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Heroin Addiction and Related Clinical Problems: 2013, 15, 1 (pages: 15 - 20)

Benzodiazepine misuse in heroin addicts: results of a post-mortem study.

Licata M., Palazzoli F., Verri P., Beduschi G., Pajusco B., Lugoboni F.

Summary: Benzodiazepines, which are typically used to treat insomnia and anxiety disorders, are widely prescribed in all medical fields. This widespread use has led to frequent, often inappropriate forms of consumption. Although benzodiazepines and illicit drugs are commonly associated, the rise in consumption outside the sphere of legitimate prescriptions, even in the general population, has been seriously underestimated. To better describe this phenomenon we assessed benzodiazepine prevalence and typology in 212 autopsy cases examined by the Forensic Medicine Department, University of Modena (Italy) in the three-year period from 2006 to 2008. The biological samples analysed for this study were central blood and urine. All the tests were performed using ultrasensitive liquid chromatography coupled with mass spectrometry in “tandem Mass Spectrometers”. After classifying the various causes of death, the study population was divided into the following groups: 70 deaths from natural causes (33%), 51 from accidental injuries (24%), 40 due to overdose (19%), 23 to homicide (11%), 23 to suicide (11%) and 5 from medical professional causes (5%). 30.8% of the females were BZD-positive, while that feature was identified in 25.9% of the males. The xenobiotics most frequently found were: Diazepam (29.6%), Delorazepam (22.5%), Flurazepam (14.1%), Lorazepam (12.7%), Alprazolam (11.3%) and Lormetazepam (11.3%). It is worth noting the total lack of Flunitrazepam, which is particularly prominent in the Drug Users group, because, worldwide, Flunitrazepam has been the most abused benzodiazepine among polydrug users. This finding tends to suggest that Flunitrazepam has been disappearing from the illegal market in Italy; it also seems to show that recent restrictions on its prescription in this country have already decreased its legal use or actually reduced it to zero.