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Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning.
Forensic Sci Int. 2013 Oct 10; 232(1-3):11-5.FS

Abstract

Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. Our purpose was to estimate the proportion of BNX to all BPN-related fatalities. The material consisted of 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine (NOR) and/or naloxone (NX) finding in urine. The data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4% of cases the NX urine concentration was higher than the threshold 100 μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the "Parenteral BNX", "Parenteral BPN" and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0 and 22.6%, respectively. BNX abuse can be fatal. Among the 225 BPN-related fatalities, parenteral abuse of BNX was shown to be common (12.4%) and BNX poisoning was the underlying cause of death in 8.4%. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN.

Authors+Show Affiliations

Hjelt Institute, Department of Forensic Medicine, P.O. Box 40 (Kytösuontie 11), FI-00014 University of Helsinki, Finland. Electronic address: margareeta.hakkinen@helsinki.fi.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24053859

Citation

Häkkinen, Margareeta, et al. "Parenteral Buprenorphine-naloxone Abuse Is a Major Cause of Fatal Buprenorphine-related Poisoning." Forensic Science International, vol. 232, no. 1-3, 2013, pp. 11-5.
Häkkinen M, Heikman P, Ojanperä I. Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning. Forensic Sci Int. 2013;232(1-3):11-5.
Häkkinen, M., Heikman, P., & Ojanperä, I. (2013). Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning. Forensic Science International, 232(1-3), 11-5. https://doi.org/10.1016/j.forsciint.2013.06.017
Häkkinen M, Heikman P, Ojanperä I. Parenteral Buprenorphine-naloxone Abuse Is a Major Cause of Fatal Buprenorphine-related Poisoning. Forensic Sci Int. 2013 Oct 10;232(1-3):11-5. PubMed PMID: 24053859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning. AU - Häkkinen,Margareeta, AU - Heikman,Pertti, AU - Ojanperä,Ilkka, Y1 - 2013/07/19/ PY - 2013/04/16/received PY - 2013/06/18/revised PY - 2013/06/21/accepted PY - 2013/9/24/entrez PY - 2013/9/24/pubmed PY - 2014/6/6/medline KW - Abuse liability KW - Buprenorphine KW - Drug abuse KW - Fatal poisoning KW - Naloxone KW - Urine analysis SP - 11 EP - 5 JF - Forensic science international JO - Forensic Sci Int VL - 232 IS - 1-3 N2 - Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. Our purpose was to estimate the proportion of BNX to all BPN-related fatalities. The material consisted of 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine (NOR) and/or naloxone (NX) finding in urine. The data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4% of cases the NX urine concentration was higher than the threshold 100 μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the "Parenteral BNX", "Parenteral BPN" and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0 and 22.6%, respectively. BNX abuse can be fatal. Among the 225 BPN-related fatalities, parenteral abuse of BNX was shown to be common (12.4%) and BNX poisoning was the underlying cause of death in 8.4%. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/24053859/Parenteral_buprenorphine_naloxone_abuse_is_a_major_cause_of_fatal_buprenorphine_related_poisoning_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(13)00340-X DB - PRIME DP - Unbound Medicine ER -