[Genetic markers in forensic medical examination of acute and chronic opioid intoxication].

The objective of the present study was to analyse cases of intoxication with opioid narcotics at different blood morphine levels, from low and very low (below 0.5 mg/l) to regular toxic ones (1-4 mg/I). It was shown that molecular genetic studies at postmortem morphine concentrations of up to 0.5 mg/l as a rule identify mutant alleles (CYP2D6*3*4; CYP2C19*2*3). Mutant alleles CYP2D6* and CYP2C19* are most frequently detected at postmortem blood morphine levels ranging from 1 to 4 mg/I. These findings make it possible to regard death cases at low morphine concentrations as due to genetic susceptibility to different morphine derivatives (heroin, morphine hydrochloride). The remaining subjects lacking mutations in CYP2D6 and CYP2C19 genes are considered to be ordinary metabolizers dying at toxic concentrations of morphine in their blood (from 1 to 4 mg/I); such cases need no genetic studies to be carried out to identify CYP2D6 and CYP2C19 polymorphism.