Abstract：
The drug combination referred to as \'benzo dope\' has become prevalent in recent years, with an increasing number of fentanyl-related deaths reporting the concomitant presence of one or more benzodiazepine drug, such as etizolam, flualprazolam and flubromazepam. The central nervous system (CNS) depressant effects of these benzodiazepine drugs can exacerbate respiratory and CNS depressant effects resulting from the use/misuse of potent opioids such as fentanyl. This combined and enhanced drug-induced toxicity can pose a significant threat to life. Over a three-year period (2020-2022), the Office of the Chief Medical Examiner, Edmonton, Alberta, Canada issued 2812 case reports with fentanyl detected; of these cases, approximately 45% (1261) were positive for at least one benzodiazepine drug. This study presents concentrations of both fentanyl and benzodiazepine drugs in post mortem blood collected from a visualized, ligated femoral vein. The study demonstrates that the blood concentration of fentanyl in benzo-dope case reports is considerably higher than in cases where no benzodiazepine drug was detected.The median concentration of fentanyl in femoral blood for cases that also contained a benzodiazepine drug was 12.4 ng/mL (2020), 11.9 ng/mL (2021) and 14.0 ng/mL (2022). The median concentration of fentanyl in femoral blood for cases that did not contain a benzodiazepine drug was 8.5 ng/mL (2020), 7.0 ng/mL (2021) and 7.2 ng/mL (2022). The percent differences between the groups were similar with those observed from quantitative analysis of drug powders from unrelated police seizures in Alberta, Canada, suggesting the observed differences in blood fentanyl concentration may be due to the use of a drug substance with a higher concentration of fentanyl.Furthermore, the reported concentration of the benzodiazepine drug(s) is low, such that the role/contribution, if any, that this drug may have played in the decedents\' death should be questioned and carefully considered by the certifying medical examiner/coroner.
摘要：
被称为“苯并涂料”的药物组合近年来变得普遍，随着越来越多的芬太尼相关死亡报告同时存在一种或多种苯二氮卓类药物，比如etizolam,氟吡唑仑和氟溴西泮。这些苯二氮卓类药物的中枢神经系统（CNS）抑制作用会加剧由于使用/误用强效阿片类药物如芬太尼而引起的呼吸和CNS抑制作用。这种组合的和增强的药物诱导的毒性可能对生命构成重大威胁。在三年期间（2020-2022年），首席体检医师办公室,埃德蒙顿,艾伯塔省,加拿大发布了2812例发现芬太尼的病例报告；在这些病例中，约45%(1261)对至少一种苯二氮卓类药物呈阳性.这项研究显示了从可视化的验尸血液中收集的芬太尼和苯二氮卓类药物的浓度，股静脉结扎。研究表明，苯并掺杂剂病例报告中芬太尼的血液浓度明显高于未检测到苯二氮卓类药物的病例。对于还含有苯二氮卓类药物的患者，股骨血液中芬太尼的中位浓度为12.4ng/mL（2020年），11.9ng/mL（2021年）和14.0ng/mL（2022年）。对于不含苯二氮卓类药物的患者，股骨血液中芬太尼的中位浓度为8.5ng/mL（2020年），7.0ng/mL（2021年）和7.2ng/mL（2022年）。两组之间的百分比差异与艾伯塔省无关警察缉获的药物粉末的定量分析相似，加拿大,提示观察到的血液芬太尼浓度差异可能是由于使用了较高浓度芬太尼的药物。此外，苯二氮卓类药物的报告浓度较低，这样的角色/贡献，如果有的话,证明医学检查官/验尸官应质疑并仔细考虑这种药物可能在死者死亡中发挥的作用。
