@article{ref1,
title="Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning",
journal="Forensic science international",
year="2013",
author="Häkkinen, Margareeta and Heikman, Pertti and Ojanperä, Ilkka",
volume="232",
number="1-3",
pages="11-15",
abstract="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 &quot;Parenteral BNX&quot; group (>100μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the &quot;Parenteral BPN&quot; group (>50μg/l BPN, 0μg/l NX) of injecting or snorting BPN abusers, while the &quot;Other BNX or BPN&quot; group (≤100μg/l NX, or ≤50μg/l BPN combined with 0μg/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 100μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the &quot;Parenteral BNX&quot;, &quot;Parenteral BPN&quot; and &quot;Other BNX or BPN&quot; 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.<p /> <p>Language: en</p>",
language="en",
issn="0379-0738",
doi="10.1016/j.forsciint.2013.06.017",
url="http://dx.doi.org/10.1016/j.forsciint.2013.06.017"
}