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Häkkinen M, Heikman P, Ojanperä I. 
“Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning”. 
Forensic Sci Int. 2013 Oct 23;232(1-3):11-5.
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 Parenteral BNX group (gt;;100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the Parenteral BPN group (gt;;50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the Other BNX or BPN group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/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 100 μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4. In the Parenteral BNX, Parenteral BPN and Other BNX or BPN 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.
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