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Heroin-using drivers: importance of morphine and morphine-6-glucuronide on late clinical impairment

  • Pharmacodynamics
  • Published:
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Abstract

Objective

To evaluate the relationship between major heroin metabolites (morphine, morphine-6-glucoronide), pattern of drug use, and late impairment of psychomotor functions.

Methods

From the database of the Norwegian Institute of Public Health, Oslo, blood morphine concentration in samples from heroin users (n=70) containing only morphine were correlated with results of the clinical test for impairment (CTI). For comparison, test results were explored in individuals without any positive analytical finding in blood samples (n=79) selected from the same database.

Results

In the “no drug” cases, 86% were judged as not impaired and 14% as impaired. In the morphine only cases, 20% were judged as not impaired, and 80% as impaired. Both daily users and non-daily users had the same proportion of impaired cases. Median blood morphine concentration (M) was 0.09 μmol/l in the “not impaired” group and 0.15 μmol/l in the “impaired” group (P=0.067). For morphine-6-glucuronide (M6G), the median blood concentration was 0.09 μmol/l in the “not impaired” group and 0.14 μmol/l in the “impaired” group (P=0.030). A significant correlation between concentration quartiles and number of cases determined as “impaired” was found for M6G (P=0.018) and for the sum M+M6G (P=0.013).

Conclusion

In our population of heroin-drugged drivers, blood concentrations of M6G and the sum M+M6G appeared to have concentration-dependent effects on the CNS that may lead to impairment as judged from a CTI. Variations in pattern of use did not seem to have any bearing on the judgement of impairment.

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Acknowledgements

To Åse Ripel for the analysis of glucuronides, to Terje Hammer and Karen Sofie Engelstad for technical assistance, and to Fernando Boix, Vigdis Vindenes and Håkon Aune for useful comments on the manuscript.

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Authors and Affiliations

  1. Division for Forensic Toxicology and Drug Abuse, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway

    Liliana Bachs, Gudrun Høiseth & Jørg Mørland

  2. Division for Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

    Svetlana Skurtveit

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  1. Liliana Bachs
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  2. Gudrun Høiseth
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  3. Svetlana Skurtveit
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  4. Jørg Mørland
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Correspondence to Liliana Bachs.

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Bachs, L., Høiseth, G., Skurtveit, S. et al. Heroin-using drivers: importance of morphine and morphine-6-glucuronide on late clinical impairment. Eur J Clin Pharmacol 62, 905–912 (2006). https://doi.org/10.1007/s00228-006-0195-y

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  • DOI: https://doi.org/10.1007/s00228-006-0195-y

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