Assessment of systemic and organotoxic effects caused by the modern synthetic opioids: clinical and forensic aspects

Abstract

ABSTRACT. Establishing the cause of death in modern drug poisonings (overdoses) is not always a simple task. The systemic toxic effects resulting from the consumption of opioid drugs of the new generations are extremely diverse and extend far beyond the nervous system. The causes of death and mechanisms of tonatogenesis are also quite diverse, so their establishment is based on a wide range of data that can be obtained both during life and in the process of forensic research. Aim. Analysis of the causes of death due to drug poisoning (opioids-related) in adults according to the data of clinical and pathohistological studies. Materials and Methods. A retrospective analysis of the medical records of 164 patients who died in the hospital as a result of opioid poisoning during the period 2017–2021 was carried out; analyzed the data of sectional and microscopic studies of tissues (lungs, kidneys, myocardium, brain, liver, spleen) of 28 people with drug overdoses involving opioids who died outside hospitals during the same period. The preparations were examined using an Olympus CX 41 microscope in transmitted light, at magnifications of 40, 100, and 400 times. Results. Clinical, functional and laboratory tests carried out in the hospital's admissions department and in the intensive care unit revealed the following pathological conditions: cerebral coma, brain edema – 158 (96.3 %); respiratory failure – 73 cases (44.5 %); liver failure – 23 (13.4 %); kidney failure, including anuria – 14 (8.5 %); syndrome of prolonged compression of soft tissues and rhabdomyolysis – 9 (5.4 %); cardiopulmonary failure, including pulmonary edema – 19 (11.5 %); the presence of thrombophlebitis, purulent wounds, sepsis – 24 (14.6 %). According to examination data, toxicological anamnesis, and information from patients' relatives, the structure of concomitant pathology was determined in accordance with ICD-10 codes. According to the data of sectional and histological studies, in 89 cases (54.2 %), changes characteristic of a systemic inflammatory reaction and a chronic inflammatory process, including sepsis, were detected. The results of clinical and pathohistological studies show that drug users have various concomitant pathologies of many organs and systems (lungs, heart, liver, kidneys, etc.), which increases the toxic effect of drugs and conditions the features of tonatogenesis. Conclusions. The study of clinical and histological parallels in cases of sudden death due to drug overdoses will allow us to increase the level of our knowledge about the mechanisms of tonatogenesis and contribute to the determination of effective measures to prevent premature mortality of the population. Keywords: drugs, overdose, mortality, lethality, forensic medicine.