CONTRIBUTION OF ASTHMA IN OPIATE DEATHS

Although some studies have shown a link between asthma deaths and opiate abuse, the process in which opiates exacerbate asthma is still unclear. Opiates may impair judgment during an acute asthma attack, leading to inadequate treatment. Alterations in mental status may increase aspiration risk. Some studies have also demonstrated an opiate-induced bronchoconstriction. In our country, according to the 2015 Annual Report of the Central Directorate for Anti- Drug Services, heroin was the drug that caused the greatest number of deaths, among the drug abuse deaths. The prevalence of asthma in Italy, according to the Italian Statistical Yearbook of 2015 (ISTAT), accounted for the 5.6% of the total population. This study has the aim to provide data on opiate deaths in the Department of Forensic Medicine of Sapienza - University of Rome and in Cook County Medical Examiner’s Office in Chicago (USA) and to compare the demographic, anamnestic, seasonal, autopsy, histological and toxicological findings of opiate users who had a history of asthma with those who did not. A histological grading of asthma changes is performed. At the end of the study, the rate of clinical history of asthma in deaths due to opiates, as well as demographic data and seasonal patterns will be evaluated. Statistical analyses will be performed to compare the toxicological levels of opiates in asthmatic and non asthmatic, to infer the role of asthma in these deaths, also considering the different histological grades of asthma. Our preliminary data (855 cases of opiate deaths) showed that a history of asthma can be present in opiate deaths (it accounted for the 9.12% -78 cases). The majority of people who died of opiate intoxication and had a history of asthma were males and African- American. Deaths usually occurred in winter and in spring, probably because cold air and pollens act as a trigger for exacerbations of asthma, together with the drug. In asthma cases, the level of morphine in blood ranged between 23-1,740 ng/ml (Mean: 209.51 ng/ml), the level of blood 6-MAM ranged between 12-280 ng/ml (Mean: 80.6 ng/ml) and the level of blood codeine ranged between 24-34 ng/ml (Mean: 26.6 ng/ml). In our cases with a history of asthma where the route of administration of the drug was inhalation, the grade of asthma was mild: this can support the hypothesis that inhalation, affecting lung tissue more directly than injection, can lead to death even if preexisting asthma changes are minor.