Décès et héroïne : proposition d'un guide d'aide au diagnostic

Accountability of death to the consumption of heroin is a frequent question encountered in forensic practice. However, its difficulty is often underestimated by medical experts, since typical situations (“the syringe into the vein”) are rare or exceptional. If toxicological analyses of blood, urine and hair samples are obviously essential to establish the causal link between death and exposure to heroin, their interpretation requires special caution, whatever the performance of these analyses could be. Through a synthesis of scientific data on the pharmacology and physiology of heroin exposure, the aims of this review are to provide to practitioners guidelines for interpretation and discussion of forensic explorations, emphasizing on sampling concepts, on interpretation of opiate concentrations and on taking in consideration of contextual factors (tolerance, co-poisoning).