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Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003.

https://arctichealth.org/en/permalink/ahliterature80715
Source
Forensic Sci Int. 2007 Jul 4;169(2-3):101-7
Publication Type
Article
Date
Jul-4-2007
Author
Jönsson Anna K
Holmgren Per
Druid Henrik
Ahlner Johan
Author Affiliation
Department of Clinical Pharmacology, Linköping University, S-581 85 Linköping, Sweden. anna.k.jonsson@lio.se
Source
Forensic Sci Int. 2007 Jul 4;169(2-3):101-7
Date
Jul-4-2007
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Analgesics, Opioid - analysis - poisoning
Cause of Death
Central Nervous System Depressants - analysis
Central Nervous System Stimulants - analysis - poisoning
Child
Dopamine Uptake Inhibitors - analysis
Ethanol - analysis
Female
Forensic Toxicology
Homicide - statistics & numerical data
Humans
Male
Middle Aged
Prospective Studies
Registries
Sex Distribution
Substance Abuse Detection
Substance-Related Disorders - mortality
Suicide - statistics & numerical data
Sweden - epidemiology
Abstract
Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.
PubMed ID
16965879 View in PubMed
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Cerebral haemorrhage induced by warfarin - the influence of drug-drug interactions.

https://arctichealth.org/en/permalink/ahliterature81375
Source
Pharmacoepidemiol Drug Saf. 2007 Mar;16(3):309-15
Publication Type
Article
Date
Mar-2007
Author
Jönsson Anna K
Spigset Olav
Jacobsson Ingela
Hägg Staffan
Author Affiliation
Department of Clinical Pharmacology, University Hospital, Linköping, Sweden. anna.k.jonsson@lio.se
Source
Pharmacoepidemiol Drug Saf. 2007 Mar;16(3):309-15
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants - adverse effects
Cerebral Hemorrhage - chemically induced - mortality - prevention & control
Child
Drug Interactions
Female
Humans
Incidence
Male
Middle Aged
Physician's Practice Patterns
Retrospective Studies
Sweden - epidemiology
Warfarin - adverse effects
Abstract
PURPOSE: To evaluate the frequency, severity and preventability of warfarin-induced cerebral haemorrhages due to warfarin and warfarin-drug interactions in patients living in the county of Ostergötland, Sweden. METHODS: All patients with a diagnosed cerebral haemorrhage at three hospitals during the period 2000-2002 were identified. Medical records were studied retrospectively to evaluate whether warfarin and warfarin-drug interactions could have caused the cerebral haemorrhage. The proportion of possibly avoidable cases due to drug interactions was estimated. RESULTS: Among 593 patients with cerebral haemorrhage, 59 (10%) were assessed as related to warfarin treatment. This imply an incidence of 1.7/100,000 treatment years. Of the 59 cases, 26 (44%) had a fatal outcome, compared to 136 (25%) among the non-warfarin patients (p
PubMed ID
16858720 View in PubMed
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Fatal unintentional intoxications with tramadol during 1995-2005.

https://arctichealth.org/en/permalink/ahliterature84912
Source
Forensic Sci Int. 2007 Dec 20;173(2-3):107-11
Publication Type
Article
Date
Dec-20-2007
Author
Tjäderborn Micaela
Jönsson Anna K
Hägg Staffan
Ahlner Johan
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Source
Forensic Sci Int. 2007 Dec 20;173(2-3):107-11
Date
Dec-20-2007
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adolescent
Adult
Aged
Analgesics, Opioid - blood - poisoning
Central Nervous System Depressants - blood
Ethanol - blood
Female
Forensic Toxicology
Humans
Male
Middle Aged
Substance-Related Disorders - mortality
Sweden - epidemiology
Tramadol - analogs & derivatives - blood - poisoning
Abstract
Tramadol is an extensively used centrally acting analgesic and is considered a safe drug devoid of many serious adverse effects of traditional opioids. However, recently, toxicity and an abuse potential of tramadol have been reported. This study examined fatal unintentional tramadol intoxications among Swedish forensic autopsy cases between 1995 and 2005. All fatal intoxications were selected, in which toxic concentrations of tramadol (>1 microg/g femoral blood) had been detected, and where the forensic pathologist considered the intoxication unintentional and the fatal outcome at least partly explained by tramadol. Toxicology analyses, police reports, autopsy protocols and medical records were scrutinized. A total of 17 cases (eleven men and six women) of fatal unintentional tramadol intoxications were identified. For these cases the median age was 44 years (range 18-78 years) and the median tramadol concentration was 2.0 microg/g (range 1.1-12.0 microg/g). Other pharmaceutical substances, illicit drugs or ethanol were detected in addition to tramadol in all of these cases. In fact, intoxication with multiple drugs was considered the cause of death in 10 (59%) cases. However, in seven cases tramadol was the only substance present in toxic concentrations. A history of substance abuse was identified in 14 (82%) subjects and a present tramadol abuse in 8 (47%). These results suggest that fatal intoxications with tramadol may occur unintentionally and that subjects with a history of substance abuse may be at certain risk. Precaution is therefore warranted when prescribing tramadol in such patients.
PubMed ID
17350197 View in PubMed
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Tramadol dependence: a survey of spontaneously reported cases in Sweden.

https://arctichealth.org/en/permalink/ahliterature95002
Source
Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1192-8
Publication Type
Article
Date
Dec-2009
Author
Tjäderborn Micaela
Jönsson Anna K
Ahlner Johan
Hägg Staffan
Author Affiliation
Division of Clinical Pharmacology, Linköping University, Linköping, Sweden. micaela.tjaderborn@liu.se
Source
Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1192-8
Date
Dec-2009
Language
English
Publication Type
Article
Abstract
BACKGROUND: Tramadol is a weak opioid analgesic, which is generally considered to be safe. However, conflicting data exist on the dependence potential of tramadol. OBJECTIVE: The aim of this study was to investigate occurrence of tramadol dependence and associated risk factors using spontaneously reported adverse drug reactions. METHODS: The Swedish database for spontaneously reported adverse drug reactions, Swedish Drug Information System (SweDIS), was searched for reports on tramadol dependence from 1 January 1995 until 31 December 2006. Selection was conducted based on the DSM-IV definition of dependence. Available information was scrutinised and registered and then presented descriptively. RESULTS: A total of 104 reports of tramadol dependence were identified, of which 60 (58%) concerned women. The median age (range) was 45 (15-84) years. Information on a history of substance abuse was present in 31 patients (30%) and 41 patients (39%) had a documented past or current use of a drug of abuse. Prescribed doses of tramadol ranged between 50-800 mg/day, and ingested doses between 50-4000 mg/day. Time of onset ranged from some weeks up to 4 years. In 72 (69%) cases the reaction was classified as serious, mainly due to hospitalisations for detoxification or discontinuation of tramadol. CONCLUSIONS: There is an occurrence of tramadol dependence in association with analgesic treatment within the recommended dose range. In susceptible patients a severe and serious dependence syndrome may develop. A history of abuse or use of a drug of abuse seems to be an important risk factor.
PubMed ID
19827010 View in PubMed
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