2. Materials and methods
Our primary data included all cases with comprehensive
toxicological postmortem analysis registered during 2010–2011
in the Hjelt Institute, Department of Forensic Medicine, University
of Helsinki. This laboratory performs all postmortem toxicology for
the Finnish population of 5.4 million inhabitants, utilising
comprehensive laboratory methods covering toxicologically relevant drugs, alcohols and poisons [16]. During 2010–2011, deaths in
Finland totalled 101,472 and medico-legal autopsies 22,421.
Medico-legal death investigation in Finland concerns sudden or
unexpected deaths, and always, deaths suspected to be related to
accident, crime, suicide, poisoning, occupational disease, medical
procedure, or war.
Our postmortem database included a forensic pathologist’s
referral, laboratory analysis results, and information from the death
certificate completed by a forensic pathologist. The referral included
a brief description of the circumstances of death, a brief medical
history with medications used by the deceased, the main macroscopic autopsy findings, and preliminary laboratory analysis
requests. From the death certificate, the database extracted
information on age, gender, manner of death according to the World
Health Organization, and cause of death and contributing factors
according to the International Classification of Diseases (ICD-10).
We extracted all cases found positive for Finland’s most
prescribed opioids: buprenorphine, codeine, fentanyl, methadone,
oxycodone, or tramadol. Morphine, although a widely used pain
medication, was excluded because morphine is also a metabolic
product of codeine, and distinguishing morphine from codeine use
in laboratory findings is very difficult. A positive opioid finding
represented a positive record of postmortem samples from any
biological sample, such as blood, urine, liver, or muscle. Concentration data represented postmortem femoral blood concentrations. A
blood alcohol concentration 0.5% indicated a positive alcohol
record. Our definition of fatal opioid poisoning was drug poisoning
as the cause of death and an opioid as the most important finding.
Abuse in our study meant use of opioids as narcotics, that is,
their illicit and unprescribed use by drug addicts. To assess
whether the drug use indicated abuse or other use, all documents
concerning each case underwent individual investigation. One of
the following defined the case as abuse: a known history of drug
abuse, drug self-administration by intravenous or nasal route, new
injection marks or injection equipment near the deceased,
laboratory analysis results of illicit drugs such as amphetamine,
cannabis, or designer drugs, and, in addition in every case, no
indication for medical use of that opioid. The term ‘‘other use’’
referred to medical use as well as to non-medical misuse without
intention to use drugs as narcotics, such as drug-induced suicides
without evidence of drug addiction.
An independent samples Mann–Whitney U-test determined the
statistical difference between the abuse and other user groups of
each opioid. A p < 0.05 denoted the limit for statistical significance.
The statistical analysis tool was IBM SPSS 21.0.
3. Results
The postmortem cases testing positive for opioids in medicolegal cause-of-death investigations in Finland during 2010–2011numbered 2088. Of these, abuse was attributable in 545 cases,
which was 26.1% of opioid-positive cases and 0.5% of all those
deceased in Finland during that period. Only one opioid was found
in 1726 (82.7%) cases. Although 384 fatal poisonings were due to
opioid drug toxicity as an underlying cause of death, no monointoxications occurred; all cases involved in addition alcohol or
drugs other than opioids. Different opioid detections totalled
2499.
Table 1 shows that both fatal opioid poisoning and accidental
manner of death were more common in the abuser cases than in
other opioid-related cases. Abusers were most commonly young
men. Comparing abuser groups to other-user groups, codeine-,
oxycodone-, and tramadol-related abuser cases included more
concomitant opioid findings, and buprenorphine-, codeine-, and
fentanyl-related abuser cases, alcohol. Median opioid concentrations in postmortem femoral blood were higher in the abuser
group than in other cases, except for methadone.
Fig. 1 shows that opioid abuse and fatal poisonings
were concentrated among the young, and other use among older
age-groups, except for methadone and buprenorphine, both of
which showed predominantly abuse, with few records for those
>60.
4. Discussion
This study showed that at least 0.5% of the deaths in Finland
during 2010–2011 involved prescription opioid abuse, a proportion
higher than the estimate of 0.1–0.2% reported in 2005 for
problematic opioid abuse [11]. If compared with causes of death
other than those drug-related, our results reveal the significance of
prescription drug abuse in Finland: 545 deaths were attributable to
opioid abuse during 2010–2011, but transport accidents, for
example, caused death in 564 cases, drowning in 354 cases, and
alcoholin3851cases[17,18].ThemagnitudeofFinnishopioidabuse
resembles results reported elsewhere. InCanada during2006–2008,
opioidabuse,suchasuseofopioidsprescribedforsomeoneelseoran
inappropriate administration route, involved 31% of the opioidrelated deaths [19], somewhat more than our figure of 26%. In a
Canadian survey from 2009, 4.8% of the study population reported
non-medical use of prescription opioids, and ‘‘getting high’’ was the
motivation for prescription opioid use for 0.4% [20]. A Norwegian
prescription study of all new codeine, tramadol, and dextropropoxyphene users during 2005–2008 revealed that of the new opioid
users, persistent problematic opioid users comprised 0.3%, and
probable problematic users 0.08% [21].
