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Fatal drug poisonings: medico-legal reports and mortality statistics.

https://arctichealth.org/en/permalink/ahliterature183691
Source
Forensic Sci Int. 2003 Sep 9;136(1-3):35-46
Publication Type
Article
Date
Sep-9-2003
Author
R A Lahti
E. Vuori
Author Affiliation
Department of Forensic Medicine, University of Helsinki, P.O. Box 40, Helsinki 00014, Finland. raimo.lahti@sll.fimnet.fi
Source
Forensic Sci Int. 2003 Sep 9;136(1-3):35-46
Date
Sep-9-2003
Language
English
Publication Type
Article
Keywords
Adult
Death Certificates
Female
Finland - epidemiology
Forensic Medicine
Humans
Male
Middle Aged
Pharmaceutical Preparations - classification
Poisoning - classification - epidemiology - mortality
Suicide - statistics & numerical data
Abstract
The entire fatal drug poisoning panorama in Finland is considered in terms of three catergories: accidental, self-inflicted and undetermined (whether accidental or with intent to harm) deaths. The study material consisted of all 500 deaths in 1997 that medical examiners, after examination(s) at the Forensic Toxicology Division (FTD) of the Department of Forensic Medicine, University of Helsinki, officially certified as resulting from drug poisoning. These deaths were matched with data on the same deaths registered at Statistics Finland (SF), the national mortality statistics office. The SF register included 72 additional instances of deaths resulting from drug poisoning. In all but two of these cases, the cause-of-death determination was based on a medico-legal inquest with autopsy and forensic toxicological examination(s) and was certified, in most of the cases, as due to the alcohol component in multiple-toxicant combinations. Reclassifying these deaths at SF to the category of drug component is in accordance with current International Classification of Diseases (ICD-10) regulation of coding "to the medicinal agent when combined with alcohol"; the principle and practice, which is recommended to be amended to equalize the status of alcohol and drug when explicitly stated by a forensic examiner as the principal toxicant in combined poisonings. With regard to manner-of-death, the agreement rates between medico-legally proven deaths from drug poisoning and those registered at SF were 79.8% for accidents, 98.5% for suicides and 0% (nil) for undetermined deaths, at the level of three-character external cause codes (E-code). All deaths originally certified as undetermined were re-assigned, most frequently to the category of accidental death. Since within an advanced and sophisticated medico-legal system, a medical examiner's evidence-based statement, even when the conclusion reached is undetermined (as to intent), should be taken as a compelling argument, the practice of reclassification cannot be considered advisable because assembled information is lost. Concerning the assigned drug-specific groups, the agreement according to the manner-of-death between certifications and registrations was fairly good. From among the accidents, however, opioid poisonings were re-assigned in 11 (29.7%) cases, mostly to the drug abuse/dependence categories, i.e. they were considered as natural deaths by the statistics office. The drug-specific observations were possible only by using the codes from the Anatomical Therapeutic Chemical (ATC) classification of drugs. This is why the incorporation of ATC codes into the ICD system, whenever reasonable, is recommended.
PubMed ID
12969618 View in PubMed
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