Detection of heroin consumption: Pitfalls and tricks

A clear confirmation or exclusion of previous heroin consumption is still one of the major challenges in forensic and clinical toxicology. A great variety of biomarkers is available for confirmation of heroin abuse, including various opium alkaloids (e.g., morphine, codeine), street heroin impurities (e.g., 6-acetylcodeine, 6-AC) and diverse metabolites (e.g., 6-monoacetylmorphine, 6-MAM and morphine glucuronides); however, these are restricted due to limitations in their suitability. In addition to the currently very limited detection windows, the presence of some biomarkers can often not exclusively be attributed to a previous heroin consumption but also due to the consumption of poppy seed products, opium preparations or specific medications. A reliable identification of the origin of these biomarkers is, however, indispensable in various contexts, e.g., in the case of driving under the influence of drugs (DUID) investigations, in driving license re-issuing processes and in post-mortem investigations.