Aspiration in lethal drug abuse-a consequence of opioid intoxication.
Int J Legal Med
; 134(6): 2121-2132, 2020 Nov.
Article
in En
| MEDLINE
| ID: mdl-32929594
ABSTRACT
AIMS:
The primary objective of this study was to investigate whether the fatalities of opioid abuse are not only related to respiratory depression but also as a result of other side effects such as emesis, delayed gastric emptying, a reduction of the cough reflex, and impaired consciousness leading to the aspiration of gastric contents, a finding regularly observed in drug-related deaths.DESIGN:
A retrospective exploratory study analyzing heroin/morphine/methadone-related deaths submitted to court-ordered autopsy.SETTING:
Center for Forensic Medicine, Medical University of Vienna, Austria (2010-2015).PARTICIPANTS:
Two hundred thirty-four autopsy cases were included in the study morphine (n = 200), heroin (n = 11), and methadone (n = 23) intoxication.FINDINGS:
Analyses revealed that 41.88% of all deceased showed aspiration of gastric contents with equal gender distribution (p = 0.59). Aspiration was more frequent in younger deceased (χ2 = 8.7936; p = 0.012) and in deceased with higher body mass index (BMI) (χ2 = 6.2441; p = 0.044). Blood opioid concentration was lower in deceased with signs of aspiration than in non-aspirators (p = 0.013). Toxicological evaluation revealed a high degree of concomitant substance abuse (91%)-benzodiazepines (61.6%) and/or alcohol (21.8%).CONCLUSIONS:
There are lower opioid concentrations in deceased with signs of aspiration, a fact which strongly points to aspiration as alternative cause of death in opioid-related fatalities. Furthermore, this study highlights the common abuse of slow-release oral morphine in Vienna and discusses alternative medications in substitution programs (buprenorphine/naloxone or tamper-resistant slow-release oral morphine preparations), as they might reduce intravenous abuse and opioid-related deaths.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Substance-Related Disorders
/
Respiratory Aspiration of Gastric Contents
/
Analgesics, Opioid
/
Morphine
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Year:
2020
Type:
Article