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Walde J, Andersson L, Johnson B, Håkansson A. Drug prescriptions preceding opioid-related deaths-a register study in forensic autopsy patients. PLoS One 2023; 18:e0285583. [PMID: 37256903 DOI: 10.1371/journal.pone.0285583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND/AIM Opioid overdose deaths have increased in Sweden and other developed countries in recent decades, despite increased treatment efforts and harm-reduction interventions. Further knowledge in this field is needed if this trend is to be reversed. Previous research suggests that mental health and patterns of prescription of opioids and other prescription drugs are associated with increased opioid-related mortality. The present study therefore aimed to investigate what drugs were prescribed during the last six months of life to individuals with a history of illicit substance use who died with opioids present in their blood, the relationship between drugs prescribed and drugs found in blood at time of death, and if prescription of specific drugs was temporally associated with death. METHODS This was a retrospective, register-based observational study that utilized data from the National Board of Forensic Medicine, the Prescribed Drug Registry, regional health care services, and municipal social services. We used conditional logistic regression to find temporal associations between the prescription and dispensing of drugs and time of death. RESULTS Prescription and dispensing of alprazolam and diazepam were temporally associated with death. The most frequently dispensed drugs were zopiclone, pregabalin, methylphenidate, diazepam and oxycodone. Methadone, alprazolam, and buprenorphine were the drugs most often found in the blood. Opioids and tranquilizers in combination were found in a vast majority of deaths, and prescription data suggested that the use of these drugs was illicit in a majority of cases. CONCLUSION Prescription of certain drugs, especially alprazolam and diazepam, should be made with great caution to patients with a history of illicit substance use or concurrent use of opioids.
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Affiliation(s)
- Jonatan Walde
- Umeå University and Region Västerbotten, Umeå, Sweden
| | - Lisa Andersson
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
| | - Björn Johnson
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
- Lund University, School of Social Work, Lund, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
- Region Skåne, Malmö Addiction Center, Malmö, Sweden
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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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Aly SM, Omran A, Gaulier JM, Allorge D. Substance Use among Adolescents: A Retrospective Study (2017-2018) in the Toxicology Unit, University Hospital of Lille, France. TOXICS 2022; 10:594. [PMID: 36287874 PMCID: PMC9611143 DOI: 10.3390/toxics10100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Research on adolescent substance use is of utmost importance. Using local toxicological data, both prevalence and pattern of substance use (SU) and substance-related death (SRD) can be assessed to design effective prevention programs. A retrospective study of toxicology investigations of all adolescents referred to the medico-legal section of the Toxicology Unit of the University Hospital of Lille, France, for a 2-year period from 2017 to 2018. In the total sample of 1961 cases, adolescents accounted for 3.3% of the cases (n = 65). Among the adolescents, 16.9% were aged 10−14 years and 83.1% were aged >14−19 years. About 69.2% were males. Less than 70% of all presented adolescents used substances. More than two-thirds (74%) of positive detections were male. Illicit substances (43%) were the most detected substance followed by alcohol (20%) and prescription substances (20%). Tetrahydrocannabinol (THC) was extremely common as it was found in 29% of all adolescents. Cocaine and amphetamines were detected in 13.8% of total tested adolescents. Polysubstance use was common between alcohol and THC and among males. About one-third of deaths were due to substance use. About 54% of SRD was associated with polysubstance detection. It is recommended that illicit substances, ethanol, and prescription substances are targeted for testing among adolescents in order to provide appropriate prevention.
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Affiliation(s)
- Sanaa M. Aly
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
| | - Ahmed Omran
- Pediatrics and Neonatology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Jean-Michel Gaulier
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
- Université de Lille, URL 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France
| | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59000 Lille, France
- Université de Lille, URL 4483—IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France
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Abstract
BACKGROUND The benzodiazepine drug alprazolam, a fast-acting tranquiliser, cannot be prescribed on the National Health Service in the United Kingdom. Illicit alprazolam supply and consumption have increased. Concern about increasing numbers of alprazolam-related fatalities started circulating in 2018. However, statistics on this issue are very limited. This study examined patterns in such mortality in Scotland. METHODS Statistics on deaths where alprazolam was mentioned in the 'cause of death' were obtained from official mortality registers. Anonymised Scottish case-level data were obtained. Data were examined in respect of the characteristics of decedents and deaths using descriptive statistics. RESULTS Scotland registered 370 deaths in 2004-2020; 366 of these occurred in 2015-2020: most involved males (77.1%); mean age 39.0 (SD 12.6) years. The principal underlying cause of death was accidental poisoning: opiates/opioids (77.9%); sedatives/hypnotics (15.0%). Two deaths involved alprazolam alone. Main drug groups implicated: opiates/opioids (94.8%), 'other benzodiazepines' (67.2%), gabapentinoids (42.9%), stimulants (30.1%), antidepressants (15.0%). Two-thirds (64.2%) involved combinations of central nervous system (CNS) depressants. DISCUSSION Alprazolam-related deaths are likely due to an increasing illicit supply. The fall in deaths in 2019-2020 is partially due to increased use of designer benzodiazepines. Treatment for alprazolam dependence is growing. Clinicians need to be aware of continuing recreational alprazolam use. When such consumption occurs with CNS depressants, overdose and death risks increase. CONCLUSIONS More awareness of alprazolam contributing to deaths, especially in conjunction with other CNS depressants, is needed by consumers and clinicians. Improved monitoring of illicit supplies could identify emerging issues of medicines' abuse.
