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Additive Effects of Cointoxicants in Single-Opioid Induced Deaths
Academic Forensic Pathology
|February 6, 2018
Summary
Cointoxicants like alcohol and benzodiazepines can lower opioid concentrations in forensic drug deaths, potentially complicating toxicology results. Documenting all substances is crucial for accurate interpretation in opioid overdose cases.
Area of Science:
- Forensic Toxicology
- Public Health
- Pharmacology
Background:
- Opioid-related deaths are a significant public health crisis in the United States.
- Postmortem toxicology interpretation can be complex due to the presence of multiple substances.
- Rural populations in West Virginia and Northern New England states share similar medical examiner systems.
Purpose of the Study:
- To investigate the impact of common cointoxicants on opioid concentrations in fatal drug overdose cases.
- To analyze relationships between opioid levels and non-opioid substances in postmortem toxicology.
- To identify factors influencing opioid concentration interpretation in forensic drug deaths.
Main Methods:
- Utilized a forensic drug database (FDD) encompassing 1482 single opioid deaths (fentanyl, hydrocodone, methadone, oxycodone) from 2007-2011.
- Modeled associations between opioid concentrations and cointoxicants (benzodiazepines, alcohol, antidepressants, etc.).
- Included covariates such as state, age, BMI, and sex in the statistical model.
Main Results:
- Alcohol, benzodiazepines, and antidepressants were associated with significantly lower concentrations of certain opioids.
- Fentanyl concentrations showed the least association with the studied cointoxicants and covariates.
- Alcohol as a cointoxicant was linked to lower opioid concentrations compared to other factors.
Conclusions:
- The presence of cointoxicants can alter opioid concentrations, potentially obscuring interpretation of postmortem toxicology alone.
- Accurate interpretation of opioid-related deaths requires comprehensive documentation of all cointoxicants.
- Findings highlight the complexity of opioid overdose toxicology and the need for thorough investigation.
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