{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:48:00Z","timestamp":1777373280950,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Academic Forensic Pathology"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:p>A forensic drug database (FDD) was used to capture comprehensive data from all drug-related deaths in West Virginia, with deaths also included from the northern New England states of Maine, Vermont, and New Hampshire. All four states serve predominantly rural populations under two million and all have similar state medical examiner systems that employ statewide uniform death certification policies and practices. This study focused on 1482 single opioid deaths (fentanyl, hydrocodone, methadone, and oxycodone) in the FDD from 2007-2011. We modeled relationships between the opioid concentrations and the presence or absence of the following commonly occurring non-opioid cointoxicants: benzodiazepines (alprazolam and diazepam), alcohol, tricyclic antidepressants, selective serotonin reuptake inhibitors, and diphenhydramine. Additional covariates of state, age, body mass index, and sex were included. Results showed that the presence of alcohol, benzodiazepines, and antidepressants were each associated with statistically significant lower concentrations of some but not all of the opioids studied, which may obscure the interpretation of postmortem toxicology results alone. Fentanyl concentrations appeared to be the least associated with the presence or absence of the variables studied, and cointoxicant alcohol appeared to be associated with lower concentrations in opioid concentrations than were most of the other factors in the model studied. These findings underscore the importance of documenting all potential cointoxicants in opioid-related deaths.<\/jats:p>","DOI":"10.23907\/2016.053","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T11:08:11Z","timestamp":1491908891000},"page":"532-542","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Additive Effects of Cointoxicants in Single-Opioid Induced Deaths"],"prefix":"10.1177","volume":"6","author":[{"given":"Marcella H.","family":"Sorg","sequence":"first","affiliation":[{"name":"University of Maine - Margaret Chase Smith Policy Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Leann","family":"Long","sequence":"additional","affiliation":[{"name":"West Virginia University School of Public Health - Statistics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie A.","family":"Abate","sequence":"additional","affiliation":[{"name":"West Virginia University - School of Pharmacy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James A.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"West Virginia Department of Health and Human Resources - Office of the Chief Medical Examiner"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James C.","family":"Kraner","sequence":"additional","affiliation":[{"name":"West Virginia Department of Health and Human Resources - Office of the Chief Medical Examiner"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret S.","family":"Greenwald","sequence":"additional","affiliation":[{"name":"Office of Chief Medical Examiner - State of Maine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas A.","family":"Andrew","sequence":"additional","affiliation":[{"name":"Office of the Chief Medical Examiner - New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven L.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Office of Chief Medical Examiner - Vermont State Department of Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie A.","family":"Wren","sequence":"additional","affiliation":[{"name":"University of Maine - Margaret Chase Smith Policy Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,9,1]]},"reference":[{"key":"bibr1-2016.053","doi-asserted-by":"crossref","unstructured":"MinettW.J., MooreT.L., JuhascikN.P.  Concentrations of opiates and psychotropic agents in polydrug overdoses: a surprising correlation between morphine and antidepressants. J Forensic Sci. 2010 Sep; 55(5): 1319\u201325. PMID: 20456586. http:\/\/dx.doi.org\/10.1111\/j.1556-4029.2010.01408.x.","DOI":"10.1111\/j.1556-4029.2010.01408.x"},{"key":"bibr2-2016.053","doi-asserted-by":"crossref","unstructured":"DasguptaN., FunkM.J., ProescholdbellS.  Cohort study of the impact of high-dose opioid analgesics on overdose mortality. Pain Med. 2016 Jan; 17(1): 85\u201398. PMID: 26333030. http:\/\/dx.doi.org\/10.1111\/pme.12907.","DOI":"10.1111\/pme.12907"},{"key":"bibr3-2016.053","doi-asserted-by":"publisher","DOI":"10.23907\/2013.011"},{"key":"bibr4-2016.053","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"issue":"40","key":"bibr5-2016.053","first-page":"881","volume":"63","author":"Jones C.M.","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"bibr6-2016.053","doi-asserted-by":"crossref","unstructured":"WebsterL.R., CochellaS., DasguptaN.  