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Affiliation(s)
- John Martin Corkery
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,John Martin Corkery, Psychopharmacology,
Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and
Medical Sciences, University of Hertfordshire, Health Research Building, College
Lane Campus, Hertfordshire AL10 9AB, UK.
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Swansea University Medical School,
Swansea University, Swansea, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK,Department of Neuroscience, Imaging and
Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and
Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hertfordshire, UK
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Li S, Wang X, Bi G, Xin G, Qin S, Xu P, Wang Y. A retrospective analysis of data from illicit drug abuse cases in Beijing between 2018 and 2020. Leg Med (Tokyo) 2022; 58:102086. [DOI: 10.1016/j.legalmed.2022.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Plis SS, Veselkina OV, Klevno VA, Vlassov VV. Acute lethal poisonings in children: a 10-year retrospective study of the Moscow Region, Russia. J Public Health Res 2021; 11. [PMID: 35166092 PMCID: PMC8874850 DOI: 10.4081/jphr.2021.1932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 08/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Poisoning is a critical public health problem. Toxic substances differ across time, region and age. Little is known about poisoning in Russia, and even less is known about lethal poisoning in children in Russia. We aimed to describe the characteristics of cases of lethal poisoning in children and adolescents. DESIGN AND METHODS Our retrospective study was based on autopsy reports from archives of the Moscow Region Bureau of Forensic Medical Examination for the period of 2009 to 2018. RESULTS A total of 438 lethal poisoning cases were recorded. The average age of the poisoned children was 11.3 years. Deaths predominantly occurred in boys, mostly due to the higher frequency of poisoning with household and technical chemicals (p<0.01). Accidental deaths were also higher in males (p < 0.01). Therapeutic drug poisoning (p<0.01) and suicide (p < 0.01) were more frequent in females. The leading cause of lethal poisoning in children was exposure to carbon monoxide, especially in children aged 5 to 9 years (p<0.01) and 1 to 4 years (p<0.01). Carbon monoxide poisoning occurred more often in winter (p<0.01). Regarding the structure of poisoning with household and technical chemicals, the most frequent was poisoning by a mixture of utility gases. CONCLUSION Our study shows that carbon monoxide poisoning is a serious problem in the region. This may be associated with the ongoing use of individual heating systems. A significant increase in the frequency of fatal poisoning by chemicals, especially by propane-butane gas mixtures while sniffing, has become a disturbing trend.
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Affiliation(s)
- Semyon S Plis
- Department of Complex Examinations, Moscow Region Bureau of Forensic Medical Examination, Moscow; Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow.
| | - Olesya V Veselkina
- Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow; Department of Innovative Health Care Management, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Moscow.
| | - Vladimir A Klevno
- Department of Forensic Medicine, Moscow Regional Research and Clinical Institute (MONIKI), Moscow.
| | - Vasiliy V Vlassov
- Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow.
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Oyekan PJ, Gorton HC, Copeland CS. Antihistamine-related deaths in England: Are the high safety profiles of antihistamines leading to their unsafe use? Br J Clin Pharmacol 2021; 87:3978-3987. [PMID: 33729599 DOI: 10.1111/bcp.14819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 01/26/2023] Open
Abstract
AIMS Antihistamines are routinely taken to control allergic reactions or sedation to induce sleep. There are, however, growing concerns regarding sedating antihistamine misuse. This research aims to evaluate deaths related to antihistamines in England occurring during 2000-2019. METHODS Cases reported to the National Programme on Substance Abuse Deaths from England occurring in 2000-2019 with antihistamine detections at postmortem were extracted for analysis. RESULTS In total, 1666 antihistamine postmortem detections were identified from 1537 cases. Sedating antihistamines available for purchase under pharmacist supervision but without need for a prescription (pharmacy-only medications) were present in a significant majority of cases (85.2%, P < .01). Despite an increasing trend for antihistamine-related deaths over time, the proportion of deaths where an antihistamine was implicated declined over the same period. Specific concerns with regards to the misuse of these pharmacy-only sedating antihistamines are raised with regards to the significant proportion of cases that were concluded as suicide (20.9%, P < .01), and the high prevalence of their use in combination with other central nervous system depressants (94.8% of cases). CONCLUSION This is the first report in over 40 years regarding antihistamine-related mortality from England. The rising trend in sedating antihistamine-related deaths may be contributed to by their increasing availability and the perceived negligible dangers associated with antihistamines, both from the general public and learned professionals. Awareness of the dangerous sedative properties that some antihistamines possess is, however, heightened in individuals deliberately seeking these effects. Urgent review of sedating antihistamines currently assigned under the pharmacy-only classification is needed to achieve antihistamine harm reduction.
