1
|
Devin J, Lyons S, Murphy L, O’Sullivan M, Lynn E. Factors associated with suicide in people who use drugs: a scoping review. BMC Psychiatry 2023; 23:655. [PMID: 37670233 PMCID: PMC10478413 DOI: 10.1186/s12888-023-05131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Suicide is a significant contributor to global mortality. People who use drugs (PWUD) are at increased risk of death by suicide relative to the general population, but there is a lack of information on associated candidate factors for suicide in this group. The aim of this study was to provide a comprehensive overview of existing evidence on potential factors for death by suicide in PWUD. METHODS A scoping review was conducted according to the Arksey and O'Malley framework. Articles were identified using Medline, CINAHL, PsycINFO, SOCIndex, the Cochrane Database of Systematic Reviews and the Campbell Collaboration Database of Systematic Reviews; supplemented by grey literature, technical reports, and consultation with experts. No limitations were placed on study design. Publications in English from January 2000 to December 2021 were included. Two reviewers independently screened full-text publications for inclusion. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS The initial search identified 12,389 individual publications, of which 53 met the inclusion criteria. The majority (87%) of included publications were primary research, with an uncontrolled, retrospective study design. The most common data sources were drug treatment databases or national death indexes. Eleven potential factors associated with death by suicide among PWUD were identified: sex; mental health conditions; periods of heightened vulnerability; age profile; use of stimulants, cannabis, or new psychoactive substances; specific medical conditions; lack of dual diagnosis service provision; homelessness; incarceration; intravenous drug use; and race or ethnicity. Opioids, followed by cannabis and stimulant drugs were the most prevalent drugs of use in PWUD who died by suicide. A large proportion of evidence was related to opioid use; therefore, more primary research on suicide and explicit risk factors is required. CONCLUSIONS The majority of studies exploring factors associated with death by suicide among PWUD involved descriptive epidemiological data, with limited in-depth analyses of explicit risk factors. To prevent suicide in PWUD, it is important to consider potential risk factors and type of drug use, and to tailor policies and practices accordingly.
Collapse
Affiliation(s)
- Joan Devin
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen’s Green, Dublin 2, Ireland
| | - Suzi Lyons
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Lisa Murphy
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Michael O’Sullivan
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Ena Lynn
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Nazarov O, Li G. Trends in alcohol and marijuana detected in homicide victims in 9 US states: 2004-2016. Inj Epidemiol 2020; 7:2. [PMID: 32127050 PMCID: PMC6943884 DOI: 10.1186/s40621-019-0229-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims. Methods We analyzed toxicological testing data for homicide victims (n = 12,638) from the 2004–2016 National Violent Death Reporting System in 9 US states (Colorado, Georgia, Massachusetts, New Jersey, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin). We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of alcohol and marijuana detected in these homicide victims during the study period. Results Overall, 37.5% of the homicide victims tested positive for alcohol, 31.0% positive for marijuana, and 11.4% positive for both substances. During the study period, the prevalence of marijuana increased from 22.3% (95% confidence interval [CI] = 19.6, 25.0) in 2004 to 42.1% (95% CI = 39.2, 44.9) in 2016 (Z = -15.7; P < .001) while the prevalence of alcohol declined slightly (Z = 1.5; P = 0.143). Marked increases in the prevalence of marijuana were observed in both sexes and across age and racial groups. Conclusions Marijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Further research is needed to assess the causal role of marijuana use and concurrent use of marijuana and alcohol in homicide victimization.
