Buprenorphine/NorBuprenorphine identification in putrefied biological samples: evaluation of a buprenorphine related death

Introduction: Deaths related to buprenorphine are rarely discovered in Italy. This paper describes a case report regarding a young marine that was found dead, in an advanced state of decomposition, in which buprenorphine/nor-buprenorphine (BUP/norBUP) are identified and quantified by GC/MS. Material and methods: BUP/norBUP were extracted from hair and from putrefied samples after acid hydrolysis (hair) and enzymatic hydrolysis by β-glucuronidase (blood, liver, urine and bile). Instrumental identification was carried out on GC/MS (Agilent 5973N) (SIM mode), monitoring respectively 450–482–506 (m/z) ion for buprenorphine and 468–500–524 (m/z) ion for nor-buprenorphine, compared to certified materials and deuterated internal standards. Results: In spite of putrefaction the presence of BUP/norBUP was demonstrated in liver (8.4 ng/mg); blood (24 ng/mL); urine and bile positive. In the hair, beyond BUP/norBUP, they were discovered cocaine, BEG, 6-MAM and morphine. Complementary systematic analyses by GC/MS revealed clozapine, lormetazepam and amoxapine, only in urine and bile. All these data support the hypothesis that the subject was under buprenorphine substitution treatment with contemporary use of antidepressive and tranquillizer drugs. Conclusion: These data demonstrate the persistence of BUP/norBUP in post mortem samples and contribute to highlight the incidence of buprenorphine in deaths involving addicts of heroin and other psychotropic drugs.