A new series of 13 buprenorphine-related deaths.
OBJECTIVE
Buprenorphine at high dosage became available in France in 1996, as a substitution treatment for heroin addicts. Since this date, numerous deaths were attributed to this drug. This paper reports a new series of 13 fatalities involving buprenorphine observed at the Institute of Legal Medicine of Strasbourg, between August 2000 to October 2001.


METHODS
During the mentioned period, about 800 forensic cases were screened at the laboratory. Buprenorphine and its primary metabolite norbuprenophine were assayed in postmortem specimens by HPLC/MS. From these 13 subjects, 11 were male. Blood levels ranged from 0.3 to 7.7 ng/mL (mean 3.5 ng/mL) and 0.3 to 16.2 ng/mL (mean 2.9 ng/mL) for buprenorphine and norbuprenorphine, respectively. The mean values appear to be within the therapeutic range.


CONCLUSIONS
IV injection of crushed tablets, a concomitant intake of psychotropics (especially benzodiazepines and neuroleptics) and the high dosage of the buprenorphine formulation available in France appear as the major risk factors for such fatalities.
Kintz
Pascal
P
Institut de Médecine Légale, 11 rue Humann, 67000 Strasbourg, France. pascal.kintz@wanadoo.fr
D000701:Analgesics, Opioid / Q000097:blood / Q000506:poisoning*; D001344:Autopsy; D002047:Buprenorphine / Q000031:analogs & derivatives* / Q000097:blood / Q000506:poisoning*; D003643:Death; D004347:Drug Interactions; D005260:Female; D005554:Forensic Medicine / Q000379:methods; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011041:Poisoning / Q000401:mortality; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000506:poisoning; D012307:Risk Factors
D000701:Analgesics, Opioid; D011619:Psychotropic Drugs; D002047:Buprenorphine; C043585:norbuprenorphine