Estimating survival times in heroin overdose: the case for rapid intervention

October 2016
Darke, S., & Duflou, J. (2016). The toxicology of heroin-related death: estimating survival times. Addiction, 111, 1607-1613. doi:10.1111/add.13429

Opioids make the largest contribution to illicit drug-related death, and overdose is the leading cause, yet intervention by onlookers has been characterised as poor. One important issue in terms of response is the rapidity of overdose and death. Essentially, is there time to intervene, or are such deaths typically so rapid as to preclude meaningful intervention?

The presence of 6-monoacetyl morphine (6MAM) in the blood is suggestive of survival times of less than 20 to 30 minutes following heroin administration. The authors analysed 145 cases of heroin-related death presenting to the Department of Forensic Medicine Sydney over a two year period from January 2013. The aim was to determine the proportions of cases in which 6MAM was present.

6MAM was detected in less than half of cases (43%), suggesting that a majority of cases had survival times after overdose of more than 20 to 30 minutes. This indicates that intervention would have been feasible in the majority of cases. However, resuscitation was attempted in only a third of cases. In only half of the cases where others were in the immediate vicinity was there any indication that resuscitation had been attempted.

Calling an ambulance is crucial, as is the rapid administration of naloxone if the drug is available, write the authors.  While medical resuscitation occurred in a third of the cases in this study, naloxone was detected in only eight per cent. Other potential life-saving interventions include keeping the patient oxygenated through cardiopulmonary resuscitation and placing the person in the recovery position.