Parent and Metabolite Opioid Drug Concentrations in Unintentional Deaths Involving Opioid and Benzodiazepine Combinations

• NCJ Number: 249393
• Journal: Journal of Forensic Sciences Volume: 60 Issue: 4 Dated: July 2015 Pages: 950-956
• Author(s): Marcia D. Fields; Marie A. Abate B.S.; Lan Hu B.S.N; D. Leann Long Ph.D.; Matthew L. Blommel; Nabila A. Haikal M.D.; James C. Kraner Ph.D.
• Date Published: July 2015
• Length: 7 pages
• Sponsoring Agency: National Institute of Justice (NIJ)
• Publication Format: Article; Document (Online)
• Publication Type: Research (Applied/Empirical); Report (Study/Research); Report (Grant Sponsored)
• Language: English
• Country: United States of America

Annotation

This research project determined the effects of benzodiazepines on postmortem opioid parent and parent/metabolite blood concentration ratios for fentanyl-, hydrocodone-, methadone-, or oxycodone-related accidental deaths.

Abstract

These opioids are partially metabolized by the CYP3A4 enzyme system, which is also affected by diazepam and alprazolam. Opioid/metabolite combinations examined in this study were as follows: fentanyl/norfentanyl, hydrocodone/dihydrocodeine, methadone/EDDP, and oxycodone/oxymorphone. Parent opioid concentrations were analyzed for 877 deaths. Parent/metabolite concentration ratios were analyzed for 349 deaths, excluding cases with co-intoxicants present known to interfere with opioid elimination. Alprazolam in combination with diazepam significantly decreased median hydrocodone concentrations by 48 percent (p = 0.01) compared to hydrocodone alone. The methadone parent/metabolite concentration ratio was reduced by 35 percent in the presence of diazepam compared to methadone alone (p = 0.03). Benzodiazepines did not statistically significantly affect fentanyl or oxycodone concentrations. Possible factors affecting opioid concentrations and possible toxicity development, including any differential effects on specific opioids, should continue to be explored. (Publisher abstract modified)