title: Fatal poisoning due to snorting buprenorphine and alcohol consumption.
abstract: High dosage buprenorphine (Subutex(®)) has been prescribed as a replacement therapy for major opioid dependencies in France since 1996. However, several studies have underlined its lethal risk, especially when administered intravenously, or when combined with benzodiazepines, alcohol or other central nervous system depressants. We report three fatal buprenorphine-related poisonings after snorting, among outside protocol individuals, observed at the Forensic Medicine Unit of Caen University Hospital. Medico-legal autopsies and complementary examinations were performed. The results are presented and discussed. Lethal poisoning after snorting buprenorphine was considered the most probable cause of death. These observations illustrate the risk of fatal poisoning by buprenorphine per-nasal route, which has rarely been reported in the literature although snorting is particularly prized by individuals outside the substitution therapy. We also observed the combination of buprenorphine and alcohol. By evaluating the pharmacological characteristics of this substance, as well as the data previously published in the literature, we have attempted to explain the pathophysiological mechanisms of this particular mode of poisoning that can easily be fatal.
authors.affiliation: Unité de Médecine Légale, CHU Côte de Nacre, av Côte de Nacre, 14033 Caen-cedex 9, France. ophelie.ferrant@yahoo.fr
authors.forename: Ophélie
authors.initials: O
authors.lastname: Ferrant
authors.forename: Frédérique
authors.initials: F
authors.lastname: Papin
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Clin
authors.forename: Christian
authors.initials: C
authors.lastname: Lacroix
authors.forename: Elodie
authors.initials: E
authors.lastname: Saussereau
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Remoué
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Goullé
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000032:analysis / Q000506:poisoning*; D002186:Cannabinoids / Q000097:blood / Q000652:urine; D002492:Central Nervous System Depressants / Q000097:blood; D003490:Cyanosis / Q000473:pathology; D000431:Ethanol / Q000097:blood; D049429:Forensic Pathology; D053593:Forensic Toxicology; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D009294:Narcotics / Q000008:administration & dosage* / Q000032:analysis / Q000506:poisoning*; D013154:Spleen / Q000473:pathology; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D002492:Central Nervous System Depressants; D009294:Narcotics; D000431:Ethanol; D002047:Buprenorphine