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Affiliation(s)
- Princess J Oyekan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Caroline S Copeland
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
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Agreement between family report and laboratory results of amphetamine-induced death. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Andersson L, Håkansson A, Berge J, Johnson B. Changes in opioid-related deaths following increased access to opioid substitution treatment. Subst Abuse Treat Prev Policy 2021; 16:15. [PMID: 33568184 PMCID: PMC7876792 DOI: 10.1186/s13011-021-00351-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. METHODS Detailed data on opioid-related deaths in Skåne during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention. RESULTS There was no significant difference in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). CONCLUSIONS Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.
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Affiliation(s)
- Lisa Andersson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Jonas Berge
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Malmö Addiction Centre, Region Skåne, Malmö, Sweden
| | - Björn Johnson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018. Sci Rep 2020; 10:22186. [PMID: 33335193 PMCID: PMC7746745 DOI: 10.1038/s41598-020-79228-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.
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Andersson L, Håkansson A, Krantz P, Johnson B. Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances. Harm Reduct J 2020; 17:5. [PMID: 31918732 PMCID: PMC6953255 DOI: 10.1186/s12954-019-0354-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skåne, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test to analyse group differences. Results A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.
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Affiliation(s)
- Lisa Andersson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden.
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Malmö Addiction Centre, Region Skåne, Malmö, Sweden
| | - Peter Krantz
- Faculty of Medicine, Department of Clinical Sciences Lund, Forensic Medicine, Lund University, Lund, Sweden
| | - Björn Johnson
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Connery HS, Taghian N, Kim J, Griffin M, Rockett IR, Weiss RD, McHugh RK. Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder. Drug Alcohol Depend 2019; 205:107612. [PMID: 31627077 PMCID: PMC6929689 DOI: 10.1016/j.drugalcdep.2019.107612] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior studies in heroin use disorder reported low rates (10%) of suicidal intention with non-fatal opioid overdose but did not assess dimensional ratings of suicidal ideation. This study aims to quantify the frequency and intensity of ratings of desire to die and perceived overdose risk proximal to the most recent opioid overdose event among individuals admitted for opioid use disorder detoxification/stabilization. METHODS Cross-sectional study (June 2017-July 2018) assessing patterns of opioid use and variables related to overdose history was conducted in a not-for-profit psychiatric hospital. Adults (>18 years) with opioid use disorder were eligible and 120 of 122 participants completed all measures. Forty-one percent were women and 85% self-identified as white. Participants' perceptions of the likelihood of overdose and their suicidal motivations (defined as desire to die) prior to most recent opioid overdose was self-rated on a scale of 0 (no desire to die/no risk of death) to 10 (I definitely wanted to die/I definitely thought I would die). RESULTS Most (92%) surviving opioid overdose used heroin/fentanyl; over half reported some desire to die prior to their most recent overdose, with 36% reporting strong (>7/10) desire to die and 21% reporting 10/10 "I definitely wanted to die." Perceptions of overdose risk were also variable, with 30% reporting no (0/10) likelihood of overdose and 13% reporting a high (10/10) likelihood. CONCLUSIONS Suicidal motivation prior to opioid overdose is common and falls along a continuum of severity. Longitudinal studies are needed to determine if suicide prevention interventions may reduce opioid overdose in those at risk.
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Affiliation(s)
- Hilary S. Connery
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nadine Taghian
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
| | - Jungjin Kim
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Partners Health Care Addiction Psychiatry Fellowship Training Program, 115 Mill Street, Belmont, MA 02478, USA.
| | - Margaret Griffin
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Ian R.H. Rockett
- West Virginia University, Department of Epidemiology, One Waterfront Place, Morgantown, WV 26506-6009, USA,University of Rochester Medical Center, Department of Psychiatry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Roger D. Weiss
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
| | - R. Kathryn McHugh
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
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Pv A, Jun Wen T, Karuvetil MZ, Cheong A, Cheok C, Kandasami G. Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2743. [PMID: 31370374 PMCID: PMC6695629 DOI: 10.3390/ijerph16152743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Abstract
Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011-2015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD ± 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (n = 27, 64.3%) followed by accidents (n = 15; 35.7%). Among the suicide cases, alcohol was the main substance used (33.3%) followed by opioids (25.9%). A total of 58.5% (n = 24) deaths occurred within a year of their last visit while 41.5% (n = 17) were dead more than a year after their last visit. Of the total cases (n = 41), 63% had a history of mental illness with depressive disorder (53.8%) being the most common. History of suicide attempts were reported in 34.1% (n = 14) of cases and 50% of the subjects (n = 21) had a history of suicidal ideation. Drug related offences were reported in 57.1% of the subjects, of which 60% (n = 18) committed suicide. The findings support the need for appropriate treatment resources to reduce the untimely deaths among substance users.
