Original ArticlesSignificance of Morphine Concentration in Bile, Liver, and Blood Analysis of 52 Cases of Heroin OverdosesMercurio, Isabella MD∗; Ceraso, Gianluigi MD†; Melai, Paola PharmD‡; Gili, Alessio PhD§; Troiano, Gianmarco MD∥; Agostinelli, Fausto†; Lancia, Massimo MD∗; Bacci, Mauro MD∗Author Information From the ∗Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia †University of Perugia ‡Hospital of Perugia §Department of Experimental Medicine, University of Perugia, Perugia ∥University of Siena, Siena Italy. Manuscript received January 21, 2019; accepted June 15, 2019. The authors report no conflict of interest. Reprints: Isabella Mercurio, MD, University of Perugia, Perugia 06123, Italy. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: December 2019 - Volume 40 - Issue 4 - p 329-335 doi: 10.1097/PAF.0000000000000508 Buy Metrics Abstract Forensic pathologists are requested to select matrices alternative to blood in cases of toxicological interest in which blood is not available for different reasons. We evaluated morphine concentrations in blood, bile, and liver samples in 52 cases of heroin overdoses, relating them to each other, to understand the information that could be derived from their analysis. Gas chromatography/mass spectrometry analysis was performed for all the samples positive on screening for opiates. Shapiro-Wilk test, nonparametric Mann-Whitney test, linear regression analysis, and Bland-Altman test were used for analysis. Linear regression demonstrated that there was not a statistically significant association in morphine concentrations between blood and bile and blood and liver. Mean liver/blood ratio was 2.76, varying from 0.131 to 13.379, and bile/blood ratio was 28.79, varying from 0.28 to 559.16. According to these results, bile analysis is a “screening test”; biliary or hepatic concentration of morphine cannot provide information on hematic concentration at the time of death, having no forensic value taken individually. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.