaths which were investigated by the Bexar County Medical Examiner's Office in an attempt to provide objective data. Over 4000 deaths with scene investigations were reviewed, and the presence of paraphernalia was found to be strongly associated with the death being drug‐related, heroin‐related, or cocaine‐related with the relative risk for each being 5.0, 15.4, and 6.6, respectively. This confirms that the presence of drug paraphernalia at the scene of death strongly suggests the death to be drug‐related and in particular heroin‐related.     

A Rush to Judgment?: The Origin of the 2001 Australian “Heroin Drought” and its Implications for the Future of Drug Law Enforcement

This paper reassesses the origins of what has been referred to as the Australian “heroin drought.” It looks at the theories that circulated in drug policy circles immediately after the supply shortage was discovered in 2001. It concludes that there may have been a ”rush to judgment” as these inferences were based on unsatisfactory data. As such, none of the theories that were advanced at the time hold true — the shortage was almost certain to have been the result of a Taliban- enforced reduction of Afghanistan grown opium. As interdiction strategies were one of the main theories for the shortage, this might seem disappointing, especially as supply reduction strategies struggle to maintain relevancy against a growing shift to demand reduction and harm reduction strategies. But this situation should not be the case — drug seizures should not be hailed as law enforcement's central strength in this or any other situation. Instead, the strong point of policing should be seen as the broad approach it takes to reduce crime through its attack on all criminal enterprises, not just its assault on a particular criminal sector — like the drug trade.     

The scourge of opiates: The illicit narcotics trade in the Islamic Republic of Iran

This study seeks to provide an overview of drug trafficking in Iran, particularly as it relates to the Iran–Afghan and Iran–Pakistan border regions. Data were obtained from a systematic review of the academic literature and from open sources, including media reports and official documents. The Iranian government is credited with dedicating substantial resources to combating the drug trafficking. Despite these efforts, Iran continues to be the most significant transit country for opium and heroin from Afghanistan. Several factors are identified that help to explain why Iran, despite its efforts, continues to play a central role in the international drug trade.     

The detection and estimation of (A) arsenic in opium, and (B) strychnine in opium and heroin, as a means of identification of their respective sources

Samples of opium with arsenic as an adulterant, and both opium and heroin with strychnine as an adulterant are not infrequently encountered in the local drug scene. The paper describes a method for the possible identification of the sources of opium and heroin in the local market on the basis of an accurate quantitation of the adulterant arsenic and strychnine contents of the respective samples. A possible extension of this concept, would be the possibility of a similar identification of sources outside the country with a view to establishing channels of entry from abroad. Arsenic is determined by the Gutzeit method while strychnine is estimated by high performance liquid chromatography (HPLC).     

Deaths from drug overdose and toxicity in Turkey: 1997-2001

Turkey is located on the main overland connection between Asia and Europe, making the country potentially vulnerable to drug trafficking and its associated harms. The aim of the present study is to explore the frequency of all deaths from drug overdose and toxicity in Turkey and to describe some of the characteristics of these deaths. We collected data on all deaths from drugs in Turkey between 1997 and 2001 using records from the Council of Forensic Medicine. Data obtained from autopsy reports were retrospectively analyzed. In the present study, 374 deaths from drugs were reported in Turkey, with a mortality rate of 0.17 per 100,000 population. Highest mortality rates were found in Istanbul (0.83) and Gaziantep (0.71). The mean age was 34.0, and most cases (71.7%) were below the age of 40. The proportion of female cases was 13.6%. Opiates were implicated in 91.5% of deaths and benzodiazepines in 25.9%. Two fifths (38.8%) of the cases involved use of more than 1 drug. In 36.6% of cases, the route of final drug administration was by injection. The most common location of death was at a home (33.7%). Interventions to reduce drug use nationally are urgently required. International cooperation in social-educational activities, scientific research, and security measures is essential for this war.     

Drugs--a growing problem in Sri Lanka

Cannabis, hashish and opium were the drugs generally abused in Sri Lanka. The laws relating to drugs were consolidated in 1935. Heroin is the most widely abused drug today. Tourists are mainly responsible for the introduction of heroin into Sri Lanka. The separatist terrorists of Sri Lanka are engaged in trafficking in drugs to find the money for the purchase of arms and ammunition.     

An epidemic of intravenous narcoticism deaths associated with the resurgence of black tar heroin

In the latter part of 1985, a dramatic rise in the number of illicit narcotic (heroin) related deaths in the State of New Mexico became apparent, and this increase persisted through the majority of the following year. A careful inspection of samples of narcotics found at the scenes of death, coupled with changes in the illicit drug traffic detected by local and state law enforcement agencies, revealed that the rising death rate corresponded with the distinctively increased availability of a form of heroin that is produced in Mexico, commonly termed "black tar" heroin. An analysis of heroin deaths, comparing characteristics of cumulative deaths in the six years before the increase with those deaths associated with the apparent epidemic, revealed several significant observations. These factors, along with the distinctive physical features of black tar heroin, suggest that the rise in the narcotic abuse death rate may be related to both unfamiliarity with this type of heroin on the part of the user and the inherent difficulty of diluting nonpowdered forms of the drug to sublethal levels.     

Heroin impurity profiling: trends throughout a decade of experimenting.

Heroin is still one of the most frequently abused drugs of today. All over the world, law enforcement agencies try to eradicate the illicit production and trafficking of this potent and highly addictive narcotic. To this aim, important information is provided by physical and chemical toxicological analysis of confiscated samples, with special attention for the identification and the quantification of minor components, such as the impurities related to the origin and manufacturing. By combining these data complex characterisations, i.e. impurity profiles, chemical signatures or fingerprints, can be obtained and used for comparative analysis. This review focuses on heroin impurity profiling during the 1990s, proclaimed by the United Nations as the 'Decade for Eradicating Drug Abuse'. Special attention will be given to the new trends in analytical techniques as well as in data handling strategies, so called chemometrics, to produce these profiles. The latter can be used in comparative analysis of seized heroin samples for tactical (batch-to-batch comparison) and strategic (origin determination) intelligence purposes.     

Analysis of cocaine-positive fatalities

A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies. Cocaine-positive fatalities were more likely in the young black and Hispanic and male population. In addition to cocaine and its metabolites, heroin and other opiates were found in 39% of persons and ethanol in 33% and barbiturates and minor tranquilizers in only 2% of the deceased. Cocaine overdose was responsible for 4% of the deaths and overdose with heroin and cocaine for 12% of the deaths. Violence was often the cause of death. Thirty-eight percent died of homicide, seven percent of suicide, and eight percent from accidents. Of particular interest were 6 persons who died of acute cardiac events directly related to cocaine as well as 4 cases of ruptured dissections of the ascending aorta, and 9 cases of cerebral hemorrhage. Autopsy findings for these individuals are described, and possible mechanisms of death are discussed.