NDARC Technical Report No. 90 (2000)
Hair morphine concentrations were compared between three groups: heroin overdose fatalities (FOD), current street heroin users (CU) and drug free therapeutic community clients (TC). Hair analyses were conducted on 2 cm of hair to ascertain heroin use in the two months preceding interview or death.
There were large differences between the three groups, with the CU group (2.10 ng/mg) having a median hair morphine concentration approximately four times that of the FOD group (0.53 ng/mg), who in turn had a concentration approximately six times that of the TC group (0.09 ng/mg). All differences between groups were statistically significant. Twenty two percent of the CU group had a hair morphine concentration over 5 ng/mg, compared to only 2% of the FOD and TC groups respectively.
There were no significant differences between males and females in hair concentrations within any of the groups. There was a significant positive correlation between hair and blood morphine concentrations (r=0.54, p<.001) among the FOD group. The were no significant correlations between blood morphine and bile concentrations (rs=0.23) or between hair morphine concentration and bile morphine concentration (rs=0.08).
The major finding of this study was that fatal heroin overdose cases were using considerably less heroin in the two months preceding death than were active street users. While using less than the active street users, fatal cases were not abstinent in this period. The recruitment of older heroin users into treatment may substantially reduce overdose mortality and morbidity. While public attention tends to focus on younger heroin users, it is older heroin users, who appear to be using less heroin, that are at greatest risk. Targeted education about the role of alcohol in overdose may also help reduce morbidity, particularly among male heroin users.