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Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning.
Eur J Clin Pharmacol. 2012 Mar; 68(3):301-9.EJ

Abstract

BACKGROUND

Although buprenorphine therapy has proved to be successful in opioid maintenance treatments, the drug is also widely abused in many countries by intravenous injection or sniffing ("snorting"). In Finland, buprenorphine is the most important abused opioid causing fatal poisonings.

PURPOSE

To evaluate the drug and alcohol findings as well as the cause and manner of death in all buprenorphine-related post-mortem cases for the age group 14-44 years in Finland from 2000 to 2008.

METHOD

This was a retrospective analysis of data on opioid-associated deaths in the Finnish comprehensive postmortem toxicology database based on medico-legal autopsies, case background information and laboratory analyses.

RESULTS

Buprenorphine was found in 29% of all 1,363 opioid-positive cases, and buprenorphine poisoning was the cause of death in 182 cases out of 391 buprenorphine-positive cases (47%). In these fatal poisonings, the blood buprenorphine/norbuprenorphine concentration ratio was significantly higher than in cases with other causes of death. The manner of death in buprenorphine poisonings that were almost exclusively accidental differed significantly from other buprenorphine-related cases, which also involved diseases and suicides. Death was immediate in 10% of fatal buprenorphine poisonings, was delayed, during sleep, in 52%, and followed an unknown course of events in 38%. In immediate poisonings, the median blood buprenorphine concentration (3.0 μg/l) was significantly higher than that in delayed poisonings (1.2 μg/l). In most buprenorphine poisonings (92%), no opioids other than buprenorphine were involved, but benzodiazepines and alcohol were found in 82 and 58% of cases, respectively. The median concentrations of opioids and benzodiazepines in buprenorphine poisonings were in the therapeutic range. Only one fatal poisoning was found in which neither alcohol nor drugs other than buprenorphine were found.

CONCLUSION

A fatal buprenorphine poisoning is typically accidental, and the average victim is a 27-year-old male addict. Circumstantial and environmental factors seem to be crucial in determining the outcome of the poisoning.

Authors+Show Affiliations

Department of Forensic Medicine, University of Helsinki, Hjelt Institute, PO Box 40, Kytösuontie 11, Helsinki, 00014, Finland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21927835

Citation

Häkkinen, Margareeta, et al. "Benzodiazepines and Alcohol Are Associated With Cases of Fatal Buprenorphine Poisoning." European Journal of Clinical Pharmacology, vol. 68, no. 3, 2012, pp. 301-9.
Häkkinen M, Launiainen T, Vuori E, et al. Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. Eur J Clin Pharmacol. 2012;68(3):301-9.
Häkkinen, M., Launiainen, T., Vuori, E., & Ojanperä, I. (2012). Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. European Journal of Clinical Pharmacology, 68(3), 301-9. https://doi.org/10.1007/s00228-011-1122-4
Häkkinen M, et al. Benzodiazepines and Alcohol Are Associated With Cases of Fatal Buprenorphine Poisoning. Eur J Clin Pharmacol. 2012;68(3):301-9. PubMed PMID: 21927835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. AU - Häkkinen,Margareeta, AU - Launiainen,Terhi, AU - Vuori,Erkki, AU - Ojanperä,Ilkka, Y1 - 2011/09/17/ PY - 2011/04/05/received PY - 2011/08/24/accepted PY - 2011/9/20/entrez PY - 2011/9/20/pubmed PY - 2012/7/3/medline SP - 301 EP - 9 JF - European journal of clinical pharmacology JO - Eur J Clin Pharmacol VL - 68 IS - 3 N2 - BACKGROUND: Although buprenorphine therapy has proved to be successful in opioid maintenance treatments, the drug is also widely abused in many countries by intravenous injection or sniffing ("snorting"). In Finland, buprenorphine is the most important abused opioid causing fatal poisonings. PURPOSE: To evaluate the drug and alcohol findings as well as the cause and manner of death in all buprenorphine-related post-mortem cases for the age group 14-44 years in Finland from 2000 to 2008. METHOD: This was a retrospective analysis of data on opioid-associated deaths in the Finnish comprehensive postmortem toxicology database based on medico-legal autopsies, case background information and laboratory analyses. RESULTS: Buprenorphine was found in 29% of all 1,363 opioid-positive cases, and buprenorphine poisoning was the cause of death in 182 cases out of 391 buprenorphine-positive cases (47%). In these fatal poisonings, the blood buprenorphine/norbuprenorphine concentration ratio was significantly higher than in cases with other causes of death. The manner of death in buprenorphine poisonings that were almost exclusively accidental differed significantly from other buprenorphine-related cases, which also involved diseases and suicides. Death was immediate in 10% of fatal buprenorphine poisonings, was delayed, during sleep, in 52%, and followed an unknown course of events in 38%. In immediate poisonings, the median blood buprenorphine concentration (3.0 μg/l) was significantly higher than that in delayed poisonings (1.2 μg/l). In most buprenorphine poisonings (92%), no opioids other than buprenorphine were involved, but benzodiazepines and alcohol were found in 82 and 58% of cases, respectively. The median concentrations of opioids and benzodiazepines in buprenorphine poisonings were in the therapeutic range. Only one fatal poisoning was found in which neither alcohol nor drugs other than buprenorphine were found. CONCLUSION: A fatal buprenorphine poisoning is typically accidental, and the average victim is a 27-year-old male addict. Circumstantial and environmental factors seem to be crucial in determining the outcome of the poisoning. SN - 1432-1041 UR - https://www.unboundmedicine.com/medline/citation/21927835/Benzodiazepines_and_alcohol_are_associated_with_cases_of_fatal_buprenorphine_poisoning_ L2 - https://dx.doi.org/10.1007/s00228-011-1122-4 DB - PRIME DP - Unbound Medicine ER -