Buprenorphine-Related Deaths in North Carolina from 2010 to 2018
Buprenorphine-Related Deaths in North Carolina from 2010 to 2018
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DOI：
10.1093/jat/bkab073
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发表时间：
2021-06-19
影响因子：
2.5
通讯作者：
Hudson, Jason S.
中科院分区：
文献类型：
--
作者：
Bishop-Freeman, Sandra C.;Friederich, Laura W.;Hudson, Jason S.
丁丙诺啡（BUP）是治疗阿片类药物使用障碍（OUD）的常用处方药。随着北卡罗来纳州处方的增加，BUP在全州范围内的例行尸检工作中更频繁地出现。在2010年至2018年期间，首席医学检查官办公室调查了131例选定病例，其中在外周血中检测到BUP并被认为是主要死亡原因（COD），没有其他阿片类药物存在，也没有在致死范围内发现其他非阿片类物质。死者年龄从14岁到64岁不等，其中67%为男性。BUP的平均/中位外周血浓度为4.1/2.1 ng/mL，其代谢产物去甲丁丙诺啡为7.8/3.4 ng/mL。这些死后血药浓度与接受舌下维持治疗的阿片类药物依赖受试者文献中报告的死前血浆治疗浓度重叠。病理学家考虑了现场发现、处方史、尸检发现、毒理学分析和死者死亡前的行为，以得出药物相关COD的结论。许多死亡是由于其他中枢神经系统抑制剂的存在而复杂化的，沿着有潜在的心血管和呼吸系统疾病。三种最常见的添加剂物质是阿普唑仑、乙醇和加巴喷丁，分别见于131例中的67例、36例和32例。解释BUP与死亡的关系是复杂的，流行病学数据中的情况可能被低估，因为在死后血液中缺乏明确的毒性或致死范围，沿着其良好的安全性。随着扩大OUD治疗的可及性成为优先事项，需要认识到死后解释的挑战，因为BUP的增加使用和转移是不可避免的。
Buprenorphine (BUP) is a commonly prescribed medication for the treatment of opioid use disorder (OUD). As prescriptions increase in North Carolina, BUP is more frequently encountered statewide in routine postmortem casework. Between 2010 and 2018, there were 131 select cases investigated by the Office of the Chief Medical Examiner where BUP was detected in peripheral blood and considered a primary cause of death (COD), with no other opioids present and no other non-opioid substances found in the lethal range. The decedents ranged in age from 14 to 64years, with 67% male. The mean/median peripheral blood concentrations were 4.1/2.1ng/mL for BUP and 7.8/3.4ng/mL for its metabolite, norbuprenorphine. These postmortem blood concentrations overlap antemortem therapeutic concentrations in plasma reported in the literature for opioid-dependent subjects receiving sublingual maintenance therapy. The pathologist considered scene findings, prescription history, autopsy findings, toxicological analysis and decedent behavior prior to death to conclude a drug-related COD. Many of the deaths were complicated by the presence of other central nervous system depressants along with contributory underlying cardiovascular and respiratory disease. The three most prevalent additive substances were alprazolam, ethanol and gabapentin, found in 67, 36 and 32 cases out of 131, respectively. Interpreting BUP involvement in a death is complex, and instances may be underestimated in epidemiological data because of the lack of a defined toxic or lethal range in postmortem blood along with its good safety profile. As expansion of access to OUD treatment becomes a priority, awareness of the challenges of postmortem interpretation is needed as increased use and diversion of BUP are inevitable.