Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning.
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 (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/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 100 μg/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.
Hjelt Institute, Department of Forensic Medicine, P.O. Box 40 (Kytösuontie 11), FI-00014 University of Helsinki, Finland. Electronic address: margareeta.hakkinen@helsinki.fi.
Margareeta
M
Häkkinen
Pertti
P
Heikman
Ilkka
I
Ojanperä
D000280:Administration, Inhalation; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000368:Aged; D002047:Buprenorphine / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D002492:Central Nervous System Depressants / Q000097:blood; D002853:Chromatography, Liquid; D000431:Ethanol / Q000097:blood; D005260:Female; D053593:Forensic Toxicology; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000401:mortality* / Q000628:therapy; D015819:Substance Abuse, Intravenous; D013405:Suicide / Q000706:statistics & numerical data; D053719:Tandem Mass Spectrometry; D055815:Young Adult
D002492:Central Nervous System Depressants; D009292:Narcotic Antagonists; D009270:Naloxone; D000431:Ethanol; D002047:Buprenorphine
Abuse liability; Buprenorphine; Drug abuse; Fatal poisoning; Naloxone; Urine analysis