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Comparison of fatal poisonings by prescription opioids.
Forensic Sci Int. 2012 Oct 10; 222(1-3):327-31.FS

Abstract

There is a rising trend of fatal poisonings due to medicinal opioids in several countries. The present study evaluates the drug and alcohol findings as well as the cause and manner of death in opioid-related post-mortem cases in Finland from 2000 to 2008. During this period, fatal poisonings by prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, methadone, oxycodone, tramadol) increased as a share of all drug poisonings from 9.5% to 32.4%, being 22.3% over the whole period. A detailed study including the most prevalent opioids was carried out for the age group of 14-44 years, which is the most susceptible age for drug abuse in Finland. Poisonings by the weak opioids, codeine and tramadol, were found to be associated with large, often suicidal overdoses resulting in high drug concentrations in blood. Methadone poisonings were associated with accidental overdoses with the drug concentration in blood remaining within a therapeutic range. The manner of death was accidental in 43%, 55% and 94% of cases in codeine, tramadol and methadone poisonings, respectively. The median concentration of codeine and the median codeine/morphine concentration ratio were higher in codeine poisonings (1.4 and 22.5 mg/l, respectively) than in other causes of death (0.09 and 5.9 mg/l, respectively). The median concentrations of tramadol and O-desmethyltramadol were higher in tramadol poisonings (5.3 and 0.8 mg/l, respectively) than in other causes of death (0.6 and 0.2 mg/l, respectively). In methadone poisonings, the median concentration of methadone (0.35 mg/l) was not different from that in other causes of death (0.30 mg/l). Sedative drugs and/or alcohol were very frequently found in fatal poisonings involving these prescription opioids.

Authors+Show Affiliations

University of Helsinki, Hjelt Institute, Department of Forensic Medicine, PO Box 40 (Kytösuontie 11), FI-00014 Helsinki, Finland. margareeta.hakkinen@helsinki.fiNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22884575

Citation

Häkkinen, Margareeta, et al. "Comparison of Fatal Poisonings By Prescription Opioids." Forensic Science International, vol. 222, no. 1-3, 2012, pp. 327-31.
Häkkinen M, Launiainen T, Vuori E, et al. Comparison of fatal poisonings by prescription opioids. Forensic Sci Int. 2012;222(1-3):327-31.
Häkkinen, M., Launiainen, T., Vuori, E., & Ojanperä, I. (2012). Comparison of fatal poisonings by prescription opioids. Forensic Science International, 222(1-3), 327-31. https://doi.org/10.1016/j.forsciint.2012.07.011
Häkkinen M, et al. Comparison of Fatal Poisonings By Prescription Opioids. Forensic Sci Int. 2012 Oct 10;222(1-3):327-31. PubMed PMID: 22884575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of fatal poisonings by prescription opioids. AU - Häkkinen,Margareeta, AU - Launiainen,Terhi, AU - Vuori,Erkki, AU - Ojanperä,Ilkka, Y1 - 2012/08/10/ PY - 2012/05/16/received PY - 2012/07/11/revised PY - 2012/07/22/accepted PY - 2012/8/14/entrez PY - 2012/8/14/pubmed PY - 2013/2/13/medline SP - 327 EP - 31 JF - Forensic science international JO - Forensic Sci Int VL - 222 IS - 1-3 N2 - There is a rising trend of fatal poisonings due to medicinal opioids in several countries. The present study evaluates the drug and alcohol findings as well as the cause and manner of death in opioid-related post-mortem cases in Finland from 2000 to 2008. During this period, fatal poisonings by prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, methadone, oxycodone, tramadol) increased as a share of all drug poisonings from 9.5% to 32.4%, being 22.3% over the whole period. A detailed study including the most prevalent opioids was carried out for the age group of 14-44 years, which is the most susceptible age for drug abuse in Finland. Poisonings by the weak opioids, codeine and tramadol, were found to be associated with large, often suicidal overdoses resulting in high drug concentrations in blood. Methadone poisonings were associated with accidental overdoses with the drug concentration in blood remaining within a therapeutic range. The manner of death was accidental in 43%, 55% and 94% of cases in codeine, tramadol and methadone poisonings, respectively. The median concentration of codeine and the median codeine/morphine concentration ratio were higher in codeine poisonings (1.4 and 22.5 mg/l, respectively) than in other causes of death (0.09 and 5.9 mg/l, respectively). The median concentrations of tramadol and O-desmethyltramadol were higher in tramadol poisonings (5.3 and 0.8 mg/l, respectively) than in other causes of death (0.6 and 0.2 mg/l, respectively). In methadone poisonings, the median concentration of methadone (0.35 mg/l) was not different from that in other causes of death (0.30 mg/l). Sedative drugs and/or alcohol were very frequently found in fatal poisonings involving these prescription opioids. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/22884575/Comparison_of_fatal_poisonings_by_prescription_opioids_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(12)00353-2 DB - PRIME DP - Unbound Medicine ER -