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Acute influence of alcohol, THC or central stimulants on violent suicide: A Swedish population study.

https://arctichealth.org/en/permalink/ahliterature258141
Source
J Forensic Sci. 2014 Mar;59(2):436-40
Publication Type
Article
Date
Mar-2014
Author
Lena Lundholm
Ingemar Thiblin
Bo Runeson
Anders Leifman
Anna Fugelstad
Source
J Forensic Sci. 2014 Mar;59(2):436-40
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Alcoholic Intoxication - epidemiology
Asphyxia - mortality
Central Nervous System Depressants - blood
Central Nervous System Stimulants - blood
Dronabinol - blood
Drowning - mortality
Ethanol - blood
Female
Forensic Psychiatry
Forensic Toxicology
Humans
Male
Middle Aged
Multivariate Analysis
Neck Injuries - mortality
Poisoning - mortality
Registries
Substance-Related Disorders - epidemiology
Suicide - psychology - statistics & numerical data
Sweden - epidemiology
Wounds, Gunshot - mortality
Wounds, Penetrating - mortality
Young Adult
Abstract
Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.
PubMed ID
24745078 View in PubMed
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Drug-related deaths: Statistics based on death certificates miss one-third of cases.

https://arctichealth.org/en/permalink/ahliterature309777
Source
Scand J Public Health. 2020 Feb; 48(1):29-37
Publication Type
Journal Article
Date
Feb-2020
Author
Anna Fugelstad
Mats Ramstedt
Ingemar Thiblin
Lars Age Johansson
Author Affiliation
Karolinska Institute, Department of Clinical Neuroscience, Sweden.
Source
Scand J Public Health. 2020 Feb; 48(1):29-37
Date
Feb-2020
Language
English
Publication Type
Journal Article
Keywords
Adult
Datasets as Topic
Death Certificates
Female
Humans
Male
Registries
Reproducibility of Results
Substance-Related Disorders - mortality
Sweden - epidemiology
Abstract
Aims: Statistics on drug-related deaths (DRD) provide crucial information on the drug situation. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) has published a specification for extracting DRD from national mortality registers to be used in international comparisons. However, surprisingly little is known of the accuracy of DRD statistics derived from national mortality registers. This study assesses the accuracy of Swedish data derived from national mortality registers by comparing it with other sources of data. Methods: We compared five Swedish datasets. Three were derived from national mortality registers, two according to a Swedish specification and one according to the EMCDDA specification. A fourth dataset was based on toxicological analyses. We used a fifth dataset, an inventory of DRD in Stockholm, to assess the completeness and coverage of the Swedish datasets. Results: All datasets were extracted from high-quality registers, but still did not capture all DRD, and both the numbers and demographic characteristics varied considerably. However, the time trends were consistent between the selections. In international comparisons, data completeness and investigation procedures may impact even more on stated numbers. Conclusions: Basing international comparisons on numbers or rates of DRDs gives misleading results, but comparing trends is still meaningful.
PubMed ID
29207931 View in PubMed
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[Incorrect conclusions about drug deaths].

https://arctichealth.org/en/permalink/ahliterature281861
Source
Lakartidningen. 2016 11 25;113
Publication Type
Article
Date
11-25-2016

Long-term mortality and causes of death among hospitalized Swedish drug users.

