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Prescription opioid abuse based on representative postmortem toxicology.
Forensic Sci Int. 2014 Dec; 245:121-5.FS

Abstract

Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010-2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with "abuse" meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20-49.

Authors+Show Affiliations

Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland. Electronic address: margareeta.hakkinen@helsinki.fi.Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25447184

Citation

Häkkinen, Margareeta, et al. "Prescription Opioid Abuse Based On Representative Postmortem Toxicology." Forensic Science International, vol. 245, 2014, pp. 121-5.
Häkkinen M, Vuori E, Ojanperä I. Prescription opioid abuse based on representative postmortem toxicology. Forensic Sci Int. 2014;245:121-5.
Häkkinen, M., Vuori, E., & Ojanperä, I. (2014). Prescription opioid abuse based on representative postmortem toxicology. Forensic Science International, 245, 121-5. https://doi.org/10.1016/j.forsciint.2014.10.028
Häkkinen M, Vuori E, Ojanperä I. Prescription Opioid Abuse Based On Representative Postmortem Toxicology. Forensic Sci Int. 2014;245:121-5. PubMed PMID: 25447184.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescription opioid abuse based on representative postmortem toxicology. AU - Häkkinen,Margareeta, AU - Vuori,Erkki, AU - Ojanperä,Ilkka, Y1 - 2014/10/24/ PY - 2014/07/10/received PY - 2014/10/14/revised PY - 2014/10/16/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2014/12/3/medline KW - Cause of death KW - Drug abuse KW - Fatal poisoning KW - Opioid KW - Postmortem concentration SP - 121 EP - 5 JF - Forensic science international JO - Forensic Sci Int VL - 245 N2 - Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010-2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with "abuse" meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20-49. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/25447184/Prescription_opioid_abuse_based_on_representative_postmortem_toxicology_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(14)00443-5 DB - PRIME DP - Unbound Medicine ER -