Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter July 21, 2020

Negative hair test result after long-term drug use. About a case involving morphine and literature review

  • Pascal Kintz EMAIL logo


Although it has been accepted by most scientists that drugs circulating in blood are eligible to hair incorporation, this cannot be considered as a general statement. A 42-year old man was found dead in his swimming pool. He was living alone, and seen alive 2 days before by a neighbour. Femoral blood, cardiac blood and hair were collected during body examination. Free morphine was identified in femoral blood at 28 ng/mL, corresponding to his treatment for chronic pain (3 × 5 mg daily for 4 months). However, with a limit of quantitation (LOQ) at 10 pg/mg, segmental hair testing (3 × 1 cm) for morphine was negative. In this paper, the author has reviewed the different factors which can be responsible of this discrepancy. Several variables can influence the detection of a drug in hair and the author has listed reasons that can account for the absence of analytical response in hair after drug administration. The drug may not be incorporated in hair. That is the case for large bio-molecules, such as hormones, which cannot be transferred from the blood capillaries to growing cells of hair. Cosmetic treatments (perming, colouring, bleaching) or environmental aggressions (ultraviolet radiation, thermal application) will always reduce the concentrations. In this case, the lack of morphine detection was attributed to the effects of chlorinated water from the swimming pool. A negative hair result is also a result. However, this can be interpreted in three different ways: 1. the owner of the hair did not take or was not exposed to the specific drug, 2. the procedure is not sensitive enough to detect the drug, or 3. something happened after drug incorporation (cosmetic treatment, environmental influence).

Corresponding author: Pascal Kintz, X-Pertise Consulting, 42 rue principale, 67206, Mittelhausbergen, France; Institut de médecine légale, 11 rue Humann, 67000, Strasbourg, France, E-mail:

  1. Research funding: None declared.

  2. Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The author states no conflict of interest.

  4. Ethical approval: In accordance with regulations dealing with dead bodies.


1. Baumgartner, AM, Jones, PF, Baumgartner, WA, Blank, CT. Radioimmunoassay of hair for determinating opiate-abuse histories. J Nucl Med 1979;20:748–52.Search in Google Scholar

2. Henderson, GL, Harkey, MR, Zhou, C, Jones, RT, Jacob, P3rd. Incorporation of isotopically labelled cocaine and metabolites into human hair: 1. Dose-response relationships. J Anal Toxicol 1996;20:1–12. in Google Scholar PubMed

3. Kintz, P. Hair analysis in forensic toxicology: an updated review with special focus on pitfalls. Curr Pharm Des 2017;23:5480–6.10.2174/1381612823666170929155628Search in Google Scholar PubMed

4. Salomone, A, Vicenti, M, Gerace, E. Interpretation of NPS in real hair samples. Toxicol Anal Clin 2017;29:4–10. in Google Scholar

5. Tsanaclis, L, Wicks, JF. Differentiation between drug use and environmental contamination when testing for drugs in hair. Forensic Sci Int 2008;176:19–22. in Google Scholar PubMed

6. Franz, F, Angerer, V, Hermanns-Claussen, M, Auwärter, V, Moosman, B. Metabolites of synthetic cannabinoids in hair—proof of consumption or false friends for interpretation? Anal Bioanal Chem 2016;408:3445–52. in Google Scholar PubMed

7. Pragst, F, Balikova, M. State of the art in hair analysis for detection of drug and alcohol abuse. Clin Chim Acta 2006;370:17–49. in Google Scholar PubMed

8. Azparren, JE, Perucha, E, Martinez, P, Munoz, R, Vallejo, G. Factors affecting strontium absorption in drownings. Forensic Sci Int 2007;168:138–42. in Google Scholar PubMed

9. Perez-Carceles, MD, Sibon, A, Gil Del Castillo, ML, Vizcaya, MA, Osuna, E, Casas, T, et al. Strontium levels in different causes of death: diagnostic efficacy in drowning. Biol Trace Elem Res 2008;126:27–37. in Google Scholar PubMed