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Affiliation(s)
- Asharani Pv
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Tan Jun Wen
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Mohamed Zakir Karuvetil
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Alvin Cheong
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Christopher Cheok
- Forensic Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Gomathinayagam Kandasami
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
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Epidemiologic Investigation of the Elderly Deaths Caused by Narcotic and Psychedelic Drug Abuse Complications Referred to the Legal Medicine Organization of Tehran, Iran During 2013 and 2014. ADDICTIVE DISORDERS & THEIR TREATMENT 2019. [DOI: 10.1097/adt.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050801. [PMID: 30841557 PMCID: PMC6427694 DOI: 10.3390/ijerph16050801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/16/2022]
Abstract
Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malmö from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1‰ was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed.
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Haukka J, Kriikku P, Mariottini C, Partonen T, Ojanperä I. Non-medical use of psychoactive prescription drugs is associated with fatal poisoning. Addiction 2018; 113:464-472. [PMID: 28841781 DOI: 10.1111/add.14014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/18/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. DESIGN AND SETTING Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. PARTICIPANTS AND CASES All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. MEASUREMENTS Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. FINDINGS In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. CONCLUSIONS Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing factor.
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Affiliation(s)
- Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pirkko Kriikku
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Claudia Mariottini
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Ilkka Ojanperä
- Forensic Toxicology Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
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Abrahamsson T, Berge J, Öjehagen A, Håkansson A. Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study. Drug Alcohol Depend 2017; 174:58-64. [PMID: 28315808 DOI: 10.1016/j.drugalcdep.2017.01.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Use of sedatives may increase risk of death in opioid users. The aim of the study was to assess whether prescription of sedatives may be associated with mortality in patients in opioid maintenance treatment. METHODS This retrospective register-based open cohort study included nation-wide register data including all individuals who were dispensed methadone or buprenorphine as opioid maintenance treatment for opioid dependence between July, 2005 and December, 2012 (N=4501). Outcome variables were overdose mortality and non-overdose mortality, respectively. Extended Cox regression analyses examined associations between type of sedative prescriptions and death, controlling for sex, age, previous overdoses and suicide attempts, psychiatric in-patient treatment and opioid maintenance treatment status. Opioid maintenance was assumed to last for 90days (or 30days in a sensitivity analysis) after the last methadone or buprenorphine prescription. RESULTS Benzodiazepine prescriptions were associated with non-overdose death (HR: 2.02, 95% CI: 1.29-3.18) but not significantly associated with overdose death (1.49, 0.97-2.29). Z-drug (1.60, 1.07-2.39) and pregabalin prescriptions (2.82, 1.79-4.43) were associated with overdose death. In the sensitivity analysis, all categories of sedatives, including benzodiazepines, were significantly associated with overdose death. CONCLUSIONS Caution is advised when prescribing sedative drugs, including benzodiazepines, z-drugs and pregabalin, to patients in opioid maintenance treatment.
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Affiliation(s)
- Tove Abrahamsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Jonas Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Agneta Öjehagen
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Anders Håkansson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden.
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Söderberg C, Wernvik E, Tillmar A, Spigset O, Kronstrand R, Reis M, Jönsson AK, Druid H. Antipsychotics Postmortem fatal and non-fatal reference concentrations. Forensic Sci Int 2016; 266:91-101. [DOI: 10.1016/j.forsciint.2016.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
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The relationship between bupropion and suicide in post-mortem investigations. Forensic Sci Int 2016; 266:343-348. [PMID: 27372438 DOI: 10.1016/j.forsciint.2016.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
We reviewed the 33727 postmortem toxicology investigations performed in Finland over a period of 5years (2009-2013) and identified those in which the antidepressant bupropion was detected. Cases positive for other antidepressant drugs were reviewed for comparison. The postmortem toxicological examination included, in all cases, the routine screening and quantification of hundreds of drugs and poisons using quality-controlled methods. Bupropion was detected in 65 cases. A large proportion of the bupropion-positive deaths resulted from suicide (55%). In fatal poisoning cases found positive for bupropion, the proportion of suicide was even higher (77%). The measured median bupropion postmortem blood concentration (0.69mg/L) was markedly higher than the normal therapeutic range in plasma in the treatment of depression (up to 0.1mg/L) and even higher in fatal bupropion poisonings (13mg/L). Only 14% of the deceased positive for bupropion were estimated to be drug abusers. However, nearly all of the drug abuse cases were from the last year of the study (2013), indicating a recent increase of the use of bupropion among drug abusers and possibly even abuse of bupropion itself. Suicide victims positive for bupropion were younger than those who died with other antidepressant drugs in their blood. In addition, the percentage of fatal poisonings among bupropion-positive postmortem cases was higher than among the users of other antidepressant drugs. Suicide was significantly more common among the deceased positive for bupropion than among users of other antidepressant drugs. An unknown degree of bupropion degradation before the assay and post-mortem redistribution of bupropion may have impacted the measured levels. Nonetheless, all post-mortem concentrations of bupropion were elevated and especially high concentrations were detected in suicides.
