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The study included all death cases (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009570) between 2018 and 2020 with a buprenorphine or norbuprenorphine finding in post-mortem toxicology and with known drug misuse history or concomitant findings of illicit drugs. Of the deceased, 10% had received OAT in the year before death. Less than 1% of individuals\u2009&lt;\u200925 years had received OAT, whereas the proportion in individuals\u2009\u2265\u200925 years was 13% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). There were significantly more females and more fatal poisonings (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) among those\u2009&lt;\u200925 years than among those\u2009\u2265\u200925 years. OAT medication at the time of death was sublingual buprenorphine-naloxone in 74% and subcutaneous buprenorphine in 23%. Except for significantly fewer benzodiazepine findings among those receiving OAT, minimal differences were found in terms of age, gender, cause and manner of death, or concomitant substance use between the deceased in and outside of OAT. Concomitant misuse of benzodiazepines, psychostimulants, alcohol, and gabapentinoids was frequent both in and outside of OAT and likely contributed to the death. These results suggest that access to OAT especially for young people and treatment of multiple addictions should be improved. Comprehensive information from medico-legal cause-of-death investigation as a starting point, combined with subsequent ante-mortem patient records, proved to be a successful approach to shed light on the Finnish scene of buprenorphine mortality.\n                  <\/jats:p>","DOI":"10.1007\/s00414-024-03273-5","type":"journal-article","created":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T23:10:22Z","timestamp":1719184222000},"page":"2331-2338","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Buprenorphine deaths confirmed by toxicology reveal a low proportion of opioid agonist treatment before death in Finland"],"prefix":"10.1007","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6744-7689","authenticated-orcid":false,"given":"Claudia","family":"Mariottini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6637-9103","authenticated-orcid":false,"given":"Margareeta","family":"H\u00e4kkinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5721-2827","authenticated-orcid":false,"given":"Pirkko","family":"Kriikku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-1473","authenticated-orcid":false,"given":"Ilkka","family":"Ojanper\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"issue":"1","key":"3273_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/s41572-019-0137-5","volume":"6","author":"J Strang","year":"2020","unstructured":"Strang J, Volkow ND, Degenhardt L, Hickman M, Johnson K, Foob GF, Marshall BDL, Tyndall M, Walsh SL (2020) Opioid use disorder. 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