Hair - A valuable resource in post-mortem toxicology

Hair - A valuable resource in post-mortem toxicology

Hair A valuable resource in post-mortem toxicology
Marie Reed, Rosa Cordero and Sue Paterson
Toxicology Unit, Division of Investigative Science, Imperial College London
[email protected]

Case 3 Limited sample A: Loss of tolerance

Case 1 Habitual drug user

INTRODUCTION

Analysis of hair in post-mortem toxicology provides a retrospective record of an individuals drug history prior to death.
This can provide important information to the pathologist, Coroner and the family of the deceased in understanding
both the cause and circumstances surrounding the death.

43 year old female

44 year old male

Previous history of drug and alcohol dependency and depression. Deceased had allegedly taken heroin that morning and later collapsed at home.

Deceased was a known heroin addict. He had been released from prison and was found the following day collapsed at home. He had

3 sections of head hair - 3 cm (9 months)

apparently obtained some heroin and a recent needle mark was found on his arm. A bottle of methadone along with drug paraphernalia
were found.

N.B. S1 = hair growth closest to the scalp/ most recent growth

Drugs present in the bloodstream circulate the hair follicle and become incorporated in the hair matrix during growth.
Once incorporated the drug becomes fixed in the hair and remains fixed as the hair grows.

1 section of head hair - 2 cm (2 months)

Limited sample of hair (13mg)

For our hair method comprehensive drug screening requires 50 mg of hair.

Head hair is the recommended sample for analysis and a mean growth rate of 1 cm per month is used for

Blood (ug/mL)

interpretation. Hair from other sites of the body can be used, but these will have different rates of growth.

Segmental analysis can provide information on patterns of use.

The aim of this poster is to demonstrate examples of actual post mortem cases where analysis of hair provided
valuable information which was not made available from analysis of routine samples such as blood, urine and other
specimens.

Drugs were extracted from the hair samples using 0.1 M HCl followed by solid phase extraction clean-up. The extracts
were submitted to dual derivitisation using MBTFA and MSTFA and analysed by GC-MS in both SIM and scan
modes.

Hair (ng/mg)
S1

S2

S3

Cocaine

ND

18.4

39.4

48.6

BE

ND

2.6

6.0

8.8

EME

ND

0.2

0.3

0.3

Cocaethylene

ND

1.0

0.9

0.9

Morphine

0.35

9.2

14.0

14.9

6-MAM

ND

18.8

29.3

Codeine

ND

1.5

Methadone

ND

Papaverine

ND

Ethanol

Blood (ug/mL)

Urine

Hair (ng/mg)

Cocaine

ND

Pos

1.9

BE

ND

Pos

0.6

EME

ND

Pos

0.8

Cocaethylene

ND

ND

ND

34.5

Morphine

0.08

Pos

ND

2.1

2.3

6-MAM

ND

Pos

ND

Pos

Pos

Pos

Codeine

ND

Pos

ND

Pos

ND

ND

Amphetamine

ND

Pos

ND

Methamphetamine

ND

Pos

ND

Methadone

ND

ND

ND

264 mg/100mL

202 mg/100mL

35 mg/100mL

A major concern for interpretation of results is the risk of external contamination.

Ethanol
This case demonstrates the typical hair results obtained for a habitual drug user. Cocaine ingestion was confirmed by
the presence of cocaine metabolites: BE, EME and cocaethylene, and heroin use by the presence of 6-MAM and

In this case the blood and urine results confirm that the deceased had taken street heroin along with cocaine,

morphine. Codeine (from acetyl-codeine) is a common contaminant of heroin and papaverine is a constituent of street

amphetamine, methamphetamine and ethanol at the time of death.

heroin. The deceased had also taken methadone during this 9 month period.

As the deceased was a known heroin addict a blood morphine concentration of 0.08 ug/mL may not have been

There are two types of external contamination -

The concentration of morphine found in the blood is consistent with the ingestion of a fatal dose, depending on the

considered significantly high due to possible tolerance. The hair results confirmed the use of cocaine in the 2 months

Passive incorporation from active use

tolerance of the individual. In this case the hair results indicate this individual was a habitual user, although their use was

decreasing, and demonstrates a degree of drug tolerance.

