Fatal poisoning in drug addicts in the Nordic countries in 2012

Abstract

This report is a follow-up to a study on fatal poisoning in drug addicts conducted in 2012 by a Nordic working group. Here we analyse data from the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. Data on sex, number of deaths, places of death, age, main intoxicants and other drugs detected in the blood were recorded. National data are presented and compared between the Nordic countries and with data from similar studies conducted in 1991, 1997, 2002 and 2007. The death rates (number of deaths per 100,000 inhabitants) increased in drug addicts in Finland, Iceland and Sweden but decreased in Norway compared to the rates in earlier studies. The death rate was stable in Denmark from 1991 to 2012. The death rate remained highest in Norway (5.79) followed by Denmark (5.19) and Iceland (5.16). The differences between the countries diminished compared to earlier studies, with death rates in Finland (4.61) and Sweden (4.17) approaching the levels in the other countries. Women accounted for 15-27% of the fatal poisonings. The median age of the deceased drug addicts was still highest in Denmark, and deaths of addicts >45 years old increased in all countries. Opioids remained the main cause of death, but medicinal opioids like methadone, buprenorphine, fentanyl and tramadol mainly replaced heroin. Methadone was the main intoxicant in Denmark and Sweden, whereas heroin/morphine caused the most deaths in Norway. Finland differed from the other Nordic countries in that buprenorphine was the main intoxicant with only a few heroin/morphine and methadone deaths. Deaths from methadone, buprenorphine and fentanyl increased immensely in Sweden compared to 2007. Poly-drug use was widespread in all countries. The median number of drugs per case varied from 4 to 5. Heroin/morphine, medicinal opioids, cocaine, amphetamines, benzodiazepines and alcohol were the main abused drugs. However, less widely used drugs, like gamma-hydroxybutyric acid (GHB), methylphenidate, fentanyl and pregabalin, appeared in all countries. New psychotropic substances emerged in all countries, with the largest selection, including MDPV, alpha-PVP and 5-IT, seen in Finland and Sweden.

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use

“…GHB-related fatalities have been reported primarily from Western countries, such as the USA, Canada, Australasia, and Europe (Caldicott et al, 2004;EMCDDA, 2008;Simonsen et al, 2015;Zvosec et al, 2011). This measure is often used as part of a range of indicators/parameters in national and international risk assessments of substances of concern (EMCDDA, 1999;Nutt et al, 2007;van Amsterdam et al, 2012) and provides "signals of emerging harms" (EMCDDA, 2014:8).…”

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

“…Various studies have been conducted to assess the abuse potential of tramadol, extending from pre-clinical receptor binding studies, studies in substance abusers (74,183), and postmarketing surveillance (184). These have shown that tramadol may induce physical dependence and withdrawal reactions, and is implicated in misuse, abuse and diversion (143), as well as intoxications, emergency department visits (185), and drug-related deaths (186,187). Yet, the addictive properties of tramadol are considered to be low (188)(189)(190).…”

“…In Sweden, tramadol is the prescription drug most commonly encountered on the illicit market (138) and one of the most prevalent prescription drugs used by subjects deceased from traffic accidents (193), as in some other countries (187). However, whereas the occurrence of misuse and abuse of tramadol is now recognised, the global prevalence and the relevance of the problem for the patients on prescribed treatment is not fully known.…”

“…Following marketing authorization, observational studies, case reports and meta-analyses of clinical trials have reported euphoria (200), dependence (102,201), tolerance development and dose increases (202)(203)(204), use of supra-therapeutic doses (205), withdrawal symptoms (206), substance-seeking behaviour (132,207), non-prescribed use and diversion (110,132,208), as well as intoxications, drug-related deaths (110,187), and drug-impaired driving (209). Of patients dispensing pregabalin, a small proportion of the users account for a large part of the total drug expenditure (200,210), which might indicate misuse and abuse (79).…”

Locomotor activating effects and addiction-like features of MDPV as assessed in preclinical studies: a review.

“…A tendency of increase in its consumption patterns as reflected by the data of seizures of this substance (unodc, 2013). In addition, in some areas of Northern and Central Europe the consequences of its use are already beginning to suppose serious medical and social problems (Csáki et al, 2013;Simonsen et al, 2015). Therefore, our goal is to provide a brief explanation of mdpV's chemical properties and review the locomotor activating effects and addiction-like features of mdpV that have been assessed in preclinical studies, while comparing them with classic addictive drugs.…”