Universität zu Köln

Schoenfeld, T., Heinemann, A., Schulz, M., Gradl, G., Andresen-Streichert, H., Mueller, A. and Iwersen-Bergmann, S. (2019). Post-mortem analysis of prescription opioids-A follow-up examination by LC-MS/MS with focus on fentanyl. Forensic Sci.Int., 305. CLARE: ELSEVIER IRELAND LTD. ISSN 1872-6283

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Abstract

Our aim was to investigate the reason for relatively low detection rates for opioids and fentanyl in particular in post-mortem cases in the State of Hamburg. We re-analysed 822 blood samples from two different time periods, 2011/12 and 2016. These samples had been previously analysed in accordance with post-mortem routine by a case selected strategy. All samples were re-analysed with an LC-MS/MS method specific for prescription opioids. The main point in the evaluation was to determine whether the previous analysis strategy had led to underreporting of drug-related deaths (DRD), especially with regard to fentanyl. Another aim was to evaluate changes in prescribing prevalence of opiates and opioids. We compared pharmacy claims data in Hamburg with Germany. The analyses showed that the number of DRD remained unaffected by the new analytical strategy. Detection rates in DRD, however, increased for fentanyl 3.4-fold from 1.2% to 4.1%, buprenorphine from 5.9% to 7.6%, oxycodone from 0% to 1.8%, tilidine from 1.8% to 2.4%. The most frequently detected opioids in DRD cases were methadone (39.4%) and heroin (20%). Prescription rates between 2011-2017 decreased in Hamburg for nearly all opioids, morphine by - 43.5%, buprenorphine - 43%, codeine - 57%, fentanyl - 25%, tilidine -17%, tramadol - 31%, and hydromorphone -6%. Oxycodone, tapentadol, and piritramide prescription rates increased. For Germany, a decrease in the prescription rates for fentanyl was also found during this period (-12.9 %), although not as pronounced as in Hamburg. Prescription rates for methadone were three to greater than five times higher in Hamburg as compared to the German average due to the higher number of substituted persons per inhabitant. Conclusion: Despite the global problem of opioid abuse, there are significant regional differences in the nature and extent of opioid abuse. It is necessary to collect data at the national level to develop appropriate prevention strategies. (C) 2019 Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schoenfeld, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heinemann, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schulz, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gradl, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Andresen-Streichert, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Iwersen-Bergmann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-126090
DOI:	10.1016/j.forsciint.2019.109970
Journal or Publication Title:	Forensic Sci.Int.
Volume:	305
Date:	2019
Publisher:	ELSEVIER IRELAND LTD
Place of Publication:	CLARE
ISSN:	1872-6283
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TRANSDERMAL PATCH; ABUSE; FATALITIES; DURAGESIC(R); GERMANY Multiple languages Medicine, Legal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12609