Modern Synthetic Opioids and Rabdomyolisis: Clinical and Forensic Aspects

Introduction. Every year, the list of chemical substances, including drugs, that can potentially cause rhabdomyolysis grows worldwide. Aim. Analysis of etiological factors that caused the development of rhabdomyolysis of non-traumatic genesis in adult patients with acute poisoning. Materials and methods. A total of 243 cases of acute poisoning among the adult population of Kyiv, complicated by non-traumatic rhabdomyolysis, were studied for the period 1999-2020. Results. According to the toxicological center and the bureau of forensic medical experts of Kyiv, the spectrum of toxic substances that cause the development of non-traumatic rhabdomyolysis is constantly changing. During the period 1999-2010, rhabdomyolysis was associated with poisonings with carbon monoxide, ethyl alcohol and its surrogates, barbiturates, clonidine, TCA, neuroleptics, and heroin. After 2010, cases of rhabdomyolysis associated with neuroleptics, street drugs: psychostimulants, heroin, methadone, in particular the combination of methadone with ethyl alcohol, or with benzodiazepines, neuroleptics, tricyclic antidepressants, have become more frequent. Cases of severe poisonings with unidentified substances were increasingly observed (12.75%). In-hospital mortality rates among patients with rhabdomyolysis remained high (from 10.0 to 25.8%) and depend on the patient's comorbidities, among which diseases of the digestive system (39.1%), the nervous system (27.9%), hematopoietic organs (20.5%) and kidneys (16.9%) predominate. The clinical picture of poisoning complicated by rhabdomyolysis is characterized not only by acute kidney injury, but also by the rapid development of multiple organ failure, which, despite the timely use of renal replacement therapy, leads to a fatal outcome. Conclusions. In recent years, there has been a growing trend of drug poisoning involving synthetic opioids (heroin, methadone in combination with ethanol and other surfactants), complicated by non-traumatic rhabdomyolysis. Key factors in the development of multiple organ failure are the combined consumption of several psychotropic and narcotic substances with alcohol and comorbid pathology.