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Ahlner J, Holmgren A, Jones AW. Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving. Forensic Sci Int 2016; 265:138-43. [PMID: 26901639 DOI: 10.1016/j.forsciint.2016.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. METHODS This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. RESULTS Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. CONCLUSIONS This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes.
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Affiliation(s)
- Johan Ahlner
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Anita Holmgren
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden
| | - Alan Wayne Jones
- Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
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Geisenberger D, Huppertz L, Büchsel M, Kramer L, Pollak S, Große Perdekamp M. Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis. Forensic Sci Int 2015; 257:e1-e5. [DOI: 10.1016/j.forsciint.2015.07.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 12/20/2022]
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Pietsch J, Paulick T, Schulz K, Flössel U, Engel A, Schmitter S, Schmidt U. Escalation of methamphetamine-related crime and fatalities in the Dresden region, Germany, between 2005 and 2011. Forensic Sci Int 2013; 233:51-4. [DOI: 10.1016/j.forsciint.2013.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/13/2013] [Accepted: 08/23/2013] [Indexed: 11/26/2022]
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Uosukainen H, Kauhanen J, Bell JS, Ronkainen K, Tiihonen J, Föhr J, Onyeka IN, Korhonen MJ. Mortality among clients seeking treatment for buprenorphine abuse in Finland. Drug Alcohol Depend 2013; 133:391-7. [PMID: 23896305 DOI: 10.1016/j.drugalcdep.2013.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is unclear whether buprenorphine abuse is associated with a similar risk of death to other substance abuse. This study examined all-cause mortality rates and causes of deaths among clients seeking treatment for buprenorphine abuse. METHODS Structured clinical interviews were conducted with 4685 clients between January 1998 and August 2008. Records of deaths that occurred among these clients were extracted from the Official Causes of Death Register in Finland. Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were computed using national mortality rates over a 13-year follow-up to examine excess mortality. Kaplan-Meier survival analysis was used to compare survival between buprenorphine and other clients. RESULTS Sixty-one of 780 (7.8%) clients who sought treatment for buprenorphine abuse and 408 of 3905 (10.4%) other clients died during the 13-year follow-up period. The most common cause of death was drug-related in buprenorphine (n=25, 41.0%) and other clients (n=142, 34.8%). Survival rates were similar among buprenorphine and other clients (log-rank χ[df=1](2)=0.215, p=0.643). The SMR was 3.0 (95% CI 2.3-3.8) and 3.1 (95% CI 2.8-3.4) for buprenorphine and other clients, respectively. Excess mortality was highest among women aged 20-29 years, and more pronounced in buprenorphine clients (SMR 27.9 [95% CI 12.6-49.0]) compared to other clients (SMR 14.0 [95% CI 9.3-19.6]). CONCLUSIONS Clients seeking treatment for buprenorphine abuse had a three times higher mortality rate than the national average, with the excess risk highest among female clients. Overall mortality rates were similar among clients seeking treatment for buprenorphine and other substance abuse.