10. Methling, M, Krumbiegel, F, Hartwig, S. Hair analysis of antidepressants and antipsychotics-Overview of quantitative data. Drug Test Anal 2020;12:659–76. in Google Scholar PubMed

11. Madry, MM, Kraemer, T, Baumgartner, MR. Large scale consumption monitoring of benzodiazepines and z-drugs by hair analysis. J Pharm Biomed Anal 2020 May 10;183:113151. in Google Scholar PubMed

12. Musshoff, F, Schwartz, G, Sachs, H, Skopp, G, Franz, T. Concentration distribution of more than 100 drugs and metabolites in forensic hair samples. Int J Leg Med 2020;134:989–95. in Google Scholar

13. Kintz, P, Gheddar, L, Ameline, A, Arbouche, N, Raul, JS. Hair testing for doping agents. What is known and remains to do. Drug Test Anal 2020;12:316–22. in Google Scholar

14. Müller, A, Jungen, H, Iwersen-Bergmann, S, Sterneck, M, Andresen-Streichert, H. Analysis of cyclosporine A in hair samples from liver transplanted patients. Ther Drug Monit 2013;35:450–8. in Google Scholar

15. Cooper, GAA, Kronstrand, R, Kintz, P. Society of hair testing guidelines for drug testing in hair. Forensic Sci Int 2012;218:20–4. in Google Scholar

16. Wang, X, Johansen, SS, Zhang, Y, Jia, J, Rao, Y, Jiang, F, et al. Deposition of diazepam and its metabolites in hair following a single dose of diazepam. Int J Leg Med 2017;131:131–41. in Google Scholar

17. Skopp, G, Kniest, A, Haisser, J, Mann, K, Hermann, D. Buprenorphine and norbuprenorphine findings in hair during constant maintenance dosage. Int J Leg Med 2012;125:277–81.10.1007/s00414-011-0555-8Search in Google Scholar

18. Negrusz, A, Moore, CM, Kern, JL, Janicak, PG, Strong, MJ, Levy, NA. Quantitation of clonazepam and its major metabolite 7-aminoclonazepam in hair. J Anal Toxicol 2000;24:614–20. in Google Scholar

19. Biondi, A, Freni, F, Carelli, C, Moretti, M, Morini, L. Ethyl glucuronide hair testing: a review. Forensic Sci Int 2019;300:106–19. in Google Scholar

20. Kintz, P. Positive multi-sectional hair analysis does not mean repetitive administration of morphine. Toxicol Anal Clin 2016;28:184–6. in Google Scholar

21. Kintz, P, Cirimele, V, Mangin, P. Lack of relationship between morphine intake and morphine concentration in hair of carcinoma patients. Ann Biol Clin 1995;53:567–75.Search in Google Scholar

22. Romano, G, Barbera, N, Lombardo, I. Hair testing for drugs of abuse: evaluation of external cocaine contamination and risk of false positives. Forensic Sci Int 2001;123:119–29. in Google Scholar

23. Stout, PR, Ropero-Miller, JD, Baylor, MR, Mitchell, JM. Morphological changes in human head hair subjected to various drug testing decontamination strategies. Forensic Sci Int 2007;172:164–70. in Google Scholar

24. Society of Hair Testing. Statement of the society of hair testing concerning the examination of drugs in human hair. Forensic Sci Int 1997;84:3–6.10.1016/S0379-0738(96)02042-7Search in Google Scholar

25. Polettini, A, Stramesi, C, Vignali, C, Montagna, M. Determination of opiates in hair. Effects of extraction methods on recovery and on stability of analytes. Forensic Sci Int 1997;84:259–69. in Google Scholar

26. Springfield, AC, Cartmell, LW, Aufderheide, AC, Buikstra, J, Ho, J. Cocaine and metabolites in the hair of ancient Peruvian coca leaf chewers. Forensic Sci Int 1993;63:269–75. in Google Scholar

27. Tsanaclis, L, Bagley, K, Bevan, S, Wicks, J. The effect of prolonged storage time on the stability of fatty acid ethyl esters in hair samples. J Anal Toxicol 2020. in Google Scholar