2. Materials and methods
Our primary data included all cases with comprehensive
toxicological postmortem analysis registered during 2010–2011
in the Hjelt Institute, Department of Forensic Medicine, University
of Helsinki. This laboratory performs all postmortem toxicology for
the Finnish population of 5.4 million inhabitants, utilising
comprehensive laboratory methods covering toxicologically relevant drugs, alcohols and poisons [16]. During 2010–2011, deaths in
Finland totalled 101,472 and medico-legal autopsies 22,421.
Medico-legal death investigation in Finland concerns sudden or
unexpected deaths, and always, deaths suspected to be related to
accident, crime, suicide, poisoning, occupational disease, medical
procedure, or war.
Our postmortem database included a forensic pathologist’s
referral, laboratory analysis results, and information from the death
certificate completed by a forensic pathologist. The referral included
a brief description of the circumstances of death, a brief medical
history with medications used by the deceased, the main macroscopic autopsy findings, and preliminary laboratory analysis
requests. From the death certificate, the database extracted
information on age, gender, manner of death according to the World
Health Organization, and cause of death and contributing factors
according to the International Classification of Diseases (ICD-10).
We extracted all cases found positive for Finland’s most
prescribed opioids: buprenorphine, codeine, fentanyl, methadone,
oxycodone, or tramadol. Morphine, although a widely used pain
medication, was excluded because morphine is also a metabolic
product of codeine, and distinguishing morphine from codeine use
in laboratory findings is very difficult. A positive opioid finding
represented a positive record of postmortem samples from any
biological sample, such as blood, urine, liver, or muscle. Concentration data represented postmortem femoral blood concentrations. A
blood alcohol concentration 0.5% indicated a positive alcohol
record. Our definition of fatal opioid poisoning was drug poisoning
as the cause of death and an opioid as the most important finding.
Abuse in our study meant use of opioids as narcotics, that is,
their illicit and unprescribed use by drug addicts. To assess
whether the drug use indicated abuse or other use, all documents
concerning each case underwent individual investigation. One of
the following defined the case as abuse: a known history of drug
abuse, drug self-administration by intravenous or nasal route, new
injection marks or injection equipment near the deceased,
laboratory analysis results of illicit drugs such as amphetamine,
cannabis, or designer drugs, and, in addition in every case, no
indication for medical use of that opioid. The term ‘‘other use’’
referred to medical use as well as to non-medical misuse without
intention to use drugs as narcotics, such as drug-induced suicides
without evidence of drug addiction.
An independent samples Mann–Whitney U-test determined the
statistical difference between the abuse and other user groups of
each opioid. A p < 0.05 denoted the limit for statistical significance.
The statistical analysis tool was IBM SPSS 21.0.
3. Results
The postmortem cases testing positive for opioids in medicolegal cause-of-death investigations in Finland during 2010–2011numbered 2088. Of these, abuse was attributable in 545 cases,
which was 26.1% of opioid-positive cases and 0.5% of all those
deceased in Finland during that period. Only one opioid was found
in 1726 (82.7%) cases. Although 384 fatal poisonings were due to
opioid drug toxicity as an underlying cause of death, no monointoxications occurred; all cases involved in addition alcohol or
drugs other than opioids. Different opioid detections totalled
2499.
Table 1 shows that both fatal opioid poisoning and accidental
manner of death were more common in the abuser cases than in
other opioid-related cases. Abusers were most commonly young
men. Comparing abuser groups to other-user groups, codeine-,
oxycodone-, and tramadol-related abuser cases included more
concomitant opioid findings, and buprenorphine-, codeine-, and
fentanyl-related abuser cases, alcohol. Median opioid concentrations in postmortem femoral blood were higher in the abuser
group than in other cases, except for methadone.
Fig. 1 shows that opioid abuse and fatal poisonings
were concentrated among the young, and other use among older
age-groups, except for methadone and buprenorphine, both of
which showed predominantly abuse, with few records for those
>60.
4. Discussion
This study showed that at least 0.5% of the deaths in Finland
during 2010–2011 involved prescription opioid abuse, a proportion
higher than the estimate of 0.1–0.2% reported in 2005 for
problematic opioid abuse [11]. If compared with causes of death
other than those drug-related, our results reveal the significance of
prescription drug abuse in Finland: 545 deaths were attributable to
opioid abuse during 2010–2011, but transport accidents, for
example, caused death in 564 cases, drowning in 354 cases, and
alcoholin3851cases[17,18].ThemagnitudeofFinnishopioidabuse
resembles results reported elsewhere. InCanada during2006–2008,
opioidabuse,suchasuseofopioidsprescribedforsomeoneelseoran
inappropriate administration route, involved 31% of the opioidrelated deaths [19], somewhat more than our figure of 26%. In a
Canadian survey from 2009, 4.8% of the study population reported
non-medical use of prescription opioids, and ‘‘getting high’’ was the
motivation for prescription opioid use for 0.4% [20]. A Norwegian
prescription study of all new codeine, tramadol, and dextropropoxyphene users during 2005–2008 revealed that of the new opioid
users, persistent problematic opioid users comprised 0.3%, and
probable problematic users 0.08% [21].
การแปล กรุณารอสักครู่..