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Affiliation(s)
- Hanna Uosukainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
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Karaarslan B, Karapirli M, Kandemir E, Kucuker H, Gurler M, Ince CH, Akyol O. The Fatal Poisoning Pattern of Ankara (Turkey) and Nearby Cities from 2007 to June 2011: A Retrospective Study in Forensic Autopsies. J Forensic Sci 2013; 58:1563-7. [DOI: 10.1111/1556-4029.12189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/23/2012] [Accepted: 08/12/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Bekir Karaarslan
- Department of Forensic Medicine; Gaziantep University Medical Faculty; Gaziantep Universitesi Kampus alani, Tip Fak. Dekanligi, Sehitkamil, 27310 Gaziantep Turkey
| | - Mustafa Karapirli
- Ankara Branch of the Council of Forensic Medicine; Sefkat Mah. Dr. Omer Besim Cad. No: 61, Kecioren, 06300 Ankara Turkey
| | - Eyup Kandemir
- The Council of Forensic Medicine; Yenibosna Cobancesme Mah. Sanayi Cad. Kimiz Sok. No:1 Bahcelievler 34196 Istanbul Turkey
| | - Hudaverdi Kucuker
- Sakarya University Medical Faculty; Department of Forensic Medicine. Sakarya Universitesi Tip Fakultesi Dekanligi; Korucuk Kampusu, Korucuk, Adapazari, 54187 Sakarya Turkey
| | - Mukaddes Gurler
- Ankara Branch of the Council of Forensic Medicine; Department of Chemistry. Sefkat Mah. Dr. Omer Besim Cad.; No: 61, Kecioren, 06300 Ankara Turkey
| | - Cengiz Haluk Ince
- The Council of Forensic Medicine; Yenibosna Cobancesme Mah. Sanayi Cad. Kimiz Sok. No:1 Bahcelievler 34196 Istanbul Turkey
| | - Omer Akyol
- Ankara Branch of the Council of Forensic Medicine; Department of Chemistry. Sefkat Mah. Dr. Omer Besim Cad.; No: 61, Kecioren, 06300 Ankara Turkey
- Hacettepe University Medical Faculty; Department of Biochemistry. Hacettepe Universitesi Tip Fakultesi; Dekanlik Binasi 3. Kat, Sihhiye, 06100 Ankara Turkey
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D'Ovidio C, Vellante P, Costantini S, Carnevale A. Death due to an unrecognized groin abscess in a drug addict: a retrospective study. J Forensic Leg Med 2013; 20:382-6. [PMID: 23756501 DOI: 10.1016/j.jflm.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/12/2012] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
Abstract
Intravenous drug injection persists despite health risks and medical complications. Venous thrombosis, septic thrombophlebitis, artery necrosis, arterio-venous fistula, mycotic aneurysm, dissecting hematoma, pseudoaneurysm formation, and soft tissues infections (i.e. abscesses, cellulitis, infected ulcers), are some of the major clinical consequences lives threatening. The aim of this work is to present this unusual autoptic case of a drug addict man died for an unrecognized groin abscess referred to the Institute of Legal Medicine, University of Chieti, causing femoral vein's erosion, and to analyse the most common patterns of vascular lesions among drug addicts. It could be stimulated a new scientific debate because groin injections and their vascular complications increase over years; while soft tissue infections may hide vascular lesions' diagnosis. So physicians should have a high index of suspicion for serious vascular problems, among intravenous drug users (IDUs): prevention for avoiding groin injection and a proper treatment are necessary.
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Affiliation(s)
- Cristian D'Ovidio
- Department of Medicine and Aging Sciences, Section of Legal Medicine, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
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Tuusov J, Vals K, Tõnisson M, Riikoja A, Denissov G, Väli M. Fatal poisoning in Estonia 2000–2009. Trends in illegal drug-related deaths. J Forensic Leg Med 2013; 20:51-6. [DOI: 10.1016/j.jflm.2012.04.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 02/07/2012] [Accepted: 04/21/2012] [Indexed: 10/28/2022]
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Reepalu A, Blomé MA, Björk J, Widell A, Björkman P. The risk of cancer among persons with a history of injecting drug use in Sweden - a cohort study based on participants in a needle exchange program. Acta Oncol 2012; 51:51-6. [PMID: 22150166 DOI: 10.3109/0284186x.2011.626445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Injecting drug use (IDU) may lead to exposure to a range of carcinogenic agents. We investigated the risk and distribution of cancers among individuals with a history of IDU in Sweden. MATERIAL AND METHODS The cancer incidence in a cohort of longitudinally followed participants in a needle exchange program (NEP), recruited between 1987 and 2007, was compared to that in the Swedish general population, matching for age group and gender. Baseline demographic and drug use data were collected and longitudinal testing of serological markers for HIV, hepatitis B and C virus was performed during NEP participation. Standardized incidence ratios (SIR) for types of cancer found in the study cohort were calculated, using data from the Swedish National Cancer Registry for reference. RESULTS The mean follow-up time for the 3255 participants was 11.8 years, constituting 38 419 person years at risk. The mean age at end of follow-up was 42.7 years, and 75% of participants were men. Seventy-eight cases of cancer were observed (SIR 1.1 [95% CI = 0.9-1.4]). The SIR was significantly increased for five cancer types among men; primary liver, laryngeal, lung, oropharyngeal and non-melanoma skin cancer (respective SIR 12.8 [95% CI = 4.2-30.0], 9.2 [95% CI = 1.9-26.8], 3.2 [95% CI = 1.5-6.1], 7.3 [95% CI = 1.5-21.2], and 3.5 [95% CI = 1.1-8.2]), and for cancers of endocrine organs among women (5.3 [95% CI = 1.7-12.4]). CONCLUSION Although the standardized overall cancer incidence in this relatively young IDU cohort was similar to that in the general population, the risk of specific types of cancer was significantly increased, suggesting that IDU confers elevated risks for certain malignancies. These findings prompt further studies to investigate causative factors and suggest the need for surveillance among persons with a history of IDU.
