Abstract
BackgroundStudies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). The main aim of this study was to determine the nature, extent and pattern of FIUI.MethodsThis observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i) the mention of one or more psychoactive substances as contributing to fatality; and (ii) the presence of a Controlled Drug at post mortem.ResultsA total of 3,803 drug-related deaths of persons aged 16–64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females), giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84%) were aged 16–44 years, with a median age at death of 33 years (Quartile deviation = 7). Fifty-six percent of FIUI occurred in urban areas of England.The population of the study jurisdictions aged 16–64 years contributed 49,545,766 person-years (py) to the study, giving an annual crude rate of 3/1,000,000 person-years (py). Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9–6.8).The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups.ConclusionThere are differences in the nature, extent and pattern of intentional and unintentional FIUI that should necessitate targeted prevention strategies. Also, there is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists.
Highlights
Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI)
There is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists
Many studies have shown that premature mortality among illicit drug users is often due to toxicity or overdose
Summary
Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). Many studies have shown that premature mortality among illicit drug users is often due to toxicity or overdose. There seems to be less interest in examining the nature, extent and pattern of fatal injuries that have occurred while intoxicated on drugs with or without alcohol. In a large United States study of post-mortem cases of fatal injury, Hood, Ryan, Monforte and Valentour [2] reported that illicit drugs, especially cocaine, were implicated in 27% of cases. MacDonald, Anglin-Bodrug, Mann, Erickson, Hathaway, Chipman and Rylett [3] have estimated that the proportion of drugs mentioned in injuries, in general, ranged between 0% and 55%. The average estimated proportion of drugs mentioned in fatal injuries was 5%, drivers fatal; 32%, self-inflicted-fatal; and 28% general fatal
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