Collapse
Affiliation(s)
- Oybek Nazarov
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| |
Collapse
|
4
|
Gjerde H, Bretteville-Jensen AL, Furuhaugen H, Bache-Andreassen L, Bergh MSS, Vindenes V. Determination of drug residues in used syringe needles. Drug Test Anal 2020; 12:410-416. [PMID: 31899604 DOI: 10.1002/dta.2759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/02/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Lihn Bache-Andreassen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Marianne Skov-Skov Bergh
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Vigdis Vindenes
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| |
Collapse
|
5
|
Sung HG, Li J, Nam JH, Won DY, Choi B, Shin JY. Concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem and risk for suicide: a case-control and case-crossover study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1535-1544. [PMID: 31037540 DOI: 10.1007/s00127-019-01713-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate whether the concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem increases the risk of suicide or triggers suicide compared with the use of zolpidem alone. METHODS We conducted a case-control and case-crossover study using the Korean National Health Insurance Service-National Sample Cohort database. Cases were older than 20 years with a suicide record (International Codes of Disease 10th Revision codes: X-60-X84 and Y87.0 intentional self-harm) between January 1, 2004, and December 31, 2013. For case-control design, ten controls were matched to each case by age, sex, index year, region, income, and health insurance type. For case-crossover analysis, we set hazard period to 60 days and assigned five corresponding sets of control periods of equal length. Exposure was assessed during 60 days before suicide for combinations of benzodiazepines, antidepressants, opioid analgesics with zolpidem against zolpidem alone. We conducted a conditional logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS In the case-control study, the risk of suicide was 2.80-fold higher in cases taking benzodiazepines and antidepressants with zolpidem than in those taking zolpidem alone (adjusted OR [aOR], 2.80; 95% CI, 1.38-5.70). However, in the case-crossover study, suicide risk showed no significant difference (crude OR [cOR], 0.92; 95% CI, 0.55-1.52) and was underpowered. CONCLUSIONS The results of the traditional case-control study confirmed that the concurrent use of benzodiazepines and antidepressants with zolpidem was associated with an increased risk of suicide compared with the use of zolpidem alone. However, there was no significant difference in the magnitude of risk in the within-person comparison design.
Collapse
Affiliation(s)
- Hi Gin Sung
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Junquing Li
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Dae Yeon Won
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - BongKyoo Choi
- Department of Medicine and Program in Public Heath, University of California, Irvine, CA, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
| |
Collapse
|
6
|
Buprenorphine in the United States: Motives for abuse, misuse, and diversion. J Subst Abuse Treat 2019; 104:148-157. [PMID: 31370979 DOI: 10.1016/j.jsat.2019.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Abstract
Opioid use disorder (OUD) and its consequences are a major public health concern. The partial agonist buprenorphine is a safe and effective treatment for OUD, but concerns about abuse, misuse, and diversion of buprenorphine have been raised. This narrative review examined the rates and motives for use of illicit buprenorphine in the United States. Findings from the 17 included studies suggest the majority of study participants using illicit buprenorphine do so for reasons related to misuse (to manage opioid withdrawal symptoms or achieve or maintain abstinence from other opioids). A smaller percentage of study respondents reported using buprenorphine for reasons related to abuse (to get high). There appears to be a gap between need for buprenorphine and access to adequate treatment. Attenuation of policy-related barriers and adoption of appropriate buprenorphine use by the treatment community are critical tools in the continued effort to reduce the burdens associated with OUD.
Collapse
|
7
|
A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning). J Forensic Leg Med 2019; 63:7-10. [DOI: 10.1016/j.jflm.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/24/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022]
|
8
|
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.
Collapse
|
9
|
Gravensteen IK, Ekeberg Ø, Thiblin I, Helweg-Larsen K, Hem E, Rogde S, Tøllefsen IM. Psychoactive substances in natural and unnatural deaths in Norway and Sweden - a study on victims of suicide and accidents compared with natural deaths in psychiatric patients. BMC Psychiatry 2019; 19:33. [PMID: 30658618 PMCID: PMC6339417 DOI: 10.1186/s12888-019-2015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden. METHODS The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses. RESULTS The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset. CONCLUSIONS Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.
