Review of Heroin Metabolites and Alkaloids Detected in Postmortem Toxicological Analysis

Objective: In toxicological analyses, a variety of alkaloids and metabolites can be detected in addition to the main drugs or stimulants. The aim of this study is to discuss the diversity, frequency and characteristics of heroin metabolites and alkaloids in postmortem toxicological analyses in the light of the literature. Methods: This study was conducted by retrospectively examining the toxicological examination results after autopsies between January 2020 and April 2022 by Pamukkale University. The cases; were evaluated in terms of sex, age, origin, drug-stimulant substances detected and their diversity. The results were compared with those of similar studies. Detected and their diversity. The findings were compared with the results of similar studies. Results: Drugs or stimulants were found in the toxicological examinations of 45 (4.8%) of 919 deceased examination and autopsy cases. Fourtyone of these cases were male and 4 were female. Methamphetamine and amphetamine-like substances were most commonly found in 26 cases. Opiate derivatives were found in 16 cases, 6-monoacetylmorphine (6-MAM) in 11 cases, meconine in 10 cases and noscapine in 7 cases. Morphine and codeine were detected and the morphine/codeine ratio was greater than 1 in all 8 cases for which quantitative analysis was performed. In addition to these substances, n-ethylamphetamine, norpseudoephedrine, thebaine, acetylcodeine, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, methadone, methyldiethanolamine, 3,4-methylenedioxyamphetamine, papaverine, ephedrine/pseudoephedrine and codeine were detected. Conclusion: There may be some difficulties in detecting illegal heroin due to reasons such as codeine found in antitussive drugs being metabolized to morphine and 6-MAM not always being detected due to its short half-life. Detection of alkaloids and metabolites such as acetylcodeine, noscapine, meconin, papaverine and thebaine suggests illicit heroin use. In addition, papaverine, noscapine and their metabolites are found in higher amounts in the composition of heroin produced in Southwest Asia than in Southeast Asia. These detected alkaloids and metabolites may be useful in detecting illegal heroin use and determining the origin of heroin.