Vitreous humor: an alternative drug investigation in postmortem samples

O humor vítreo (HV) é um gel aquoso, transparente e incolor, situado entre o cristalino e a retina. Ele pode ser uma ferramenta para determinação de drogas de abuso, sobretudo quando é impossível fazer a determinação em sangue devido à sua ausência ou sua deterioração, por exemplo em casos de exsanguinação, embalsamento e carbonização. As drogas e seus metabólitos passam para o HV por difusão passiva e, de modo geral, a concentração dos analitos no HV é similar às concentrações obtidas no sangue. A cocaína e a benzoilecgonina são facilmente detectadas na matriz. Por outro lado, a difusão da morfina é bem limitada. O maior interesse do estudo de opioides é a análise de 6-acetilmorfina, que pode diferenciar o uso de heroína e morfina. O delta-9-tetrahidrocanabinol é uma molécula muito polar e fortemente ligada a proteínas plasmáticas, o que limita a sua difusão para o HV. Entre as anfetaminas, a metilenodioximetanfetamina e a metanfetamina são as moléculas mais estudadas no HV. Foi desenvolvido e validado um método utilizando GC-MS para análise simultânea de cocaína, anfetaminas, opioides, canabinoides e respectivos metabólitos em HV. Os analitos de interesse foram extraídos do HV utilizando extração em fase sólida e analisadas por GC-MS, utilizando o modo de aquisição SIM. A faixa de linearidade foi de 10 a 1000 ng/mL para todos os analitos, com exceção do éster de metilanidroecgonina (10 a 750 ng/mL). A exatidão variou de 95,6 a 104,0%, a precisão inter-ensaio variou de 1,2 a 10,0% e a precisão intra-ensaio foi menor que 10,4% para todos os analitos. O limite de quantificação para todas as drogas foi de 10 ng/mL e a recuperação variou de 70,4 a 100,1% para compostos básicos e neutros, entretanto os compostos ácidos apresentaram baixa recuperação - menor que 40%. A dosagem de etanol foi realizada por GC-FID e extração por headspace. Os métodos validados foram aplicados em 250 amostras de HV coletadas de vítimas de morte violentas nos anos de 2011 e 2012 que foram necropsiadas no Departamento Médico Legal de Vitória - ES. A maioria das vítimas era do sexo masculino (85,4%) e a causa mais comum de morte foi homicídio (46,2%), destes, 89,5% foram mortos por disparo de arma de fogo. Os acidentes de trânsito corresponderam a 44,1%; suicídio, 2,4%; e outras mortes totalizaram 7,2% das amostras. Substâncias psicoativas (álcool e drogas) foram positivas em 60,4% dos casos. Em 23,2% das amostras foi quantificada cocaína e/ou seu metabólito, e em um terço destes foi identificado o uso de crack. O álcool estava presente em 19,2% dos casos e a associação entre cocaína e álcool em 12,8% dos casos. Outras drogas incluíram anfetaminas (13 casos) e codeína (1 caso). Quando comparadas as concentrações das drogas pesquisadas no sangue e HV, a anfetamina e metanfetamina mostraram boa correlação entre as duas matrizes. A 6-acetilmorfina encontrada no HV foi utilizada para demonstrar o uso de heroína, uma vez que as concentrações foram mais altas do que no sangue. Entretanto, o HV não pode ser utilizado como amostra alternativa para detecção de canabinoides.Vitreous humor is the aqueous gel located between the lens and retina. Vitreous humor is a useful alternative postmortem matrix for the detection of drugs, particularly in death investigations where postmortem blood is not available or is of limited quality or quantity (e.g. after hemorrhagic shock, burns, embalming or decomposition processes). Drugs and their metabolites enter the vitreous humor by passive diffusion from blood across the blood-vitreous barrier. Vitreous humor concentrations are often similar to the drug concentrations in the circulation blood. Cocaine and benzoylecgonine are easily detected in this matrix. On the order hand, morphine diffusion is limited. The interest in opiates is due to 6-acetylmorphine, which is stable in vitreous humor and can confirm heroin abuse. Drugs that are highly protein-bound, such as THC, achieve lower vitreous humor concentrations as only the free fraction can cross the blood-vitreous barrier. Methamphetamine and methylenodioxymetamphetamine are also detected in vitreous humor. A GC-MS method for simultaneous analysis of cocaine, amphetamines, opiates, cannabinoids and its metabolites in vitreous humor was developed and fully validated. Vitreous humor samples were extracted using solid phase extraction and analyzed by GC-MS in SIM mode. For all analytes the linearity ranged from 10 to 1000 ng/mL, excepted for anydroecgonine methylester which ranged from 10 to 750 ng/mL. Inter-assay imprecision ranged from 1.2 to 10.0% and intra-assay imprecision was less than 10.4% for all analytes at all QC concentrations. Accuracy ranged from 95.6 to 104.0% and recoveries ranging from 70.4 - 100.1% for basic and neutral compounds, the acids compounds had poor recovery (less than 40%). The limits of detection were up to 1.0 ng/mL. Ethanol was quantified by headspace extraction and GC-FID. The validated methodology was applied to 250 vitreous humor samples collected from violent death victims between 2011 and 2012 in the Departamento Médico Legal de Vitória - ES. Most of the victims were male (85.4%) and the most common cause of death was homicide (46.2%), in which 89.5 occurred by firearm shot. Traffic accident represented 44.1%, suicide 2.4% and other deaths 7.2%. Psychoactive substances (alcohol and?or drugs of abuse) were positive in 60.4% of the cases. Cocaine was quantified in 23.2% of the samples and one third was positive for crack cocaine. Ethanol was present in 19.2% of the cases and the association between cocaine and alcohol in 12.8%. Other drugs included amphetamines (13 cases) and codeine (1 case). When comparing the drug concentrations in blood and vitreous humor, amphetamine and methamphetamine showed a good correlation. 6-acetylmorphine in vitreous humor can demonstrate heroine abuse and its concentration is higher in vitreous humor than in blood. However, vitreous humor is not a good matrix for the detection of cannabinoids

