Forensic Pathology for Police - Brainshare Public Online Library

Opiates and Related Substances 279
Fig. 11.23 Using polarized light, the foreign material present within the lung in Fig. 11.22 is
readily apparent (photo courtesy of Dr. Patrick E. Lantz, MD, Wake Forest University, Winston-
Salem, NC)
There may be gross evidence of constipation (impacted stool within the bowels)
and/or urinary retention (a markedly distended bladder) (Disc Image 11.23).
The preceding paragraphs provide basic information that may be considered
common to all opiates. The following paragraphs provide additional information
regarding specific drugs.
Morphine
Morphine is a legal, but restricted opiate that is considered one of the best drugs
for pain relief. Its use is regulated such that it may only be dispensed with a prescription.
Injectable and oral preparations are common. As with other opiates, drug
dependence and addiction may form in persons using this drug and, as such, abuse of
morphine is relatively common. Its half-life is much longer (>1 hour) than its illegal
counterpart, heroin. Since heroin is actually metabolized into morphine, morphine is
frequently detected in postmortem samples of persons dying from heroin overdose.
Heroin
The chemical name of heroin is diacetylmorphine (two acetyl groups attached
to morphine). Its half-life is only about 5 minutes. It is first metabolized to
6-monoacetyl morphine (6-MAM), which is subsequently metabolized to morphine.
Heroin continues to break down after death, such that it is relatively uncommon to
identify heroin itself in postmortem samples. The presence of 6-MAM confirms that
heroin was present. The use of sodium fluoride containing tubes (gray-top tubes)
for blood collection helps to prevent continued metabolism of heroin and 6-MAM.
Since the metabolism of heroin is so fast, a definite postmortem “lethal level” has not