https://arctichealth.org/en/permalink/ahliterature269676
Source
Scand J Public Health. 2014 Jun;42(4):364-9
Publication Type
Article
Date
Jun-2014
Author
Anna Fugelstad
Anders Annell
Gunnar Ågren
Source
Scand J Public Health. 2014 Jun;42(4):364-9
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Cause of Death - trends
Drug Users - statistics & numerical data
Female
Follow-Up Studies
HIV Infections - mortality
Hospitalization - statistics & numerical data
Humans
Male
Mortality - trends
Substance-Related Disorders - mortality
Sweden - epidemiology
Abstract
To study long-term mortality and causes of death in a cohort of drug users in relation to main type of drug use and HIV-status.
A total of 1640 hospitalized drug users in Stockholm was followed up from 1985 to the end of 2007. The mortality was compared with the general Swedish population and hazard ratios (HR) for the main risk indicators were calculated. The causes of death were studied, using information from death certificates.
630 persons died during the observation period. The Standard Mortality Ratio (SMR) was 16.1 (males 13.8, females 18.5). The crude mortality rate was 2.0 % (males 2.2% and females 1.5%). The mortality rate was higher in heroin users than among amphetamine users, HR 1.96, controlled for age and other risk factors. The mortality rate among individuals infected with the human immunodeficiency virus (HIV) was high (4.9 %), HR 2.64, compared with HIV-negative individuals. Most of the deaths were from other causes than acquired immune deficiency syndrome. One-third of deaths (227) were caused by heroin intoxication. The number of deaths from HIV-related causes decreased after 1996, when highly active anti-retroviral therapy was introduced. In all, there were 92 HIV-related deaths. Deaths from natural causes increased during the observation period. The SMR was highest for cardiovascular and gastrointestinal diseases. The results indicate a correlation between amphetamine use and death from cerebral haemorrhage. A high proportion of natural deaths were alcohol-related.
The death rate among illicit drug users was persistently high. Alcohol consumption was a contributing factor to premature death.
PubMed ID
24608092 View in PubMed
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[More and more methadone deaths. "Leakage" from ongoing more liberal treatment programs might be a cause]

https://arctichealth.org/en/permalink/ahliterature96780
Source
Lakartidningen. 2010 May 5-11;107(18):1225-8
Publication Type
Article

Mortality and causes of death among homeless women and men in Stockholm.

https://arctichealth.org/en/permalink/ahliterature137787
Source
Scand J Public Health. 2011 Mar;39(2):121-7
Publication Type
Article
Date
Mar-2011
Author
Ulla Beijer
Sven Andreasson
Gunnar Agren
Anna Fugelstad
Author Affiliation
Karolinska Institute, Sweden.
Source
Scand J Public Health. 2011 Mar;39(2):121-7
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Cohort Studies
Emigrants and Immigrants
Female
Follow-Up Studies
Homeless Persons - psychology
Humans
Male
Mental Disorders - complications - therapy
Middle Aged
Risk factors
Substance-Related Disorders - ethnology - mortality - therapy
Sweden - epidemiology - ethnology
Young Adult
Abstract
To study the mortality and causes of death among homeless men and women in relation to the risk indicators, previous treatment for alcohol and drug abuse, previous treatment for mental disorders and non-Swedish citizenship.
The mortality was studied in a cohort comprising 1,757 men and 526 women compared with the general population and persons with inpatient treatment for alcohol- and drug-related disorders. The follow-up period was from 1995 to 1997 until the end of 2005. The causes of death were analyzed.
421 deaths occurred during the follow-up period. The relative risk of death was 3.1, with no difference in mortality between homeless men and homeless women. Previous treatment for alcohol and drug abuse disorders was related to excess mortality and previous treatment for mental disease to lower mortality. Homeless people with inpatient treatment for alcohol or drug use disorders had no higher mortality than the general population in Stockholm with a similar history. There was a dominance of alcohol- and drug-related causes of death.
Compared with previous studies of homeless people in Stockholm the excess mortality among men found in this study is of the same magnitude. Mortality among women is lower. The mortality rate in homeless people with previous treatment for an alcohol and illicit drug use disorder did not differ from those treated for these disorders in the general population.
The most important finding is that excess mortality among homeless men and women in Stockholm is entirely related to alcohol and drug abuse.
PubMed ID
21247970 View in PubMed
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Opioid-related deaths and previous care for drug use and pain relief in Sweden.

