Abstract
The interaction of diseases with drugs and toxins may result in significantly worse outcomes in a forensic context when i) chronic diseases cause toxicity by increasing drug levels due to reduced renal clearance or slowed hepatic breakdown, and ii) drugs exacerbate underlying lethal mechanisms. In other words, ‘negative disease-drug synergy’ may result in increased drug toxicity and/or greater organ dysfunction despite the use of standard dosages. This is yet another confounding factor to be considered in the interpretation of postmortem toxicological results, as underlying illness and disease states may significantly alter drug availability and physiological responses.
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References
Byard RW. Frailty syndrome – medicolegal considerations. J Forensic Leg Med. 2015;30C:34–8.
Wong CH, Weiss D, Sourial N, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res. 2010;22:54e62.
Byard RW. The complex spectrum of forensic issues arising from obesity. Forensic Sci Med Pathol. 2012;8:402–13.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Bodymass index and mortality in a prospective cohort of US adults. New Engl J Med. 1999;341:1097–105.
Byard RW. Carbon monoxide - the silent killer. Forensic Sci Med Pathol. 2019;15:1–2.
Lewis D, Kenneally M, van den Heuvel C, Byard. RW. Increasing age and methamphetamine use. J Forensic Leg Med. 2021;80:102181.
Karch SB, Stephens BG, Ho CH. Methamphetamine-related deaths in San Francisco: demographic, pathologic, and toxicologic profiles. J Forensic Sci. 1999;44:359–68.
Ekström MP, Bornefalk-Hermansson A, Abernathy AP, Currow DC. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014;348: g445.
Steynor M, MacDuff A. Always consider the possibility of opioid induced respiratory depression in patients presenting with hypercapnic respiratory failure who fail to improve as expected with appropriate therapy. Case Rep Crit Care. 2015;562319.
Baillargeon J, Singh G, Kuo Y-F, Raji MA, Westra J, Sharma G. Association of opioid and benzodiazepine use with adverse respiratory events in older adults with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2019;16:1245–51.
Byard RW, Gilbert JD. Narcotic administration and stenosing lesions of the upper airway – a potentially lethal combination. J Clin Forensic Med. 2005;12:29–31.
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Byard, R.W. The relationship between chronic disease and drugs/toxins—how important is negative disease-drug synergy?. Forensic Sci Med Pathol 19, 477–478 (2023). https://doi.org/10.1007/s12024-023-00608-3
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DOI: https://doi.org/10.1007/s12024-023-00608-3