Citation

Häkkinen M, Heikman P, Ojanperä I. Forensic Sci. Int. 2013; 232(1-3): 11-15.

Affiliation

Hjelt Institute, Department of Forensic Medicine, P.O. Box 40 (Kytösuontie 11), FI-00014 University of Helsinki, Finland. Electronic address: margareeta.hakkinen@helsinki.fi.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.forsciint.2013.06.017

PMID

24053859

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 (>100μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50μg/l BPN, 0μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100μg/l NX, or ≤50μg/l BPN combined with 0μg/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 100μg/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.

Language: en