title: Comparison of fatal poisonings by prescription opioids.
abstract: There is a rising trend of fatal poisonings due to medicinal opioids in several countries. The present study evaluates the drug and alcohol findings as well as the cause and manner of death in opioid-related post-mortem cases in Finland from 2000 to 2008. During this period, fatal poisonings by prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, methadone, oxycodone, tramadol) increased as a share of all drug poisonings from 9.5% to 32.4%, being 22.3% over the whole period. A detailed study including the most prevalent opioids was carried out for the age group of 14-44 years, which is the most susceptible age for drug abuse in Finland. Poisonings by the weak opioids, codeine and tramadol, were found to be associated with large, often suicidal overdoses resulting in high drug concentrations in blood. Methadone poisonings were associated with accidental overdoses with the drug concentration in blood remaining within a therapeutic range. The manner of death was accidental in 43%, 55% and 94% of cases in codeine, tramadol and methadone poisonings, respectively. The median concentration of codeine and the median codeine/morphine concentration ratio were higher in codeine poisonings (1.4 and 22.5 mg/l, respectively) than in other causes of death (0.09 and 5.9 mg/l, respectively). The median concentrations of tramadol and O-desmethyltramadol were higher in tramadol poisonings (5.3 and 0.8 mg/l, respectively) than in other causes of death (0.6 and 0.2 mg/l, respectively). In methadone poisonings, the median concentration of methadone (0.35 mg/l) was not different from that in other causes of death (0.30 mg/l). Sedative drugs and/or alcohol were very frequently found in fatal poisonings involving these prescription opioids.
authors.affiliation: University of Helsinki, Hjelt Institute, Department of Forensic Medicine, PO Box 40 (Kytösuontie 11), FI-00014 Helsinki, Finland. margareeta.hakkinen@helsinki.fi
authors.forename: Margareeta
authors.initials: M
authors.lastname: Häkkinen
authors.forename: Terhi
authors.initials: T
authors.lastname: Launiainen
authors.forename: Erkki
authors.initials: E
authors.lastname: Vuori
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
mesh_terms: D000059:Accidents / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000097:blood* / Q000506:poisoning*; D002047:Buprenorphine / Q000097:blood / Q000506:poisoning; D002492:Central Nervous System Depressants / Q000097:blood; D003061:Codeine / Q000097:blood / Q000506:poisoning; D011431:Dextropropoxyphene / Q000097:blood; D062787:Drug Overdose / Q000401:mortality*; D000431:Ethanol / Q000097:blood; D005283:Fentanyl / Q000097:blood / Q000506:poisoning; D005387:Finland / Q000453:epidemiology; D053593:Forensic Toxicology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000097:blood; D008691:Methadone / Q000097:blood / Q000506:poisoning; D009020:Morphine / Q000097:blood; D009293:Opioid-Related Disorders / Q000401:mortality*; D010098:Oxycodone / Q000097:blood / Q000506:poisoning; D011041:Poisoning / Q000401:mortality; D063487:Prescription Drug Misuse; D013405:Suicide / Q000706:statistics & numerical data; D014147:Tramadol / Q000031:analogs & derivatives / Q000097:blood / Q000506:poisoning; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants; D006993:Hypnotics and Sedatives; C080580:O-demethyltramadol; D014147:Tramadol; D000431:Ethanol; D002047:Buprenorphine; D009020:Morphine; D010098:Oxycodone; D011431:Dextropropoxyphene; D008691:Methadone; D005283:Fentanyl; D003061:Codeine