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The success of high-dose buprenorphine (HDB) as substitution therapy for major opioid dependence is related to its partial agonist effect on opioid receptors, which in theory makes it very safe to use. However, numerous deaths directly attributable to buprenorphine have been described in the literature. These deaths are generally related to misuse of HDB with intravenous administration and/or concomitant use of benzodiazepines, and they usually occur in patients on HDB substitution therapy for opioid dependence. We present three deaths attributed to HDB which arose from uncommon mechanisms and led to unusual forensic situations. The first death was that of a patient admitted to hospital after simultaneous prescription of HDB, clonazepam, oxazepam, and cyamemazine. The second death followed forcible administration of a very low dose of HDB to a patient with post-hepatitis C cirrhosis and heart failure. The third death was subsequent to an HDB overdose, probably with suicidal intent, in a young woman who had not been prescribed the drug as opiate substitute. Such deaths raise the question of the mechanisms involved and draw attention to the resulting unusual forensic situations.

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International forensic protocols are typically developed by committees drawn from multiple disciplines and are presented to the forensic community in the hope the protocols will be adopted. While the contributors are undoubtedly experts within their respective disciplines, they may lack practical international large-scale death investigative experience. As a result, the protocols produced are often cumbersome or impractical. Many are abandoned or heavily modified after brief field trials, such as the INFORCE mass grave field protocol in Iraq in 2004 or the Simmon's personal identification protocol in Kosovo in 2000. Information gleaned from any brief field trials is rarely conveyed to the larger forensic community. This study presents the findings of a pilot study examining the validity and feasibility of a proposed protocol, the International Protocol on the Documentation and Investigation of Sexual Violence in Conflict: