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Cited by 21Forensic Toxicology and Drug AnalysisOpioid Use Disorder TreatmentSubstance Abuse Treatment and Outcomes

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Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations

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Bech, Anne Berit, Clausen, Thomas, Waal, Helge, Vindenes, Vigdis, Edvardsen, Hilde Erøy, Frost, Joachim, Skeie, Ivar·2021·Addiction
DOI 10.1111/add.15211
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Abstract

AIMS: To present the substances and their concentrations detected post-mortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act, and explore the association between drug-induced cause of death and the pooled opioid and benzodiazepine concentrations. DESIGN: Cross-sectional nationwide study. SETTING: Norway. PARTICIPANTS: One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with post-mortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports. MEASUREMENTS: Presence of alcohol and non-alcohol substances in the bloodstream at time of death, determined through records of toxicology of post-mortem femoral blood. FINDINGS: A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug-induced deaths compared with other causes of death (362 ng/mL versus 182 ng/mL, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/mL, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ML) was associated with increased odds of a drug-induced cause of death (odds ratio, 1.003; 95% confidence interval: 1.001-1.006). CONCLUSIONS: In Norway, overall opioid concentration seems to play an important role in drug-induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.

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  • Pucci et al. concluded that the pre-hospital median dose of naloxone 0.80 mg (range: 0.40-2.00mg) was consistent with typical doses required to reverse acute poisoning from potent opioids.

    “Pucci et al. [30] concluded that the pre-hospital median dose of naloxone 0.80 mg (range: 0.40-2.00mg) was consistent with typical doses required to reverse acute poisoning from potent opioids.”

    From Nitazenes: review of comparative pharmacology and antagonist action (2025) · cites this paper as [30]

    The Discussion mentions intranasal naloxone as a harm-reduction measure, but gives no pre-hospital dose or dose range. Searches for Pucci, 0.80 mg, and naloxone doses found no passage assessing doses needed to reverse acute poisoning from potent opioids. Page numbers were not available in our copy. (LLM, conf=0.76)

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  • These cases were reversed by naloxone, which is consistent with the typical doses required for the reversal of acute poisoning from a potent opioid by paramedics.

    “with respect to the controversial dose of take-home naloxone, these cases were reversed by naloxone, which is consistent with the typical doses required for the reversal of acute poisoning from a potent opioid by paramedics [30,59].”

    From Nitazenes: review of comparative pharmacology and antagonist action (2025) · cites this paper as [30]

    The Discussion recommends distributing intranasal naloxone for harm reduction, but does not report cases reversed by naloxone or doses used by paramedics. Searches for naloxone reversal and typical doses for acute opioid poisoning found no passage addressing those claims; the study examines postmortem toxicology. (LLM, conf=0.76)

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Metadata

Authors
Bech, A. B., Clausen, T., Waal, H., Vindenes, V., Edvardsen, H. E., Frost, J., & Skeie, I.
Affiliations
  • University of Oslo (NO)
  • Oslo University Hospital (NO)
  • Department of Forensic Sciences Oslo University Hospital Oslo Norway
  • St Olav's University Hospital (NO)
Corresponding author
Bech, Anne Berit
ORCID
Venue
Addiction
Publisher
Wiley
Published
2020-09-17
Volume
116
Issue
4
Pages
845-855
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/add.15211
OpenAlex
W3046491422
Cited by
21
References
1
Citations by year
2026: 1 · 2025: 5 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 4
FWCI
2.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Addiction (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-sa)
Funders
Sykehuset Innlandet HF (150351)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
opioid substitution therapy, methadone, buprenorphine, postmortem toxicology, benzodiazepines, drug-induced death, opioid overdose, substance use disorders, causes of death, conversion factors

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