Fatal oral heroin overdose. A case report

The presence of 6-MAM in blood after oral administration of heroin suggests a massive and recent absorption before the death, probably greater than 1 gram [1]. Indeed, several publications showed that after an ingested dose lower than 1 gram, neither heroin nor 6-MAM could be detected in blood due to a very high activity of deacetylation systems in either the gut or the liver or both [1]. Blood concentrations of morphine and 6-MAM measured were potentially lethal, in particular for a naive subject, by inducing a respiratory depression. However, it was not possible to conclude if the death was related to the heroin overdose or to the hanging, probably a mixed process.