University of Helsinki, Hjelt Institute, Department of Forensic Medicine, PO Box 40 (Kytösuontie 11), FI-00014 Helsinki, Finland.
Forensic Sci Int. 2012 Oct 10;222(1-3):327-31. doi: 10.1016/j.forsciint.2012.07.011. Epub 2012 Aug 10.
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.
在一些国家，医用阿片类药物导致的致命中毒呈上升趋势。本研究评估了 2000 年至 2008 年期间芬兰与阿片类药物相关的死后案例中的药物和酒精检测结果以及死亡原因和方式。在此期间，处方类阿片药物（丁丙诺啡、可待因、右丙氧芬、芬太尼、美沙酮、羟考酮、曲马多）导致的致命中毒占所有药物中毒的比例从 9.5%上升至 32.4%，在整个研究期间占比 22.3%。对芬兰最易滥用药物的 14-44 岁年龄组进行了一项包括最常见阿片类药物的详细研究。结果显示，弱阿片类药物可待因和曲马多中毒与大剂量、通常是自杀性过量有关，导致血液中药物浓度很高。美沙酮中毒与药物意外过量有关，血液中的药物浓度仍在治疗范围内。可待因、曲马多和美沙酮中毒的死亡方式分别有 43%、55%和 94%为意外。可待因中毒的可待因和吗啡浓度中位数分别为 1.4mg/L 和 22.5mg/L，高于其他死因（分别为 0.09mg/L 和 5.9mg/L）。曲马多中毒的曲马多和 O-去甲基曲马多浓度中位数分别为 5.3mg/L 和 0.8mg/L，高于其他死因（分别为 0.6mg/L 和 0.2mg/L）。美沙酮中毒的美沙酮浓度中位数（0.35mg/L）与其他死因无差异（0.30mg/L）。在涉及这些处方类阿片药物的致命中毒中，经常发现镇静药物和/或酒精。
