Fatal Drug Overdoses Research Articles

Fatal Drug Overdose After Liberation From Prison: A Retrospective Study of Female Ex-Prisoners from Strathclyde Region (Scotland)

Aims: this study investigated the role of recent liberation from prison as a contributor to the high level of drug overdose deaths in Strathclyde (Scotland), possibly due to reduced tolerance to opiates. Design and participants: data on all imprisoned female drug users previously resident in Strathclyde were collected from admissions/liberations and medical records of Scotland's only female prison for the time period of October 1993 until September 1995. Records were matched by name and date of birth to the drug death records for Strathclyde. Results: of liberated ex-prisoners, 331/690 (48%) were recorded as known drug users. There were 14 sudden and unexpected deaths matched in the Strathclyde death records. Of these, ten (10/14) were recorded as fatal drug overdoses, which represents approximately 28% of the number of female fatal drug overdoses in Strathclyde over the sample period. Three of ten fatal overdoses occurred within 38 days of liberation, the remainder at least 147 days after liberation (mea...

HIV infection among victims of accidental fatal drug overdoses in New York City

HIV infection among victims of accidental fatal drug overdoses in New York City

HIV infection among victims of accidental fatal drug overdoses in New York City

To determine the factors associated with HIV seroprevalence rates for victims of drug overdoses. Descriptive epidemiologic survey of a complete 3-year sample of accidental fatal drug overdoses. New York City (population 7,322,564). All people over 15 years of age (n = 2159) who died of accidental fatal drug overdoses during 1991-93. Using medical examiner data and logistic regression analyses were conducted to examine the association between HIV seroprevalence and gender, race, age and type of drug overdose. There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV positive. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). Victims residing in communities with higher levels of poverty had higher rates of HIV infection but poverty did not account for the high rates of HIV infection among African-Americans. The highest rates of HIV infection were found among victims aged 35-44 years (38.8%) and 45-54 years (33.7%). Dying from an opiate overdose was associated with a 2.4 times increase in the likelihood of being HIV positive. If opiate abuse continues to rise in the United States, HIV infection will increase in the next few years. Women who abuse drugs participate in risky sexual practices and are more likely than men to develop HIV infection from receptive sex as well as sharing of needles. Harm reduction programs should address risky sex as well as needle programs. There should be further study of why African-Americans who died of drug overdoses have the highest rates of HIV infection.

Poverty and Fatal Accidental Drug Overdoses of Cocaine and Opiates in New York City: An Ecological Study

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A

Detection of Alprazolam in Three Cases of Methadone/Benzodiazepine Overdose

Benzodiazepine abuse is common among clients at methadone maintenance clinics. Diazepam and lorazepam are readily detected by immunological screening methods and confirmed by GC/MS. Alprazolam has been relatively difficult to confirm. We recently reported a modification of an existing serum HPLC procedure which allows us to analyze whole blood. We report here three cases of fatal drug overdose caused by co-ingestion of methadone and alprazolam. In all three cases, alprazolam was detected by HPLC and could not be identified by alkaline extraction GC/MS. Postmortem blood concentrations of methadone were at the lower range or below the concentrations previously identified in methadone overdose fatalities, suggesting an increased risk from co-ingestion of methadone and alprazolam.

Accidental fatal drug overdoses in New York City: 1990-1992.

This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

Detection and removal of internally concealed drugs

International drug couriers frequently seek to evade detection by concealing drugs within the body. "Swallowers" swallow packages which they hope to retrieve after travelling; "stuffers" insert packages into the rectum or vagina. The danger of these practices is that packages can leak or burst, leading to a potentially fatal drug overdose. One drug courier arrested in South Australia had swallowed 143 separate parcels of heroin and morphine. Detection of concealed drugs is by abdominal, rectal or vaginal examination, aided by radiological investigation. Surgical removal may be required if swallowed packages burst or begin to leak. Doctors servicing prisons and airports need to be aware of how body packers can be detected and managed.

Substances involved in fatal drug overdoses in Brisbane, 1979-1987.