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Affiliation(s)
- Anton Reepalu
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
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Marasovic Susnjara I, Definis Gojanovic M, Vodopija D, Capkun V, Smoljanovic A. Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia. Croat Med J 2011; 52:629-36. [PMID: 21990081 PMCID: PMC3195972 DOI: 10.3325/cmj.2011.52.629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aim To study drug-induced mortality and characteristics of overdose deaths in the war (1991-1995), pre-war (1986-1990), and post-war period (1996-2000) in Split-Dalmatia County. Methods We retrospectively searched through Databases of the Department of Forensic Medicine, University Hospital Split, the national register of death records, the archives of the Split-Dalmatia County Police, and the Register of Treated Drug Addicts of the Croatian National Institute of Public Health, covering the period from 1986 to 2000, according to drug poisoning codes IX and X of the International Classification of Diseases. The indicators were statistically analyzed. Results There were 146 registered drug-induced deaths, with 136 (93%) deceased being men. The median age of all cases was 27 years (interquartile range 8). Most of them were single (70.6%), unemployed (44.6%), and secondary school graduates (69.2%). In the war period, there were 4.8 times more deaths than in the pre-war period (P = 0.014), and in the post-war period there were 5.2 times more deaths than in the pre-war period (P = 0.008). The most common site of death was the deceased person’s home. The toxicological analyses showed that 59 (61%) deaths were heroin related, alcohol use was found in 62 cases (42.5%), and multi-substance use was found in more than a half of the cases. In 133 (91.1%) cases, deaths were classified as unintentional, whereas 13 (8.9%) were classified as suicides. Conclusion The war, along with other risk factors, contributed to unfavorable developments related to drug abuse in Split-Dalmatia County, including the increase in the drug-induced mortality rate.
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Molecularly imprinted polymer with high-fidelity binding sites for the selective extraction of barbiturates from human urine. J Chromatogr A 2011; 1218:4612-8. [DOI: 10.1016/j.chroma.2011.05.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 05/11/2011] [Accepted: 05/16/2011] [Indexed: 11/23/2022]
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Kristiansen MG, Løchen ML, Gutteberg TJ, Mortensen L, Eriksen BO, Florholmen J. Total and cause-specific mortality rates in a prospective study of community-acquired hepatitis C virus infection in northern Norway. J Viral Hepat 2011; 18:237-44. [PMID: 20337923 DOI: 10.1111/j.1365-2893.2010.01290.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Knowledge of the natural course and especially the total and cause-specific mortality of community-acquired chronic HCV infection is limited. The aims of our study were to determine the total and cause-specific mortality in patients infected with chronic hepatitis C in a community-based setting in northern Norway. This prospective cohort study included 1010 HCV-positive patients diagnosed with recombinant immunoblot assay between 1 January 1990 and 1 January 2000, with a median observation time from diagnosis to follow-up of 7 years. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Time and cause of death were ascertained from the Norwegian Causes of Death Register. Age-adjusted death rates and standardised mortality ratios (SMRs) were compared with those of the general Norwegian population. In total, 122 deaths were recorded. The Kaplan-Meier estimate of survival was 88% at 14 years. The SMR in the cohort relative to the general population was 6.66. Most of the excess deaths in both genders were because of liver-related causes, those associated with a drug-using lifestyle and suicide. The statistically significant increase in SMRs ranged from 4.2 for death by cancer in women to 64.6 for liver disease in women. There was no statistically significant increase in SMRs from cardiovascular disease in either gender or from cancer in men. In conclusion, our study shows that the death rate in patients infected with hepatitis C is 6.66 times higher than in the general Norwegian population.
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Affiliation(s)
- M G Kristiansen
- Clinic of Internal Medicine, Nordland Hospital, Bodø, Norway.
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Li L, Zhang X, Levine B, Li G, Zielke HR, Fowler DR. Trends and Pattern of Drug Abuse Deaths in Maryland Teenagers. J Forensic Sci 2011; 56:1029-33. [DOI: 10.1111/j.1556-4029.2011.01743.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fast GC-MS method for the simultaneous screening of THC-COOH, cocaine, opiates and analogues including buprenorphine and fentanyl, and their metabolites in urine. Anal Bioanal Chem 2010; 399:1623-30. [DOI: 10.1007/s00216-010-4471-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 11/18/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
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Iravani FS, Akhgari M, Jokar F, Bahmanabadi L. Current trends in tramadol-related fatalities, Tehran, Iran 2005-2008. Subst Use Misuse 2010; 45:2162-71. [PMID: 20394504 DOI: 10.3109/10826081003692098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tramadol is a widely prescribed drug. Abuse of tramadol as well as tramadol-related deaths have been increasing in Iran. The objective of the present study is to evaluate the trends of tramadol-related deaths that occurred between 2005 and 2008 in Tehran, Iran. Biological samples obtained during the autopsy were analyzed. Tramadol was detected in 294 cases by itself or together with other drugs. The majority of the cases were young male adults. Tramadol-related deaths in 2008 were 32.5 times more than in 2005. These results suggest that tramadol-related fatalities are growing in Iran especially among substance abusers.
