FORENSIC MEDICAL EVALUATION OF COMBINED ACTION OF OPIOID DRUGS AND ETHYL ALCOHOL AT NON-LETHAL CONCENTRATION IN CORPSE TISSUES
Ethyl alcohol is determined in biological samples in 42,9-55,9% of the cases of acute opioid drug poisoning. There is no unified algorithm for diagnosing death from poisoning at non-lethal concentration of drugs and alcohol in the tissues of the corpse. The study of the mechanisms of combined action of ethanol and opiates allows to determine the criteria of forensic medical assessment of poisoning at non-lethal concentration of the substances in biological samples. A retrospective analysis of 300 reports of forensic medical examination with the results of forensic-chemical and forensic-histological studies of death from poisoning by functional poisons has been performed. Methods of statistical correlation and regression analysis were used to establish the relationship between the non-lethal concentration of opioid drugs, non-lethal alcohol concentration, presence of internal organs pathology and probability of death from acute concomitant poisoning with psychotropic substances. Much lower lethal concentration of alcohol and opiates when combined has been established in biological samples in comparison with the values established in the literature: the concentration of morphine in bile - 7.04 times, in liver - 9.6 times; the concentration of alcohol in blood - 3 times. The absence of dependence between the concentration of psychoactive substances in biological samples, presence of somatic pathology and death probability has been established. Ethanol and opioid drugs in combination have ethnosystem agonism due to stimulation of receptors of the GABAergic and opiate systems. This fact allows for their low concentration to be considered lethal. Diagnosis of death from acute alcohol and opioid poisoning at low concentration in biological samples requires signs of acute death, exceeding the «threshold» concentration of drugs and alcohol, regardless of the presence/absence of non-fatal pathological changes in internal organs.