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Aspiration was more frequent in younger deceased (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20098.7936; <jats:italic>p<\/jats:italic>\u2009=\u20090.012) and in deceased with higher body mass index (BMI) (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20096.2441; <jats:italic>p<\/jats:italic>\u2009=\u20090.044). Blood opioid concentration was lower in deceased with signs of aspiration than in non-aspirators (<jats:italic>p<\/jats:italic>\u2009=\u20090.013). Toxicological evaluation revealed a high degree of concomitant substance abuse (91%)\u2014benzodiazepines (61.6%) and\/or alcohol (21.8%).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>There are lower opioid concentrations in deceased with signs of aspiration, a fact which strongly points to aspiration as alternative cause of death in opioid-related fatalities. Furthermore, this study highlights the common abuse of slow-release oral morphine in Vienna and discusses alternative medications in substitution programs (buprenorphine\/naloxone or tamper-resistant slow-release oral morphine preparations), as they might reduce intravenous abuse and opioid-related deaths.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00414-020-02412-y","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T23:14:10Z","timestamp":1600125250000},"page":"2121-2132","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Aspiration in lethal drug abuse\u2014a consequence of opioid intoxication"],"prefix":"10.1007","volume":"134","author":[{"given":"Johannes","family":"Nicolakis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00fcnter","family":"Gmeiner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4492-0808","authenticated-orcid":false,"given":"Monika Heidemarie","family":"Seltenhammer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"2412_CR1","unstructured":"United Nations Office on Drugs and Crime (2018) World drug report 2018"},{"key":"2412_CR2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0376-8716(00)00150-2","volume":"61","author":"D Risser","year":"2001","unstructured":"Risser D, Honigschnabl S, Stichenwirth M et al (2001) Drug-related emergencies and drug-related deaths in Vienna, 1995-1997. 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