https://arctichealth.org/en/permalink/ahliterature310351
Source
Drug Alcohol Depend. 2019 08 01; 201:253-259
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-01-2019
Author
Anna Fugelstad
Ingmar Thiblin
Lars Age Johansson
Gunnar Ågren
Anna Sidorchuk
Author Affiliation
Department of Clinical Neuroscience, Karolinska Institute, Götgatan 83E, SE-11662 Stockholm, Sweden. Electronic address: anna.fugelstad@ki.se.
Source
Drug Alcohol Depend. 2019 08 01; 201:253-259
Date
08-01-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Analgesics, Opioid - adverse effects - therapeutic use
Drug Overdose - mortality
Female
Humans
Male
Medical History Taking - methods
Middle Aged
Mortality - trends
Opioid-Related Disorders - diagnosis - mortality
Pain - drug therapy - mortality
Pain Management - methods - mortality
Retrospective Studies
Sweden - epidemiology
Young Adult
Abstract
In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.
We included 2834 forensically examined individuals (ages 15-64 years) that died of poisoning in Sweden in 2006-2014. For each death we acquired data on previous opioid prescriptions and SUD treatments. We compared three study groups: pain control (n?=?788); a SUD treatment group (n?=?1629); and a group with no prescription for pain control or SUD treatment (n?=?417).
Overall fatal poisonings increased from 2.77 to 7.79 (per 100,000 individuals) from 2006 to 2014 (relative 181% increase). Fatal poisoning increased from 2006 to 2014 by 269% in the pain control group (0.64 to 2.36 per 100,000) and by 238% in the SUD treatment group (1.35 to 4.57 per 100,000). Heroin-related deaths remained constant; consequently, the increase was likely attributable to prescription opioids.
A rapid increase in deaths attributable mainly to prescription opioids for pain control, was reported previously in the United States. Our study indicated that increased access to prescription opioids might contribute to higher death rates also in Sweden among patients seeking pain control and individuals with an established SUD; however, deaths related to prescription opioids mainly occurred among those with SUDs.
PubMed ID
31260826 View in PubMed
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[Statistics on narcotics-related mortality are difficult to interpret].

https://arctichealth.org/en/permalink/ahliterature186021
Source
Lakartidningen. 2003 Feb 27;100(9):738-40
Publication Type
Article
Date
Feb-27-2003

Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin users.

https://arctichealth.org/en/permalink/ahliterature9771
Source
Addiction. 2003 Apr;98(4):463-70
Publication Type
Article
Date
Apr-2003
Author
Anna Fugelstad
Johan Ahlner
Lena Brandt
Gunnel Ceder
Staffan Eksborg
Jovan Rajs
Olof Beck
Author Affiliation
Department of Clinical Neurosciences, Karolinska Hospital, Stockholm, Sweden.
Source
Addiction. 2003 Apr;98(4):463-70
Date
Apr-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alcohol Drinking - adverse effects
Biological Markers - blood
Death, Sudden - etiology
Female
Heroin Dependence - blood - diagnosis - mortality
Humans
Male
Middle Aged
Morphine - blood
Morphine Derivatives - blood
Narcotics - blood
Regression Analysis
Retrospective Studies
Risk factors
Sweden - epidemiology
Abstract
AIMS: To detect risk factors for sudden death from heroin injection. DESIGN: Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. SETTING: Stockholm, Sweden. MEASUREMENTS: Autopsy investigation and toxicological analysis of blood and urine; and police reports. FINDINGS: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. CONCLUSIONS: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
PubMed ID
12653816 View in PubMed
Less detail

Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?

https://arctichealth.org/en/permalink/ahliterature142213
Source
Addiction. 2010 Sep;105(9):1625-32
Publication Type
Article
Date
Sep-2010
Author
Anders Romelsjö
Barbro Engdahl
Marlene Stenbacka
Anna Fugelstad
Ingrid Davstad
Anders Leifman
Ingemar Thiblin
Author Affiliation
Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden. anders.romelsjo@ki.se
Source
Addiction. 2010 Sep;105(9):1625-32
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Buprenorphine - poisoning - therapeutic use
Clinical Protocols
Drug Overdose
Female
Hospitalization - trends
Humans
Male
Methadone - poisoning - therapeutic use
Mortality - trends
Narcotic Antagonists - poisoning - therapeutic use
Opioid-Related Disorders - mortality - rehabilitation
Practice Guidelines as Topic
Substance Abuse Treatment Centers
Substance Abuse, Intravenous - epidemiology
Sweden - epidemiology
Young Adult
Abstract
To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006.
We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden.
Sweden.
Patients in maintenance treatment.
Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations.
The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County.
The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.
PubMed ID
20626377 View in PubMed
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10 records – page 1 of 1.