Historique
Article de Périodique
High buprenorphine-related mortality is persistent in Finland (2018)
Auteur(s) :
KRIIKKU, P. ;
HAKKINEN, M. ;
OJANPERA, I.
Année
2018
Page(s) :
76-82
Langue(s) :
Anglais
Refs biblio. :
42
Domaine :
Autres substances / Other substances ; Drogues illicites / Illicit drugs
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus géographique
FINLANDE
Thésaurus mots-clés
BUPRENORPHINE
;
MORTALITE
;
SURDOSE
;
TRAITEMENT DE MAINTENANCE
;
EVOLUTION
;
TOXICOLOGIE
;
INJECTION
;
NALOXONE
;
MEDECINE LEGALE
;
CAUSE DE DECES
;
POLYCONSOMMATION
Résumé :
Sublingual buprenorphine is used in opioid maintenance treatment but buprenorphine is also widely abused and causes fatal poisonings. The aim of this study was to investigate buprenorphine-positive fatalities in order to gain novel information on the magnitude and nature of buprenorphine abuse. All post-mortem toxicology cases positive for urinary buprenorphine, including fatal poisonings caused by buprenorphine and fatalities in which the cause of death was unrelated to buprenorphine, in the five year period of 2010–2014 in Finland were characterized according to urine buprenorphine and naloxone concentrations (n=775). Urine concentrations were used to assess which buprenorphine preparation had been used; mono-buprenorphine or a buprenorphine-naloxone combination, and whether they had been administered parenterally. In at least 28.8% of the buprenorphine-positive cases the drug had been administered parenterally. The majority of the parenteral users (68.6%) had taken mono-buprenorphine. Fatal poisoning was significantly more common among the identified parenteral users (65.5%) than among other users of buprenorphine products (45.3%). The proportion of buprenorphine-related poisoning was similar in identified parenteral users of mono-buprenorphine (68.6%) and buprenorphine-naloxone (64.1%). In nearly all of the fatal poisoningss the deceased had used other drugs and/or alcohol along with buprenorphine (98.7%). The median age of the deceased increased significantly over the study period, from 32 to 38 years. Our results show that there is ongoing parenteral abuse of both mono-buprenorphine and buprenorphine-naloxone combination. Parenteral users of buprenorphine put themselves into a great risk of fatal poisoning or other accidental injury death which is further exacerbated by the frequent poly-drug use.
Highlights:
In 28.8% of the fatalities, buprenorphine had been administered parenterally.
The proportion of parenteral use remained relatively constant over the study period.
The majority of the parenteral users had taken mono-buprenorphine.
Poly-substance use was evident in nearly all buprenorphine-positive fatalities.
Highlights:
In 28.8% of the fatalities, buprenorphine had been administered parenterally.
The proportion of parenteral use remained relatively constant over the study period.
The majority of the parenteral users had taken mono-buprenorphine.
Poly-substance use was evident in nearly all buprenorphine-positive fatalities.
Affiliation :
Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland