Medical Psychotropics in Forensic Autopsies in European Countries: Results from a Three-Year Retrospective Study in Spain

Abstract

Medical psychotropics are widely used and prescribed in developed countries. These medications may have an impairing effect on mood or perception and may induce harmful behaviors. Nevertheless, in Europe, studies on their importance from a medico-legal perspective are scarce. To fill this gap, we evaluate the determinants of these drugs in a retrospective study based on data obtained from forensic autopsies. Toxicological analyses were performed on 394 blood samples from compulsory autopsies at the Institute of Legal Medicine of Las Palmas. Of the samples, 41% (159) were positive for at least one psychotropic, with benzodiazepines being the most frequently detected (24.1%), followed by opiates and antidepressants. Benzodiazepines, opiates, and antidepressants were detected more frequently in men who suffered a violent death. More than 30% of the positive samples showed two or more drugs, suggesting a prevalence of polypharmacy among forensic autopsy subjects, with the most frequently combination found being benzodiazepines plus opiates (28.3% of positive samples). A combination of opiates plus antidepressants was also found in subjects involved in violent deaths. Our results suggest that more than 40% of the adult European population involved in medico-legal issues may be under the influence of legal psychotropics. The link between violent deaths and the use of medical psychotropics is particularly worrisome and indicates that these drugs should be carefully monitored in developed countries, in all forensic autopsies, in a similar way to illegal psychotropics.

Ethanol and Medical Psychotropics Co-Consumption in European Countries: Results from a Three-Year Retrospective Study of Forensic Samples in Spain

“…Our results demonstrate that legal psychotropics are frequently found in compulsory autopsies of adult subjects in Spain (see Table 2 ). These findings agree with those previously published, which indicate that BZDs, opiates, and ethanol are the most frequently detected drugs in forensic toxicological analyses in European [ 10 , 11 ] and non-European countries [ 5 , 6 ]. Thus, in our series, residues of MPs were present in more than 40% of the deceased, with BZDs being the most frequently detected psychotropic medicines (25.3% of the study subjects) followed by MOs and ADPs.…”

“…Due to their effects on the CNS, an increased presence and involvement of medical psychotropics in forensic issues seems evident [ 26 , 27 ]. Thus, in this same series, our group reported that BZDs, MOs, and ADPs were found more frequently in men who suffered a violent death and that BZDs use was positively associated with violent death [ 10 ], similar to data reported in Australia, where BZDs were detected in 13.2% of homicide and suicide deaths [ 28 , 29 ].…”

“…Although there is a possibility that postmortem redistribution may affect the blood MPs levels, it must be said that MPs measured in our study show a low postmortem redistribution, so the precision of forensic toxicological findings is high [ 10 ]. Regarding ethanol, postmortem ethanol diffusion is a debated issue, with significant difference between heart and peripheral blood concentration [ 35 ].…”

“…MPs, like ethanol, are frequently detected in standard toxicological analyses at compulsory autopsies [ 5 , 6 ]. Previous studies have shown that a high percentage of compulsory autopsies were positive for MPs in Spain [ 10 ].…”