CONTAMINATION

Hair is a very porous material and adsorption of drugs can occur from urine, sweat and sebum. Parent drug and

prior to death, but no other drugs were detected. The absence of heroin constituents in the hair indicate abstinence in this
time period. As the deceased had recently been in prison his drug habits were likely to have altered.

metabolite will be detected in hair, but concentrations may be elevated.
Environmental contamination

External contaminants e.g. smoke and powders can also be absorbed into the hair matrix. These elevate the parent

All hair segments are subjected to shampoo and solvent washes to remove surface contamination. The solvent
washes are analysed to determine the presence of significant external contamination. This may have contributed to
the hair drug concentration and needs to be considered during interpretation.

Case 4 Limited sample B: Proof of previous use

Case 2 Confirmation of drug history

drug concentration in the hair, however no metabolite would be present.

27 year old female

Deceased had a previous history of depression and had reportedly taken recreational drugs in the past. She was found suspended

33 year old male

Known heroin smoker, found collapsed.

1 section of head hair 3.5 cm (3.5 months)

Limited sample of hair (13mg)

from her bedroom door.

The following figures demonstrate examples of results from solvent washes from a heroin smoker (fig.1) and an i.v.

3 sections of head hair - 3 cm (9 months)

heroin user (fig.2).

6MAM in washes and extract
Fig. 1 Significant environmental contamination
Abundance

Hair 6MAM = 174 ng/mg

Fig. 2 Drug free solvent washes
Abundance

IPA

1400000

Blood (ug/mL)

Hair 6MAM = 3.6 ng/mg
Hair

75000

1300000

70000

1200000

65000

1100000

60000

1000000

55000

S1

S2

S3

Hair (ng/mg)

Cocaine

ND

ND

ND

56.5

BE

ND

Pos

ND

0.5

EME

ND

Pos

ND

ND

Cocaethylene

ND

ND

ND

ND

1.2

0.6

0.5

BE

ND

ND

0.2

0.3

0.2

EME

ND

ND

ND

ND

ND

Morphine

0.10

Pos

ND

2.0

Cocaethylene

ND

ND

0.2

0.1

ND

6-MAM

ND

ND

ND

2.0

High Therapeutic

Pos

Pos

Pos

Pos

Codeine

ND

ND

ND

0.2

Methadone

0.07

Pos

ND

ND

Dothiepin

ND

ND

Pos

ND

< 10 mg/100mL < 10 mg/100mL Ethanol 15 mg/100mL Ethanol 35000 600000 Stomach ND 40000 700000 Urine ND 45000 DCM 800000 Blood (ug/mL) Hair (ng/mg) Cocaine Citalopram 50000 900000 Stomach 30000 500000 25000 400000 20000 300000 15000 200000 10000 Hair 100000 0 In this case the hair, blood and stomach contents all provided evidence that this individual was taking citalopram IPA DCM 5000 0 21.85 21.90 21.95 22.00 22.05 22.10 22.15 22.20 21.60 21.65 21.70 21.75 21.80 21.85 21.90 21.95 Time-->

Time-->

Heroin smoker

I.V. heroin user

(DCM = dichloromethane, IPA = iso-propyl alcohol)
References
R. Cordero, S. Paterson. Simultaneous quantification of opiates, amphetamines, cocaine and metabolites and diazepam and metabolite in a single hair sample using GC-MS.
Journal of Chromatography B. 850: 423-431 (2007)
Society of Hair testing. Recommendations for hair testing in forensic cases. Forensic Sci Int 145:83-84 (2004)
S. Paterson, R. Cordero, E. Stearns. Chronic drug use by hair analysis: its role in understanding both the medical cause of death and the circumstances surrounding the
death.
In submission.

regularly as treatment for depression. The hair results however, confirmed that the deceased had also been a regular,

The deceased was a known heroin user with a blood morphine concentration of 0.10 ug/mL and with evidence of

low level cocaine user during this 9 month period.

cocaine, methadone and dothiepin use at the time of death. Hair analysis confirmed the use of cocaine and heroin in

Long term cocaine use has been linked with adverse psychological effects of overt depression, dysphoria and paranoia
and has been associated with suicidal intent. The hair results suggest that although the deceased had been taking her
antidepressant medication, her depression may have been exacerbated by her cocaine use.
The use of recreational drugs was suggested in the case history, but the potential link between cocaine abuse with
suicide would not have been considered had the hair not been analysed.

the 3.5 months prior to death.
In this case although the sample was limited, significant concentrations of cocaine, heroin and their metabolites were
found in the hair. As the blood morphine was similar to that found in case 3 this suggests that if the individual described
in case 3 was a habitual user then heroin constituents would have been detected in the hair. A hair sample smaller than
50 mg may be viable, but results have to be interpreted with extra caution.

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