A Quantitative and Comparative Study of Heroin-Related Metabolites in Different Postmortem Fluids and Tissues

This study assessed and compared the postmortem concentrations of 6-monoacetylmorphine [6-MAM] and 6-acetylcodeine [6-AC], morphine, and codeine in various tissues and fluids from 52 postmortem cases related to heroin use. Samples were received at the Poison Control and Forensic Chemistry Center in Jeddah, Saudi Arabia, and analyzed using liquid chromatography-mass spectrometry. Descriptive and inferential statistics, including median, range, variability, and outliers, were used for analysis. The results showed significant variability in heroin and metabolite concentrations across different fluids and tissues. Tissue specimens were analyzed in 38 cases (73%), with 50% of cases exhibiting putrefaction. Blood and tissue samples were available in 39 cases, highlighting the need for alternative specimens in challenging cases. Notably, heroin metabolites were detected in unique matrices, such as nasal swabs, bladder tissues, lung tissues, and small intestine tissues, underscoring the potential of these samples in forensic investigations, especially when traditional bodily fluids are unavailable or compromised. These findings suggest that environmental factors, timing of substance use, and postmortem changes influence substance distribution, emphasizing the need to consider the location of death when interpreting toxicological results for accurate forensic analysis. This study provides valuable insights into the distribution, correlation, and significance of heroin and its metabolites in postmortem samples, aiding the confirmation of heroin overdose. These findings contribute to the limited data on postmortem cases in the Middle East and North Africa, particularly Saudi Arabia, supporting efforts to curb drug abuse in this region. This knowledge can inform public health strategies and forensic practices, ultimately aiding efforts to address and mitigate drug abuse.