Combined Ethanol, Cocaine, Heroin and Methadone Abuse: a Deadly Mix, Review of the Literature

M. Akhgari, F. Jokar, L. Bahmanabadi
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Abstract

Background: Polysubstance use or abuse is defined as the ingestion or use of more than one drug of abuse within a defined time frame, aiming to enhance or modulate psychoactive effects, alleviate unwanted side effects of one substance and free access to different kinds of substances. Although deaths involving cocaine and other psychostimulants are increasing in many countries, it is not common in Iran due to the high price of cocaine due to a decrease in the supply chain to Iran. Case presentation: We report the case of a death due to polysubstance use. Analytical toxicology results were positive for cocaine, cocaethylene, morphine (heroin metabolite), and methadone in combination with positive blood and vitreous humor alcohol contents. The most significant histopathologic features were vascular hypertrophy, chronic myocardial ischemia, moderate to severe atherosclerosis, acute myocardial infarction, hemorrhagic pulmonary edema, diffuse alveolar collapse, micro-vesicular steatosis, focal hepatocyte necrosis, chronic hepatitis, and steatohepatitis. Discussion: polysubstance users mix drugs to reduce the negative effects of each drug. However, mixing recreational drugs is very dangerous. Pharmacokinetic and pharmacodynamics interactions in polysubstance users can produce health consequences leading to death. Conclusion: Results of this forensic case study increased attention to overdose mortality due to polydrug use.
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混合乙醇、可卡因、海洛因和美沙酮滥用:一种致命的混合物,文献综述
背景:多物质使用或滥用被定义为在规定的时间范围内摄入或使用一种以上的滥用药物,目的是增强或调节精神作用,减轻一种物质的不良副作用,并自由获取不同种类的物质。虽然与可卡因和其他精神兴奋剂有关的死亡人数在许多国家都在增加,但在伊朗这种情况并不常见,因为供应给伊朗的可卡因供应链减少,导致可卡因价格居高不下。病例介绍:我们报告了一例因使用多种物质而死亡的病例。分析毒理学结果为阳性可卡因,可卡因,吗啡(海洛因代谢物),美沙酮合并阳性血液和玻璃体酒精含量。最显著的组织病理特征是血管肥大、慢性心肌缺血、中重度动脉粥样硬化、急性心肌梗死、出血性肺水肿、弥漫性肺泡塌陷、微泡性脂肪变性、局灶性肝细胞坏死、慢性肝炎和脂肪性肝炎。讨论:多种药物使用者混合使用药物以减少每种药物的负面影响。然而,混合娱乐性药物是非常危险的。多物质使用者体内的药代动力学和药效学相互作用可产生导致死亡的健康后果。结论:这一法医案例研究的结果增加了对多种药物使用导致的过量死亡率的关注。
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期刊介绍: Asia Pacific Journal of Medical Toxicology (APJMT) aims to expand the knowledge of medical toxicology and tries to provide reliable information in this field for medical and healthcare professionals. APJMT mainly focuses on research related to medical toxicology issues in the Asia Pacific region and publishes articles on clinical and epidemiological aspects of toxicology, poisonings emergency care, addiction, drug interactions and adverse effects. The journal accepts and welcomes high quality papers in the form of original articles and rarely review articles, case reports and scientific letters relevant to medical practice in toxicology.
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