SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P24
"THE DOSE MAKES THE POISON", DISCUSSION OF THREE CASES OF LETHAL HEROIN
INTOXICA TIONS
W Bemhard*, B Aebi, M Gasser, St. Bolliger, Institute of Legal Medicine, Bern, Switzerland,
W. Vycudilik, Institute ofLegal Medicine, Vienna, Austria
Introduction: The lethal dose of heroin differs widely. Tolerance plays a key role. To the persons in the
official Swiss heroin program, the drug is often prescribed in high dose. In spite of the medical
surveillance, lethal poisoning is not an uncommon finding.
Results: Case A) A 35 y.o. male administered himself (intravenously) under medical observation in 30 min.
400 mg chemically pure heroin and ingested 500 mg Morphine-retard. He then went back home. Two days
later he was found death in his flat. Toxicological findings: heart blood: free morphine 1605 nglmL, M-3-G
686 ng/mL, M-6-G 390 ng/mL. Interpretation: the deceased did not swallow the Morphine-retard capsules.
He smuggled them out of the injection place, the so-called "Fixerstilbli" and injected them instead. Cause
of death: heroin and morphine intoxication. Manner of death: suicide or accident. Case B) A 39 y.o. male
came by himself to a hospital with stomach pain. During the medical treatment he received O.2mg of
fentanyl and 5mg diazepam by the medical staff. During his stay he snorted two times a powder which was
believed by the nurses to be cocaine. Four hours after the start of the medical treatment he died.
Toxicological findings: serum (peripheral) sample taken at the hospitalization: free morphine 267 nglmL,
Codeine 32 nglmL. Serum from heart blood collected at the autopsy: free morphine 726 nglmL, codeine
120 ng/mL. Findings: The patient snorted, instead of cocaine, "street heroin". Cause of death: heroin
poisoning. Manner of death: suicide or accident. Case C) A 28 y.o. female was found dead in her flat. An
injection mark was found in her right antecubital fossa. Toxicological findings: heart blood: free morphine
140 nglmL, total morphine 693 ng/mL. Results of police investigation: a stranger injected approx. 400 mg
of street heroin (purity approx 15%) intravenously on this female on her request. Cause of death: heroin
poisoning. Manner of death: killing on request.
Conclusions: High doses of heroin and morphine are needed to satisfy the patients in the official heroin
program, and are typically tolerated by them. However, in spite of medical surveillance lethal overdoses are
observed. Quite low heroin doses may be lethal for opiate-naive subjects.
Keywords: heroin, morphine, postmortem
Page 359