Toxicological Profile of Opioid Positive Medicolegal Autopsy Cases: A 2-year Case Series

Opioid abuse has emerged as a major global public health concern contributing significantly to drug-related morbidity and mortality. Recent trends indicate a gradual shift from heroin use toward pharmaceutical and synthetic opioids. This is often accompanied by poly-substance consumption. The medicolegal autopsy toxicology provides valuable epidemiological insight into evolving substance abuse patterns, particularly in regions where surveillance data are limited. The present case series is aimed to analyse the toxicological profile and patterns of opioid and associated substance use in opioid-positive medicolegal autopsy cases. A total of 10 opioid-positive autopsy cases were analysed. The age ranged from 20 to 36 years (mean age 27 years) with predominance of males (90%). Most cases belonged to rural areas (70%) and were brought dead to the hospital (80%). Tapentadol and tramadol were the most frequently detected opioids (90% each), followed by morphine (70%), codeine (30%), norhydrocodone (30%) and acetylcodeine (10%). Detection of 6-monoacetylmorphine in 50% of cases indicated heroin use. Poly-substance use was observed in 50% of cases, with associated drugs including ketamine, cannabinoids, diazepam, ethyl alcohol and phosphine gas. The case series highlights the pattern of opioid use along with poly-substance abuse. Young adult males constituted the majority of affected individuals. Medicolegal autopsy toxicology serves as an important tool for identifying emerging substance abuse trends and may aid in strengthening surveillance, rational prescribing practices and preventive public health strategies.