Collapse
Affiliation(s)
- Ida Kathrine Gravensteen
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Øivind Ekeberg
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Ingemar Thiblin
- 0000 0004 1936 9457grid.8993.bDepartment of Surgical Sciences, Uppsala University, Box 256, 751 05 Uppsala, Sweden
| | - Karin Helweg-Larsen
- 0000 0001 0674 042Xgrid.5254.6Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Erlend Hem
- 0000 0004 1936 8921grid.5510.1Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1111 Blindern, N-0317 Oslo, Norway ,0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Sidsel Rogde
- 0000 0004 0389 8485grid.55325.34Department of Forensic Sciences, Oslo University Hospital, Box 4950 Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Box 1072 Blindern, N- 0316 Oslo, Norway
| | - Ingvild Maria Tøllefsen
- Division of Medicine, Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950 Nydalen, N-0424, Oslo, Norway.
| |
Collapse
|
10
|
Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases. Forensic Sci Int 2017; 281:127-133. [DOI: 10.1016/j.forsciint.2017.10.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/20/2022]
|
11
|
Martinotti G, Cinosi E, Santacroce R, Papanti D, Pasquini A, Mancini V, Corbo M, Fiori F, Sarchione F, Marchetti D, Verrocchio MC, Di Giannantonio M, Torrens M, Schifano F, Morlan Coarasa MJ, Merino Del Villar C. Substance-related psychopathology and aggressiveness in a nightlife holiday resort: Results from a pilot study in a psychiatric inpatient unit in Ibiza. Hum Psychopharmacol 2017; 32. [PMID: 28557062 DOI: 10.1002/hup.2586] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to describe a sample of subjects admitted to a psychiatric unit after the intake of psychoactive substances for recreational purposes. METHODS Between June and September 2015, 49 subjects were included. Sociodemographic characteristics and psychopathological aspects were investigated, and urine samples for further analysis were collected. Three subgroups (cannabinoids, stimulants, and depressors users) were identified, according to the structured interview regarding substance use and urinalysis. RESULTS Level of aggressiveness was found to be significantly higher (p < .05) in the cannabinoids subgroup. Self-reported symptom severity was comparable among groups, but trends could be identified: SCL-90 results showed a prevalence of anxiety symptoms among depressors users, hostility or aggression in the tetrahydrocannabinol subgroup, and psychoticism in the stimulants subgroup. CONCLUSIONS The use of psychoactive substances was be characterised by poly-use of both traditional and novel substances. The presence of aggressiveness emerged as a main feature associated with the use of cannabis and other cannabinoids. Binge drinking and sleep deprivation also represented a relevant component in almost all the evaluated subjects.
Collapse
Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy.,Department of Pharmacy, Pharmacology, Postgraduate Medicine, University of Hertfordshire, Hatfield, Herts, UK
| | - Eduardo Cinosi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Rita Santacroce
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy.,Department of Pharmacy, Pharmacology, Postgraduate Medicine, University of Hertfordshire, Hatfield, Herts, UK
| | - Duccio Papanti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Italy
| | - Anna Pasquini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Valerio Mancini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Mariangela Corbo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Federica Fiori
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Fabiola Sarchione
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Daniela Marchetti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, University "G.d'Annunzio", Chieti, Italy
| | - Marta Torrens
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fabrizio Schifano
- Department of Pharmacy, Pharmacology, Postgraduate Medicine, University of Hertfordshire, Hatfield, Herts, UK
| | | | | |
Collapse
|
12
|
Pedersen W, Sandberg S, Copes H. Destruction, fascination and illness: risk perceptions and uses of heroin and opiate maintenance treatment drugs. HEALTH, RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1256377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Willy Pedersen
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
| | - Sveinung Sandberg
- Department of Criminology and Sociology of Law, University of Oslo, Oslo, Norway
| | - Heith Copes
- Department of Justice Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
13
|
Flaagøy SH, Morild I, Maehle BO, Lilleng PK. Petechial Hemorrhages and Ethanol in Deaths from Intoxication. J Forensic Sci 2016; 61:1266-9. [DOI: 10.1111/1556-4029.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/18/2015] [Accepted: 01/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Siren Helen Flaagøy
- Department of Pathology; Haukeland University Hospital; Bergen N-5021 Norway
| | - Inge Morild
- Department of Pathology; Haukeland University Hospital; Bergen N-5021 Norway
- Department of Clinical Medicine; The Gade Laboratory for Pathology; University of Bergen; Haukeland University Hospital; Bergen N-5021 Norway
| | - Bjørn Ove Maehle
- Department of Clinical Medicine; The Gade Laboratory for Pathology; University of Bergen; Haukeland University Hospital; Bergen N-5021 Norway
| | - Peer Kaare Lilleng
- Department of Pathology; Haukeland University Hospital; Bergen N-5021 Norway
- Department of Clinical Medicine; The Gade Laboratory for Pathology; University of Bergen; Haukeland University Hospital; Bergen N-5021 Norway
| |
Collapse
|
14
|
Tøllefsen IM, Thiblin I, Helweg-Larsen K, Hem E, Kastrup M, Nyberg U, Rogde S, Zahl PH, Østevold G, Ekeberg Ø. Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries. BMC Public Health 2016; 16:449. [PMID: 27229154 PMCID: PMC4882827 DOI: 10.1186/s12889-016-3135-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 05/13/2016] [Indexed: 01/09/2023] Open
Abstract
Background National mortality statistics should be comparable between countries that use the World Health Organization’s International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences. Methods The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports. Results In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents. Conclusion There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.
