Buprenorphine (BUP) is a commonly prescribed medication for the treatment of opioid use disorder (OUD). As prescriptions increase in North Carolina, BUP is more frequently encountered statewide in routine postmortem casework. Between 2010 and 2018, there were 131 select cases investigated by the Office of the Chief Medical Examiner where BUP was detected in peripheral blood and considered a primary cause of death (COD), with no other opioids present and no other non-opioid substances found in the lethal range. The decedents ranged in age from 14 to 64 years, with 67% male. The mean/median peripheral blood concentrations were 4.1/2.1 ng/mL for BUP and 7.8/3.4 ng/mL for its metabolite, norbuprenorphine. These postmortem blood concentrations overlap antemortem therapeutic concentrations in plasma reported in the literature for opioid-dependent subjects receiving sublingual maintenance therapy. The pathologist considered scene findings, prescription history, autopsy findings, toxicological analysis and decedent behavior prior to death to conclude a drug-related COD. Many of the deaths were complicated by the presence of other central nervous system depressants along with contributory underlying cardiovascular and respiratory disease. The three most prevalent additive substances were alprazolam, ethanol and gabapentin, found in 67, 36 and 32 cases out of 131, respectively. Interpreting BUP involvement in a death is complex, and instances may be underestimated in epidemiological data because of the lack of a defined toxic or lethal range in postmortem blood along with its good safety profile. As expansion of access to OUD treatment becomes a priority, awareness of the challenges of postmortem interpretation is needed as increased use and diversion of BUP are inevitable.

中文翻译：

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2010 年至 2018 年北卡罗来纳州与丁丙诺啡相关的死亡人数

丁丙诺啡 (BUP) 是治疗阿片类药物使用障碍 (OUD) 的常用处方药。随着北卡罗来纳州处方的增加，BUP 在全州范围内的例行尸检案例中更频繁地遇到。2010 年至 2018 年期间，首席法医办公室调查了 131 例在外周血中检测到 BUP 并被认为是主要死因 (COD) 的特定病例，没有其他阿片类药物存在，也没有发现其他非阿片类药物物质在致命范围内。死者年龄从14岁到64岁不等，男性占67%。BUP 的平均/中位外周血浓度为 4.1/2.1 ng/mL，其代谢物去甲丁丙诺啡为 7.8/3.4 ng/mL。这些死后血液浓度与文献中报道的接受舌下维持治疗的阿片类药物依赖受试者血浆中的死前治疗浓度重叠。病理学家考虑了现场发现、处方历史、尸检结果、毒理学分析和死者在死前的行为，以得出与药物相关的 COD。许多死亡因存在其他中枢神经系统抑制剂以及潜在的心血管和呼吸系统疾病而变得复杂。三种最普遍的添加物质是阿普唑仑、乙醇和加巴喷丁，在 131 例中分别有 67 例、36 例和 32 例。解释 BUP 参与死亡是复杂的，由于缺乏明确的死后血液毒性或致死范围以及良好的安全性，流行病学数据可能会低估实例。随着扩大 OUD 治疗的使用成为当务之急，需要意识到尸检解释的挑战，因为 BUP 的增加使用和转移是不可避免的。