An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Med. 2011 Jun; 12 Suppl 2: S26\u201335. PMID: 21668754. http:\/\/dx.doi.org\/10.1111\/j.1526-4637.2011.01134.x.","DOI":"10.1111\/j.1526-4637.2011.01132.x"},{"key":"bibr7-2016.053","doi-asserted-by":"crossref","unstructured":"JonesC.M., MackK.A., PaulozziL.J. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013 Feb 20; 309(7): 657\u20139. PMID: 23423407. http:\/\/dx.doi.org\/10.1001\/jama.2013.272.","DOI":"10.1001\/jama.2013.272"},{"key":"bibr8-2016.053","doi-asserted-by":"publisher","DOI":"10.23907\/2015.011"},{"key":"bibr9-2016.053","doi-asserted-by":"crossref","unstructured":"SolomonD.H., RassenJ.A., GlynnR.J.  The comparative safety of opioids for nonmalignant pain in older adults. Arch Intern Med. 2010 Dec 13; 170(22): 1979\u201386. PMID: 21149754. http:\/\/dx.doi.org\/10.1001\/archinternmed.2010.450.","DOI":"10.1001\/archinternmed.2010.450"},{"key":"bibr10-2016.053","doi-asserted-by":"crossref","unstructured":"KhodnevaY., MuntnerP., KerteszS.  Prescription opioid use and risk of coronary heart disease, stroke, and cardiovascular death among adults from prospective cohort (REGARDS study). Pain Med. 2015 Sep 11. [Epub ahead of print]. PMID: 26361245. http:\/\/dx.doi.org\/10.1111\/pme.12916.","DOI":"10.1111\/pme.12916"},{"key":"bibr11-2016.053","doi-asserted-by":"crossref","unstructured":"MesgarpourB., GrieblerU., GlechnerA.  Extended release opioids in the management of cancer pain: a systematic review of efficacy and safety. Eur J Pain. 2014 May; 18(5): 605\u201316. PMID: 24115561. http:\/\/dx.doi.org\/10.1002\/j.1532-2149.2013.00401.x.","DOI":"10.1002\/j.1532-2149.2013.00401.x"},{"key":"bibr12-2016.053","doi-asserted-by":"crossref","unstructured":"JonesJ.D., MogaliS., ComerS.D. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012 Sep 1; 125(1-2): 8\u201318. PMID: 22857878. PMCID: PMC3454351. http:\/\/dx.doi.org\/10.1016\/j.drugalcdep.2012.07.004.","DOI":"10.1016\/j.drugalcdep.2012.07.004"},{"key":"bibr13-2016.053","doi-asserted-by":"crossref","unstructured":"JonesA.W., KugelbergF.C., HolmgrenA., AhlnerJ. Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug-alcohol interactions and poly-drug use. Forensic Sci Int. 2011 Mar 20; 206(1-3): 43\u201351. PMID: 20630671. http:\/\/dx.doi.org\/10.1016\/j.forsciint.2010.06.015.","DOI":"10.1016\/j.forsciint.2010.06.015"},{"key":"bibr14-2016.053","doi-asserted-by":"crossref","unstructured":"KoskiA., VuoriE., OjanperaI. Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine. Hum Exp Toxicol. 2005 Aug; 24(8): 389\u201396. PMID: 16138729. http:\/\/dx.doi.org\/10.1191\/0960327105ht542oa.","DOI":"10.1191\/0960327105ht542oa"},{"key":"bibr15-2016.053","doi-asserted-by":"crossref","unstructured":"H\u00e4kkinenM., LauniainenT., VuoriE., Ojanper\u00e4I. Comparison of fatal poisonings by prescription opioids. Forensic Sci Int. 2012 Oct 10; 222(1-3): 327\u201331. PMID: 22884575. http:\/\/dx.doi.org\/10.1016\/j.forsciint.2012.07.011.","DOI":"10.1016\/j.forsciint.2012.07.011"},{"key":"bibr16-2016.053","doi-asserted-by":"crossref","unstructured":"PirnayS., BorronS.W., GiudicelliC.P.  A critical review of the causes of death among post-mortem toxicological investigations: analysis of 34 buprenorphine-associated and 35 methadone-associated deaths. Addiction. 2004 Aug; 99(8): 978\u201388. PMID: 15265095. http:\/\/dx.doi.org\/10.1111\/j.1360-0443.2004.00790.x.","DOI":"10.1111\/j.1360-0443.2004.00790.x"},{"key":"bibr17-2016.053","doi-asserted-by":"crossref","unstructured":"PaulozziL.J., LoganJ.E., HallA.J.  A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction. 2009 Sep; 104(9): 1541\u20138. PMID: 19686524. http:\/\/dx.doi.org\/10.1111\/j.1360-0443.2009.02650.x.","DOI":"10.1111\/j.1360-0443.2009.02650.x"},{"key":"bibr18-2016.053","doi-asserted-by":"crossref","unstructured":"DarkeS., DuflouJ., TorokM. The comparative toxicology and major organ pathology of fatal methadone and heroin toxicity cases. Drug Alcohol Depend. 2010 Jan 1; 106(1): 1\u20136. PMID: 19720472. http:\/\/dx.doi.org\/10.1016\/j.drugalcdep.2009.07.014.","DOI":"10.1016\/j.drugalcdep.2009.07.014"}],"container-title":["Academic Forensic Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.23907\/2016.053","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.23907\/2016.053","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.23907\/2016.053","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:55:10Z","timestamp":1777366510000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.23907\/2016.053"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.23907\/2016.053"],"URL":"https:\/\/doi.org\/10.23907\/2016.053","relation":{},"ISSN":["1925-3621","1925-3621"],"issn-type":[{"value":"1925-3621","type":"print"},{"value":"1925-3621","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}