Opioid receptors are critical for heroin dependence, and A118G SNP of the opioid receptor gene (OPRM1) has been linked with heroin abuse. In our population of European Caucasians (n ‫؍‬ 118), Ϸ90% of 118G allelic carriers were heroin users. Postmortem brain analyses showed the OPRM1 genotype associated with transcription, translation, and processing of the human striatal opioid neuropeptide system. Whereas down-regulation of preproenkephalin and preprodynorphin genes was evident in all heroin users, the effects were exaggerated in 118G subjects and were most prominent for preproenkephalin in the nucleus accumbens shell. Reduced opioid neuropeptide transcription was accompanied by increased dynorphin and enkephalin peptide concentrations exclusively in 118G heroin subjects, suggesting that the peptide processing is associated with the OPRM1 genotype. Abnormal gene expression related to peptide convertase and ubiquitin͞proteosome regulation was also evident in heroin users. Taken together, alterations in opioid neuropeptide systems might underlie enhanced opiate abuse vulnerability apparent in 118G individuals.drug abuse ͉ dynorphin ͉ enkephalin ͉ mRNA

During the 30-year period 1961–1990, a total of 22 deaths with criminal mutilation/dismemberment of the human body were registered in Sweden. The mutilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Mutilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic mutilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the “serial killing” type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

Medicolegally investigated deaths among 34 male users of anabolic androgenic steroids (AAS) are described. Nine persons were victims of homicide, 11 had committed suicide, 12 deaths were judged as accidental and 2 as indeterminate. In two cases of accidental poisoning, the levels of pharmaceuticals and illicit drugs were considered too low to be the sole cause of death and AAS was considered part of the lethal polypharmacia. Chronic cardiac changes were observed in 12 cases. In two cases of accidental poisonous deaths, these changes were regarded as contributory cause of death. Homicides, suicides, and poisonings determined accidental or indeterminate in manner were related to impulsive, disinhibited behavior characterized by violent rages, mood swings, and/or uncontrolled drug intake. The observations in the present study indicate an increased risk of violent death from impulsive, aggressive behavior, or depressive symptoms associated with use of AAS. There are also data to support earlier reports of possible lethal cardiovascular complications from use of AAS. Furthermore, a contributing role of AAS in lethal polypharmacia is suggested. Finally, the observations indicate that use of AAS may be the gateway of approach to abuse of other psychotropic drugs.

We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.

A ten-year series of 142 homicidal fatalities caused by sharp force injury was studied with the aim to systematize information inherent in the characteristics of the victim and the pattern of injuries. The population of victims consisted of 112 males (79%) and 30 females (21%); among perpetrators, 125 (88%) were males. Among victims as well as among perpetrators, persons of non-Swedish origin were overrepresented in relation to their share of the nonselected population. In 82 cases (58%), one or two wounds had been inflicted; in 23 cases (16%), ten or more wounds. In the latter group, eleven victims but no perpetrators were female. In the majority of cases victim and perpetrator were known to each other, and in instances of multiple wounding, a close relationship between the two was clearly more common than in the group of one- to two-wound fatalities. Tests for blood alcohol were positive in 86 of 116 victims (74%), the majority being in elimination phase. Furthermore, 96 of 120 perpetrators (80%) had positive tests or were known to be drunk at the time of the killing. In multiple wound fatalities, alcohol inebriation was less common both among victims and perpetrators. In these cases, the two persons involved were usually closely related or intimately known to each other, and in the absence of psychiatric disorder in the assailant, the motive was of a passionate type.