HEPATOTOXIC EFFECTS DUE TO THE COMBINED CONSUMPTION OF OPIOID DRUGS AND ALCOHOL

Abstract

Introduction. Over the past 20 years, opioid consumption in the world has reached epidemic proportions, which has led to an increase in premature mortality and significantly changed the epidemiology of liver diseases.

Aim. The study of features of liver injury with combined consumption of opioid drugs and alcohol.

Materials and methods. A retrospective analysis of the medical data of 1,540 patients with the diagnoses of "Acute narcotic poisoning" and "Acute methadone poisoning" (ICD-10:Т40.0-Т40.3); 42 acts of forensic medical and forensic histological examination of death cases associated with illegal methadone and alcohol were considered. Clinical, biochemical, and pathohistological studies were used. Histological samples were examined using an Olympus CX 41 microscope in transmitted light, at magnifications of 100, 200, and 400 times. The SPSS Statistics 29.0.0.0 program was used, Pearson's correlation analysis was used, p≤0.05.

Results. According to the results of forensic and histological studies, pronounced infiltration of the liver tissue by small lymphocytes (r=0.471, р=0.002) was found in persons with a long history of illegal methadone and alcohol consumption, which was combined with portal fibrosis (r=0.333, р=0.021) and, in some cases, moderate proliferation of bile ducts (r=0.203, p=0.047). Morphometric analysis of liver biopsies revealed sinusoidal dilatation, inflammatory and fibrotic changes of the terminal hepatic venules (r=0.501, p=0.017); sclerotic changes were noted from the expansion of the portal tracts due to fibrosis and to the initial signs of a partial structure violation, which indicates the transition to cirrhosis.

Conclusions. The progressive spread of the practice of combined consumption of opioid drugs on the example of methadone and alcohol increases the risk of hepatotoxic effects, in particular, accelerating the development of fibrosis and cirrhosis.