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Online first: January 31, 2019 SUMMARY Introduction/Objective Heroin is metabolized to 6-monoacetylmorphine (6-MAM) and morphine. The objective of this study is to examine 6-MAM, morphine, and codeine relationships in order to distinguish deaths related to heroin consumption from deaths related to morphine and/or codeine consumption. Methods The autopsy blood and urine samples from 45 opioid drug addicts were examined. Gas chromatography/mass spectrometry was applied to evaluate morphine, 6-MAM, and codeine. Two groups were formed: 6-MAM-positive (n = 35) and 6-MAM-negative (n = 10). Results Compared to the 6-MAM-negative group, blood morphine levels were higher in the 6-MAMpositive group (p = 0.022), while blood codeine levels were similar (p = 0.575). In the 6-MAM-negative group, the blood morphine/codeine ratio was 8.3, and it was 4.3 in the 6-MAM-positive group. There was no difference between the groups regarding urine morphine levels (p = 0.859). The urine morphine/codeine ratio was 6.2 in the 6-MAM-negative group, whilst it was 32.2 in the 6-MAM-positive group. In the blood samples, morphine and codeine concentrations were significantly correlated (r = 0.607; p = 0.006). In urine samples, correlations between morphine and codeine (r = 0.766; p < 0.001), morphine and 6-MAM (r = 0.650; p < 0.001), as well as codeine and 6-MAM (r = 0.620; p < 0.001), were also significant. Conclusion Analyses of 6-MAM and morphine/codeine ratio in blood and urine autopsy samples may be used as diagnostic tools to distinguish deaths related to the consumption of different opioid drugs.

The importance of 6-MAM levels and morphine/codeine ratio in diagnosis of death among drug addicts