Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning

Forensic Sci Int. 2013 Oct 10;232(1-3):11-5. doi: 10.1016/j.forsciint.2013.06.017. Epub 2013 Jul 19.


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 (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>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.

Keywords: Abuse liability; Buprenorphine; Drug abuse; Fatal poisoning; Naloxone; Urine analysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Administration, Sublingual
  • Adolescent
  • Adult
  • Aged
  • Buprenorphine / administration & dosage
  • Buprenorphine / poisoning*
  • Buprenorphine / urine
  • Central Nervous System Depressants / blood
  • Chromatography, Liquid
  • Ethanol / blood
  • Female
  • Forensic Toxicology
  • Homicide / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Naloxone / administration & dosage
  • Naloxone / poisoning*
  • Naloxone / urine
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / poisoning*
  • Narcotic Antagonists / urine
  • Opiate Substitution Treatment
  • Opioid-Related Disorders / mortality*
  • Opioid-Related Disorders / therapy
  • Substance Abuse, Intravenous
  • Suicide / statistics & numerical data
  • Tandem Mass Spectrometry
  • Young Adult


  • Central Nervous System Depressants
  • Narcotic Antagonists
  • Naloxone
  • Ethanol
  • Buprenorphine