Collapse
Affiliation(s)
- Ingvild Maria Tøllefsen
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway. .,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway. .,Division of Medicine, Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway.
| | - Ingemar Thiblin
- Department of Surgical Sciences, Uppsala University, Box 256, 751 05, Uppsala, Sweden
| | - Karin Helweg-Larsen
- Department of Social Medicine and Public Health Research, Copenhagen University, Nørregade 10, Copenhagen K, DK-1165, Denmark
| | - Erlend Hem
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway
| | | | - Ullakarin Nyberg
- Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Sweden, Norra Stocholms psychiatri S:t Görans sjukhus, Stockholm, SWE-112 81, Sweden
| | - Sidsel Rogde
- Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Box 1072, Blindern, N- 0316, Oslo, Norway
| | - Per-Henrik Zahl
- Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway
| | - Gunvor Østevold
- Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway
| | - Øivind Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway
| |
Collapse
|
15
|
Lee D, Delcher C, Maldonado-Molina MM, Thogmartin JR, Goldberger BA. Manners of Death in Drug-Related Fatalities in Florida. J Forensic Sci 2016; 61:735-42. [DOI: 10.1111/1556-4029.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Dayong Lee
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
| | - Chris Delcher
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | - Mildred M. Maldonado-Molina
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | | | - Bruce A. Goldberger
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Nonnatural deaths among users of illicit drugs: pathological findings and illicit drug abuse stigmata. Am J Forensic Med Pathol 2015; 36:44-8. [PMID: 25590496 DOI: 10.1097/paf.0000000000000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the study was to provide information on illicit drug abuse stigmata and general pathological findings among an adult narcotic drug-using population aged 20 to 59 years whose death was nonnatural. A total of 1603 medicolegal autopsy reports from 2000 to 2009 concerning cases positive for morphine, heroin, amphetamines, ecstasy, cannabis, LSD (lysergic acid diethylamide), PCP (phencyclidine), and high levels of GHB (γ-hydroxybutyric acid) in addition to methadone and buprenorphine were investigated. Reported findings of hepatitis, portal lymphadenopathy, recent injection marks, drug user's equipment, and numbers of significant pathological conditions were registered and analyzed according to cases positive for opiates, opioids (OPs), and central nervous system (CNS)-stimulating illicit drugs, respectively. Of the selected cases, 1305 were positive for one or more opiate or OP. Cases positive for OPs had significantly more findings of noninfectious pathological conditions. Hepatitis, portal lymphadenopathy, recent injections marks findings of drug user's equipment were all findings found more frequently among the opiate OP-positive individuals. Portal lymphadenopathy was significantly more often found in cases with hepatitis than in cases with other or no infection. In the population positive for CNS stimulants, hepatitis recent injection marks were more frequent findings than in the CNS stimulant-negative group, irrespective of whether they were opiate OP positive or negative.
Collapse
|
18
|
Häkkinen M, Vuori E, Ojanperä I. Prescription opioid abuse based on representative postmortem toxicology. Forensic Sci Int 2014; 245:121-5. [PMID: 25447184 DOI: 10.1016/j.forsciint.2014.10.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010-2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with "abuse" meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20-49.
Collapse
Affiliation(s)
- Margareeta Häkkinen
- Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
| | - Erkki Vuori
- Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Ojanperä
- Hjelt Institute, Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|