28. Kintz, P. Value of the concept of minimal detectable dosage in hair. Forensic Sci Int 2012;218:28–30. in Google Scholar

29. Wang, X, Johansen, SS, Nielsen, MKK, Linnet, K. Segmental hair analysis-interpretation of the time of drug intake in 2 patients undergoing drug treatment. J Forensic Sci 2019;64:950–5. in Google Scholar

30. Goullé, JP, Noyon, J, Bietry, F, Patricot, B, Roumajon, A, Bouige, D. Hair opiates during pain treatment. Forensic Sci Int 1997;84:137–44. in Google Scholar

31. Püschel, K, Thomasch, P, Arnold, W. Opiate levels in hair. Forensic Sci Int 1983;21:181–6. in Google Scholar

32. Baumgartner, WA, Hill, VA. Hair analysis for drugs of abuse: decontamination issues. In: Sunshine, I, editor. Recent developments in therapeutic drug monitoring and clinical toxicology. New York: Marcel Dekker; 1992:577–97 pp.Search in Google Scholar

33. Cirimele, V, Kintz, P, Mangin, P. Drug concentrations in human hair after bleaching. J Anal Toxicol 1995;19:331–2. in Google Scholar

34. Pötsch, L, Skopp, G. Stability of opiates in hair fibers after exposure to cosmetic treatment. Forensic Sci Int 1996;81:95–102. in Google Scholar

35. Jurado, C, Kintz, P, Menendez, M, Repetto, M. Influence of cosmetic treatment of hair on drug testing. Int J Leg Med 1997;110:159–63. in Google Scholar PubMed

36. Witt, S, Wunder, C, Paulke, A, Verhoff, MA, Schubert-Zsilavecz, M, Toennes, SW. Detection of oxidative hair treatment using fluorescence microscopy. Drug Test Anal 2016;8:826–31. in Google Scholar PubMed

37. Eisenbeiss, L, Binz, T, Baumgartner, MR, Steuer, AE, Kraemer, T. A new possible marker for hair adulteration: detection of PTeCA (1H-pyrrole-2,3,4,5-tetracarboxylic acid) in bleached hair. Drug Test Anal 2020;12:230–8. in Google Scholar PubMed

38. Favretto, D, Tucci, M, Monaldi, A, Ferrara, SD, Miolo, G. A study on photodegradation of methadone, EDDP, and other drugs of abuse in hair exposed to controlled UVB radiation. Drug Test Anal 2014:78–84. in Google Scholar PubMed

39. Ramirez Fernandez, MDM, Wille, SMR, Di Fazio, V, Samyn, N. Influence of bleaching and thermal straightening on endogenous GHB concentrations in hair: an in vitro experiment. Forensic Sci Int 2019;297:277–83. in Google Scholar PubMed

40. Luginbühl, M, Nussbaumer, S, Weinmann, W. Decrease of ethyl glucuronide concentrations in hair after exposure to chlorinated swimming pool water. Drug Test Anal 2018;10:689–93. in Google Scholar PubMed

41. Morini, L, Pozzi, F, Groppi, A. Stability of benzodiazepines in hair after prolonged exposure to chlorinated water. Forensic Sci Int 2017;278:217–20. in Google Scholar PubMed

42. Marrinan, S, Roman-Urrestarazu, A, Naughton, D, Levari, E, Collins, J, Chilcott, R, et al. Hair analysis for the detection of drug use-is there potential for evasion. Hum Psychopharmacol Clin Exp 2017;32:e2587. in Google Scholar PubMed

43. Röhrich, J, Zömtlein, S, Pötsch, L, Skopp, G, Becker, J. Effects of the shampoo Ultra Clean on drug concentrations in hair. Int J Leg Med 2000;113:102–6. in Google Scholar

Received: 2020-06-19
Accepted: 2020-07-10
Published Online: 2020-07-21
Published in Print: 2021-02-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 10.12.2023 from
Scroll to top button