Sorg Marcella H, Long D Leann, Abate Marie A, Kaplan James A, Kraner James C, Greenwald Margaret S, Andrew Thomas A, Shapiro Steven L, Wren Jamie A
Acad Forensic Pathol. 2016 Sep;6(3):532-542. doi: 10.23907/2016.053.
A forensic drug database (FDD) was used to capture comprehensive data from all drug-related deaths in West Virginia, with deaths also included from the northern New England states of Maine, Vermont, and New Hampshire. All four states serve predominantly rural populations under two million and all have similar state medical examiner systems that employ statewide uniform death certification policies and practices. This study focused on 1482 single opioid deaths (fentanyl, hydrocodone, methadone, and oxycodone) in the FDD from 2007-2011. We modeled relationships between the opioid concentrations and the presence or absence of the following commonly occurring non-opioid cointoxicants: benzodiazepines (alprazolam and diazepam), alcohol, tricyclic antidepressants, selective serotonin reuptake inhibitors, and diphenhydramine. Additional covariates of state, age, body mass index, and sex were included. Results showed that the presence of alcohol, benzodiazepines, and antidepressants were each associated with statistically significant lower concentrations of some but not all of the opioids studied, which may obscure the interpretation of postmortem toxicology results alone. Fentanyl concentrations appeared to be the least associated with the presence or absence of the variables studied, and cointoxicant alcohol appeared to be associated with lower concentrations in opioid concentrations than were most of the other factors in the model studied. These findings underscore the importance of documenting all potential cointoxicants in opioid-related deaths.
一个法医药物数据库（FDD）被用于收集西弗吉尼亚州所有与药物相关死亡的全面数据，新英格兰北部的缅因州、佛蒙特州和新罕布什尔州的死亡数据也被纳入其中。这四个州的主要人口均为农村人口，且均不足两百万，并且都有类似的州法医系统，采用全州统一的死亡证明政策和做法。本研究聚焦于2007年至2011年FDD中的1482例单一阿片类药物死亡案例（涉及芬太尼、氢可酮、美沙酮和羟考酮）。我们对阿片类药物浓度与以下常见非阿片类共同中毒物质的存在与否之间的关系进行了建模：苯二氮䓬类药物（阿普唑仑和地西泮）、酒精、三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂和苯海拉明。还纳入了州、年龄、体重指数和性别的其他协变量。结果显示，酒精、苯二氮䓬类药物和抗抑郁药的存在分别与某些但并非所有所研究阿片类药物的浓度在统计学上显著降低相关，这可能会单独掩盖死后毒理学结果的解读。芬太尼浓度似乎与所研究变量的存在与否关联最小，并且共同中毒物质酒精似乎比模型中研究的大多数其他因素与阿片类药物浓度降低的关联更大。这些发现强调了记录阿片类药物相关死亡中所有潜在共同中毒物质的重要性。
