Drug-related death in Denmark in 2007.

INTRODUCTION: We investigated fatal poisonings among drug addicts in 2007. The cause of death, abuse pattern and geographic differences are presented. MATERIAL AND METHODS: All drug-related deaths examined at the three forensic medicine institutes in Denmark in 2007 were evaluated. RESULTS: The number of drug-related deaths in 2007 was 226. Methadone deaths had increased since 1997 while heroin/morphine deaths decreased. In earlier studies, very few deaths from central stimulants like cocaine and amphetamines occurred (1-1.5%), but in 2007 6% of the deaths were caused by these drugs. Multiple drug use was common. Heroin/morphine, cocaine, amphetamine, cannabis, methadone, benzodiazepines and alcohol were included in the poly-drug use. CONCLUSION: This investigation shows stabilization in the number of fatal poisonings in drug addicts. Geographic differences were observed. Methadone was the most frequent cause of fatal poisoning and there was a continuous decrease in heroin/morphine deaths. Fatal deaths from cocaine and amphetamine have increased considerably. Multiple drug use was common. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Postmortem detection of hepatitis B, C, and human immunodeficiency virus genomes in blood samples from drug-related deaths in Denmark*.

Blood-borne viral infections are widespread among injecting drug users; however, it is difficult to include these patients in serological surveys. Therefore, we developed a national surveillance program based on postmortem testing of persons whose deaths were drug related. Blood collected at autopsy was tested for anti-HBc, anti-HBs, anti-hepatitis C virus (HCV), or anti-human immunodeficiency virus (HIV) antibodies using commercial kits. Subsets of seropositive samples were screened for viral genomes using sensitive in-house and commercial polymerase chain reaction (PCR) assays. Hepatitis B virus (HBV) DNA was detected in 20% (3/15) of anti-HBc-positive/anti-HBs-negative samples, HCV RNA was found in 64% (16/25) of anti-HCV-positive samples, and HIV RNA was detected in 40% (6/15) of anti-HIV-positive samples. The postmortem and antemortem prevalences of HBV DNA and HCV RNA were similar. Postmortem HIV RNA testing was less sensitive than antemortem testing. Thus, postmortem PCR analysis for HBV and HBC infection is feasible and relevant for demonstrating ongoing infections at death or for transmission analysis during outbreaks.

[Deaths among drug addicts in Eastern Denmark 2005]. / Dødsfald blandt narkomaner i Østdanmark i 2005.

INTRODUCTION: The purpose of this study was to investigate deaths among drug addicts in Eastern Denmark in 2005, partly fatal poisonings, partly deaths where the cause of death not was a poisoning and to compare the results with those reported in studies from 1991, 1997 and 2002. MATERIAL AND METHODS: All deaths among drug addicts investigated at the Institute of Forensic Medicine in Copenhagen. RESULTS: The number of deaths among drug addicts was 160 of which 64% were due to fatal poisoning. The number of drug addict deaths has remained almost constant in the period 1991-2005, but in 2002 and 2005 a decrease of about 10% was seen in the fraction of fatal poisonings. As in 2002, a decrease in the fraction of heroin/morphine poisonings was seen, and an increase in the fraction of methadone poisonings with a proportion of heroin/morphine poisonings of 17% and a proportion of methadone poisonings of 39%. As in the previous studies, the most commonly detected drugs were methadone, heroin/morphine, benzodiazepines and cannabis and, as in 2002, methadone was more frequently detected than heroin/morphine. In the non-poisoning deaths, the most frequent manner of death was natural death (44%). In 12% the manner of the death was suicide, in 14% death was accidental, in 4% homicide was the manner of death and in 26% the manner of death was undetermined. CONCLUSION: The increase in the number of fatal poisonings with methadone and the decrease in the number of fatal poisonings with heroin/morphine seen in the 2002 study continued in 2005. The poly-drug use had increased in 2005 with more drugs detected in each case than before.

[Fatal cases of poisoning in eastern Denmark during a five-year period (1998-2002)]. / Forgiftningsdødsfald over en femårig periode (1998-2002) i Østdanmark.

INTRODUCTION: The goal of this investigation was to determine the pattern of fatal poisonings in eastern Denmark from 1998 to 2002 and compare it with similar investigations from 1979 to 1996. MATERIALS AND METHODS: The material included 2,996 autopsies from eastern Denmark in which extensive forensic chemical investigations were performed. RESULTS: Of the 2,996 autopsies, 694 cases were drug addicts, in whom 497 fatal overdoses were detected, while in the remaining 2,302 cases of nonaddicts, 443 fatal poisonings were determined. Morphine (heroine) and methadone were the main causes of death among the fatal poisonings of the drug addicts, accounting for 90% of the cases. The fatal poisonings among the nonaddicts were due mainly to medicine (73% of the cases); 13% were due to carbon monoxide and/or cyanide poisoning, and 12% were due to acute ethanol poisoning. The medicine was a wide range of strong and weak analgesics, antidepressants and antipsychotic drugs of older and newer origins. Comparison with earlier investigations from 1979 to 1996 showed that the poisoning pattern had changed, but similarities were also seen. The most frequently occurring drugs involved in fatal poisonings in eastern Denmark from 1979 to 2002 were morphine, methadone, ethanol and carbon monoxide/cyanide, of which methadone increased in occurrence over the 23-year period. CONCLUSION: The investigation of fatal poisonings is an important element in monitoring changes in drug abuse and poisoning patterns and levels.

Surveillance of HIV and viral hepatitis by analysis of samples from drug related deaths.

OBJECTIVES: To determine the prevalence of antibodies against HIV, hepatitis B (HBV) and hepatitis C (HCV) in postmortem samples from drug related deaths (DRDs) in Denmark. DESIGN: Prospective cohort study. Postmortem samples tested for anti-HIV, anti-HCV anti-HBc and anti-HBs. Comparison to pre-mortem testing when possible. DRDs were searched for in the national register of drug treatment, national prison registers, and the national infectious disease register. SETTING: National level. PARTICIPANTS: Drug related deaths admitted to Danish Institutes of Forensic Medicine during 2004. MAIN OUTCOME MEASURES: Prevalence of antibodies, injection drug use, drug treatment experience and prevalence of cirrhosis. RESULTS: Samples for analysis were obtained from 78% (233/299) of DRDs. The prevalences of anti-HIV, anti-HCV and anti-HBc were 4% (9/214), 51% (110/215), and 35% (74/209), indicating a persisting low prevalence of HIV and a declining prevalence of HCV and HBV. Injecting ever was detected among 45% of DRDs and this was associated with a significantly higher prevalence of hepatitis B and C. Among the DRDs 56% received drug treatment and 12% had cirrhosis at autopsy. Evidence of vaccination against HBV was found among 16% (21/128). CONCLUSIONS: Monitoring of viral hepatitis and HIV among DRDs is feasible, and our survey indicates a falling prevalence among Danish drug users. Surveillance based on drug users in treatment may overestimate the true prevalence.