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Microdialysis of Ethanol During Operant Ethanol Self-administration and Ethanol Determination by Gas Chromatography
Published on: September 5, 2012
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Pharmacokinetic interactions between ethanol and heroin: a study on post-mortem cases.
C H Thaulow1, G Høiseth1, J M Andersen1
1Division of Forensic Medicine and Drug Abuse Research, Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
Forensic Science International
|July 23, 2014
Summary
Ethanol significantly alters heroin metabolism by inhibiting key steps, increasing risks of combined use. This pharmacokinetic interaction affects the breakdown of 6-monoacetylmorphine (6-MAM) and morphine, complicating outcomes.
Area of Science:
- Forensic Toxicology
- Pharmacokinetics
- Pharmacodynamics
Background:
- Ethanol and heroin are central nervous system depressants with dangerous pharmacodynamic interactions.
- Previous research suggested pharmacokinetic interactions between ethanol and heroin metabolism.
- Combined use increases risks of respiratory depression and mortality.
Purpose of the Study:
- To investigate pharmacokinetic interactions between heroin and ethanol.
- To compare heroin metabolite concentrations in cases with and without ethanol.
- Utilizing a large dataset from forensic autopsy cases.
Main Methods:
- Analysis of 1474 forensic autopsy cases (2000-2012) positive for 6-monoacetylmorphine (6-MAM).
- Exclusion of cases with post-mortem ethanol formation (0.1-0.3‰) or missing ethanol analysis.
- Categorization into ethanol-positive (≥0.4‰) and ethanol-negative groups, and by heroin intake recency (blood 6-MAM vs. urine 6-MAM).
Main Results:
- Significantly lower ratios of morphine/6-MAM, M3G/morphine, and M6G/morphine in ethanol-positive cases.
- In recent heroin intake cases, only the morphine/6-MAM ratio was lower with ethanol.
- In less recent heroin intake cases, lower M3G/morphine and M6G/morphine ratios were observed with ethanol.
Conclusions:
- Ethanol inhibits heroin metabolism, specifically the hydrolysis of 6-MAM to morphine and the glucuronidation of morphine.
- This pharmacokinetic interaction exacerbates the risks associated with combined heroin and ethanol use.
- Findings highlight the complex interplay beyond known pharmacodynamic effects.
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