Comparative study of postmortem concentrations of antidepressants in several different matrices

Peripheral blood (PB) is considered to be the golden standard for measuring postmortem drug concentrations. In several cases, PB is however not available, but information regarding drug findings might still be crucial in order to determine the cause of death. Antidepressants are frequently detected in postmortem samples from forensic toxicology cases, but the literature investigating concentrations in other matrices than peripheral and heart blood is limited. We here describe a study for comparison of concentrations for a large number of different drugs in six different matrices. A total of 173 postmortem cases were included in the study material. The results from 44 cases with findings of antidepressants (amitriptyline/nortriptyline, citalopram, mianserin, mirtazapine, paroxetine, sertraline, trimipramine and venlafaxine) are presented in this article. Concentrations in peripheral and cardiac blood (CB), pericardial fluid (PF), two muscle samples and vitreous humour (VH) are compared. Ratios between concentrations in different matrices have also been compiled from available literature. All the investigated antidepressants were detected in all different matrices, and comparable concentration levels were found in the different matrices with a few exceptions. Concentrations in VH were generally lower than in the other matrices, and in a few cases with low concentrations in blood the antidepressants were not detected in VH. For most of the cases, ratios of 0.5–2 were found between concentration in PB and that in the other matrices. Some deviant concentrations where however found. This study shows that CB, PF, muscle and VH can provide important indications of the corresponding concentrations in PB when PB is not available

Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil

<p><b>Objective:</b> The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011–2012.</p> <p><b>Methods:</b> Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography–flame ionization method for alcohol and by a gas chromatography–mass spectrometry for amphetamines, cocaine, and cannabis.</p> <p><b>Results:</b> The results showed that 44.8% (<i>n</i> = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine.</p> <p><b>Conclusions:</b> For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.</p