[elliott006]

My brother died on November 1, 2007. I recently received his autopsy report. The cause of death was cocaine and heroine intoxication. I am looking for insight into the drug levels that were found in his body. I have scoured the Internet for information on toxic/fatal drug levels but have been unsuccessful in finding any information. I do realize that tolerance plays a part. I am hoping someone here has a quasi-medical background and might be able to shed some light or give me an informed opinion. I want to know if these levels are high or not:

Alprazolam .029 mg/L (blood, femoral)
Benzoylecgonine  .11 mg/L (blood, femoral)
Morphine .09 mg/L (blood, femoral)

The heroine metabolite Monoacetylmorphine was found but the report does not specify 3 or 6 and it does not give a level; it just says detected (vitreous). 

Thank you in advance for your help.

[Arkcon]

By remarkable coincidence, there's a lot of useful information for you in this thread here:

http://www.chemicalforums.com/index.php?topic=22225.0;topicseen

It might be a little out of your league, but if you study it much of it may come together for you.

[elliott006]

Thank you for the redirect. I now assume that a level of .11 mg/L (110,000 ng/L)  of benzoylecgonine is on the high side; especially once you factor in the half life. I know the blood samples were not tested immediately but I think they were tested in an appropriate time frame. It was just all the protocol that took it so long for the report to reach me.

Can anyone add insight to the heroine?

[elliott006]

Will a half life calculation of a drug still be applicable post mortem since the body is no longer metabolizing it? If there is no longer metabolization then the time from sampling to testing is unimportant. Am I way off here?

[limpet chicken]

That seems like quite a bit of alprazolam to me, considering its high potency, short half life and dose response curve.

It is marketed in 0.25, 0.5, 1 and 2mg IR tablets and 3mg sustained release tablets, has a fairly short duration of action (1-2 hours or so on the low side) and is synergistic with opioids, taking both alprazolam and morphine will produce quite severe respiratory depression, and mixing opiates with cocaine (which is what produced that benzoyl ecgonine) is also dangerous, the so called speedball effect, results in greater cardiotoxicity than with cocaine alone, and cocaine is already pretty cardiotoxic, intravenous use of local anaesthetics is known to produce high plasma concentrations quickly, cocaine nasally or orally will produce a less steep dose response curve than IV use, but the dosages are higher, and amounts used quite excessive sometimes (going through a gram in an hour isn't unusual for some users, and I have gone through up to an 8th oz in a night in the past of what yielded avg. 60-75% after cleaning up and recrystallisation of street product)

[horse_lover200613]

I believe I can give you a quite accurate answer if you would give me an estimate of your brothers height and weight.  That plays a large factor in the accuracy of my answer.
Horse_lover200613
Mallory

[chiralic]

Hello everyone:

Please check it out :
http://www.jatox.com/abstracts/2000/jan-feb/59-apple.htm

Chiralic

[chiralic]

Hi elliott006:

The following information can help you about your question...so if you need  more detail about it please write me a private email to chiralic@gmail.com

G. Skopp
Preanalytic aspects in postmortem toxicology
Forensic Science International Volume 142, Issues 2-3, 10 June 2004, Pages 75-100
http://dx.doi.org/10.1016/j.forsciint.2004.02.012 <=(click on the link)

Olaf H. Drummer
Postmortem toxicology of drugs of abuse
Forensic Science International Volume 142, Issues 2-3, 10 June 2004, Pages 101-113
http://dx.doi.org/10.1016/j.forsciint.2004.02.013 <=(click on the link)

Cannabis and cocaine: a lethal cocktail triggering coronary sudden death
Cardiovascular Pathology   (article IN PRESS)
http://dx.doi.org/10.1016/j.carpath.2007.05.005 <=(click on the link)

R. Wennig
Threshold values in toxicologynext term — useful or not?
Forensic Science International Volume 113, Issues 1-3, 11 September 2000, Pages 323-330
http://dx.doi.org/10.1016/S0379-0738(00)00254-1 <=(click on the link)

Also, I copied a couple abstract of Toxicological Reviews:

Flanagan RJ, Connally G.
Interpretation of analytical toxicology results in life and at postmortem.
Toxicol Rev. 2005;24(1):51-62.

Interpretation of analytical toxicology results from live patients is sometimes difficult. Possible factors may be related to: (i) the nature of the poison(s) present; (ii) sample collection, transport and storage; (iii) the analytical methodology used; (iv) the circumstances of exposure; (v) mechanical factors such as trauma or inhalation of stomach contents; and (vi) pharmacological factors such as tolerance or synergy. In some circumstances, detection of a drug or other poison may suffice to prove exposure. At the other extreme, the interpretation of individual measurements may be simplified by regulation. Examples here include whole blood alcohol (ethanol) in regard to driving a motor vehicle and blood lead assays performed to assess occupational exposure. With pharmaceuticals, the plasma or serum concentrations of drugs and metabolites attained during treatment often provide a basis for the interpretation of quantitative measurements. With illicit drugs, comparative information from casework may be all that is available. Postmortem toxicology is an especially complex area since changes in the composition of fluids such as blood depending on the site of collection from the body and the time elapsed since death, amongst other factors, may influence the result obtained. This review presents information to assist in the interpretation of analytical results, especially regarding postmortem toxicology. Collection and analysis of not only peripheral blood, but also other fluids/tissues is usually important in postmortem work. Alcohol, for example, can be either lost from, or produced in, blood especially if there has been significant trauma, hence measurements in urine or vitreous humour are needed to confirm the reliability of a blood result. Measurement of metabolites may also be valuable in individual cases.

and...


Flanagan RJ, Connally G, Evans JM.
Analytical toxicology: guidelines for sample collection postmortem.
Toxicol Rev. 2005;24(1):63-71.

The reliability and relevance of any analytical toxicology result is determined in the first instance by the nature and integrity of the specimen(s) submitted for analysis. This article provides guidelines for sample collection, labelling, transport and storage, especially regarding specimens obtained during a postmortem examination. Blood (5 mL) should be taken from two distinct peripheral sites, preferably left and right femoral veins, taking care not to draw blood from more central vessels. Urine (if available), vitreous humour (separate samples from each eye), a representative portion of stomach contents, and liver (10-20 g, right lobe) are amongst other important specimens. A preservative (sodium fluoride, 0.5-2% weight by volume (w/v) should be added to a portion of the blood sample/the sample from one vein, and to urine. Leave a small (10-20% headspace) in tubes containing liquids if they are likely to be frozen. Precautions to minimise the possibility of cross-contamination of biological specimens must be taken, especially if volatile poison(s) may be involved. If death occurred in hospital, any residual antemortem samples should be sought as a matter of urgency. Hair/nail collection should be considered if chronic exposure is suspected, for example, in deaths possibly related to drug abuse. A lock of hair the width of a pen tied at the root end is required for a comprehensive drug screen. The value of providing as full a clinical/occupational/circumstantial history as possible together with a copy of the postmortem report (when available) and of implementing chain-of-custody procedures when submitting samples for analysis cannot be over-emphasised.

If you need copy of theses articles please let me know and I'll send by email

My best regards,

Chiralic