Suicide rates may be reduced by decreasing the availability, cultural acceptance or lethality of certain methods of suicide. With these principles in mind fatal overdoses in Brisbane 1979-1987 were surveyed for substances involved. Psychotropic agents, especially barbiturates predominated. Chloral hydrate was far the most commonly implicated single compound. A case is put for curtailing the availability of barbiturates and chloral hydrate. This combined with increasing detection of depressed persons may lead to a further rise in overdoses involving antidepressants which as a group require reduction in their lethality.

Dextropropoxyphene deaths: coroner's report.

Dextropropoxyphene has been increasingly prescribed as an analgesic in the UK, chiefly in the form of Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg per tablet). After reports of sudden deaths from the misuse of this combination, prescribing is declining. Distalgesic remains the most common cause of fatal drug overdose in the West Midlands, UK. The 1983 Birmingham inquests are compared with those from the year 1976 to 1979. In comparison with other drug fatalities, death characteristically occurs rapidly, as little as 1 h after ingestion and usually before hospital treatment can be initiated. Toxicity is increased by alcohol which is also extensively abused. The fatal dose may be as small as 15 tablets or possibly less. Many victims are young and some never intended to take their life. Convulsions and respiratory failure precede death. The elderly and respiratory cripples may be more vulnerable to accidental death. Evidence suggests a liability to dependence or even addiction with dextropropoxyphene.

Occurrence of pulmonary fat and bone marrow embolism.

The lungs of 136 persons dying as a result of road traffic accidents were studied retrospectively for the presence of fat and bone marrow emboli. Comparable investigations were made in 54 cases of acute myocardial failure reported to the medicolegal authorities and in 50 cases of fatal drug overdose. A further 50 cases of myocardial failure dying in hospital were studied for the presence of bone marrow embolism only. It was considered that despite occurrence of an occasional anomalous case, both fat and bone marrow emboli are related to injury but that the incidence and severity of bone marrow embolism in particular depends greatly upon the conditions of the accidental death. The occurrence of pulmonary embolic phenomena in cases of natural death was attributed to resuscitative measures rather than the underlying condition. The results indicated that the medicolegal significance attached to the findings should, by themselves, be limited to the positive identification of injuries sustained before or at the time of death in the individual case.

The symptomatic therapy of pain

Drug overdose is a significant public health problem, yet little is known about racial/ethnic differences in drug overdose rates and/or in responses to a drug overdose following naloxone administration. This paper examines differences in rates of survivorship, response, revival and administration of naloxone by race and ethnicity among those who experienced a drug overdose in Pennsylvania between January 1, 2018 and December 31, 2019. Spatio-temporal variations in drug overdose locations were examined to facilitate understanding of service development, planning, and delivery of effective treatment need.Ten thousand two hundred and ninety drug overdose incidents were analyzed from the Pennsylvania Overdose Information Network (ODIN). The ODIN is a centralized repository that contains information on drug overdoses victims including age, gender and race/ethnicity, naloxone administrations and survivorship, drug(s) suspected of causing the overdose, victim outcomes (e.g. hospitalizations and arrests) and average naloxone dosage per victim. Between group differences were tested using χ2 -tests of independence. Multivariate logistic regression was used to estimate the predicted probability of survivorship according to victim characteristics. All statistical analyses and mapping were performed using the R statistical programming environment.About eighty-seven percent of drug overdose response victims were white, and seventy-one percent were between the ages of 20–39. White females were more likely to receive an overdose response compared to black or Hispanic females. A non-opioid was indicated more frequently in overdoses involving black victims compared to either whites or Latinos. Latinos and blacks were more likely to survive a drug overdose. However, following naloxone administration, no racial or ethnic differences in survivorship were noted. Differences in responsiveness to naloxone and transitions to care following the drug overdose event were also found. Finally, overdoses among Blacks and Latinos demonstrated a stronger spatial patterning across counties compared to whites.This study found a significant, disparate impact of race/ethnicity on fatal drug overdoses when naloxone is not administered. Further, individuals who were administered naloxone and subsequently received medical care in a hospital experienced lower drug-related mortality, suggesting that first responders are critical intervention points for individuals in need of medical treatment following a drug overdose. However, while naloxone administration is a necessary first step in the recovery process, longitudinal pathways towards treatment are critical to stem the drug overdose crisis.