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Affiliation(s)
- Fariba Sardari Iravani
- Forensic Toxicology Department, Scientific and Educational Research Center of Legal Medicine Organization, Tehran, Iran
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Atkins S, Sevilla JM, Blazquez M, Pineda T, Gonzalez-Rodriguez J. Electrochemical Behaviour of Carbamazepine in Acetonitrile and Dimethylformamide Using Glassy Carbon Electrodes and Microelectrodes. ELECTROANAL 2010. [DOI: 10.1002/elan.201000341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
ISSUES The toxicology of homicide offenders and victims, and homicide as a cause of death among psychoactive substance users. APPROACH Review of the toxicology of homicide, and homicide as a cause of death among psychoactive substance users. KEY FINDINGS A half or more of offenders are intoxicated by a psychoactive substance at the time of the homicide, with alcohol the most commonly reported substance. Levels of substances among victims are comparable with those seen among perpetrators. Among both offenders and victims, levels of substances far exceed population use. Among substance users, homicide specific mortality rates of substance users far exceed population rates. Reducing rates of alcohol and other drug consumption, at national and individual levels, can be expected to substantially reduce rates of, and risk for, homicide. CONCLUSIONS AND IMPLICATIONS Psychoactive substances are strongly associated with homicide. One of the major societal benefits that can be derived from active attempts to reduce alcohol and other drug use are reductions in homicide rates.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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Postmortem data related to drug and toxic substance use in the Federal District, Brazil, from 2006 to 2008. Forensic Sci Int 2010; 200:136-40. [DOI: 10.1016/j.forsciint.2010.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/19/2010] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
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Zwingenberger S, Pietsch J, Hommola A, Dreßler J. Illegal drug-related deaths in East Germany between 1995 and 2004. Forensic Sci Int 2010; 199:58-62. [DOI: 10.1016/j.forsciint.2010.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/25/2010] [Accepted: 03/06/2010] [Indexed: 11/25/2022]
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Multidrug poisoning involving nicotine and tramadol. Forensic Sci Int 2010; 194:e17-9. [DOI: 10.1016/j.forsciint.2009.09.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 09/15/2009] [Accepted: 09/21/2009] [Indexed: 11/19/2022]
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Talu A, Rajaleid K, Abel-Ollo K, Rüütel K, Rahu M, Rhodes T, Platt L, Bobrova N, Uusküla A. HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:56-63. [DOI: 10.1016/j.drugpo.2009.02.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 02/10/2009] [Accepted: 02/27/2009] [Indexed: 11/26/2022]
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Zackrisson AL, Lindblom B, Ahlner J. High frequency of occurrence of CYP2D6 gene duplication/multiduplication indicating ultrarapid metabolism among suicide cases. Clin Pharmacol Ther 2009; 88:354-9. [PMID: 19907421 DOI: 10.1038/clpt.2009.216] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In Sweden, about 550 individuals die every year of drug intoxication. Many of these drugs are metabolized by CYP enzymes such as CYP2D6 and CYP2C19. A lack of these enzymes, resulting in poor metabolism, can lead to adverse reactions and even to fatality. On the other hand, an ultrarapid metabolism can lead to insufficient drug plasma concentration, resulting in failure of treatment, or it can lead to high concentrations of active/toxic metabolites. The aim of this project was to study the genetic profile of individuals with regard to the presence of CYP2D6 and CYP2C19 genes, in cases of fatal intoxication (242), suicide (intoxications excluded) (262), and natural death (212). PCR, followed by pyrosequencing, was used for all the analyses. We found that, among those who died of suicide (suicide cases), there was a higher number carrying more than two active CYP2D6 genes (corresponding to the phenotype of ultrarapid metabolizer) as compared with those who died of natural causes (natural-death cases) (P = 0.007).
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Affiliation(s)
- A L Zackrisson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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Brådvik L, Berglund M, Frank A, Lindgren A, Löwenhielm P. Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study. BMC Psychiatry 2009; 9:48. [PMID: 19653902 PMCID: PMC2731754 DOI: 10.1186/1471-244x-9-48] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 08/04/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death. METHODS All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects. RESULTS Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse. CONCLUSION The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.
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Affiliation(s)
| | | | - Arne Frank
- Clinical Alcohol Research, Malmö, Sweden
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Current trends in drug abuse associated fatalities – Jordan, 2000–2004. Forensic Sci Int 2009; 186:44-7. [DOI: 10.1016/j.forsciint.2009.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 12/20/2008] [Accepted: 01/14/2009] [Indexed: 11/20/2022]
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