Fatal poisoning in drug addicts in the Nordic countries in 2017

Simonsen, Kirsten Wiese; Kriikku, Pirkko; Thelander, Gunilla; Edvardsen, Hilde Marie Erøy; Þórðardóttir, S.; Andersen, Charlotte Uggerhøj; Jönsson, Anna K.; Frost, Joachim; Christoffersen, Dorte; Delaveris, Gerd Jorunn Møller; Ojanperä, Ilkka

doi:10.1016/j.forsciint.2020.110343

Cited by 54 publications

(61 citation statements)

References 13 publications

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“…Finland has an opioid abuse profile different from the neighboring Nordic countries, with a very limited supply of heroin and less methadone abuse. Buprenorphine accounts for about one third of the total drug poisoning mortality (5.84 per 100,000 for inhabitants aged 15-64 in 2017) (Simonsen et al, 2020). Uosukainen et al studied clients seeking treatment for buprenorphine abuse and found that daily buprenorphine abuse, intravenous administration, and concurrent substance use were common (Uosukainen et al, 2013a).…”

Section: Introductionmentioning

confidence: 99%

Concomitant drugs with buprenorphine user deaths

Mariottini

Kriikku

Ojanperä

2021

Drug and Alcohol Dependence

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Background: Buprenorphine is abused in several countries notwithstanding its benefits as an analgesic and as an opioid agonist treatment medication. Benzodiazepines and alcohol have previously been associated with buprenorphine toxicity. This study elucidates the role of emerging concomitant drugs in different groups of buprenorphine user deaths. Methods: All cases in the Finnish national post-mortem toxicology database from 2016-2019 in which buprenorphine or norbuprenorphine was a laboratory finding in any post-mortem specimen and age at death of 15-64 years were investigated for cause and manner of death, concurrent drug and alcohol findings, age, and gender. Results: There were 792 deaths with a buprenorphine finding, of which buprenorphine was implicated in poisoning without other opioids in 271 cases (34 %). In this group of buprenorphine poisoning deaths, concomitant benzodiazepines were found in 94 % (clonazepam 53 %), illicit drugs in 63 %, gabapentinoids in 50 % (pregabalin 41 %), alcohol in 41 %, antidepressants in 32 %, and antipsychotics in 28 % of cases; only three deaths showed no benzodiazepines, alcohol, or gabapentinoids. Polydrug use was common regardless of the cause of death. In the age group 15 to 24 years, concomitant use of benzodiazepines and illicit drugs, and buprenorphine poisoning were more prevalent than in the age group 25-64 years. Conclusions: The unprecedentedly high concomitant use of benzodiazepines in buprenorphine user deaths obscures other possible pharmacological risk factors for buprenorphine poisoning that could be relevant for prevention. Higher mortality in the younger age group suggests particularly unsafe drug use patterns that should be addressed.

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Section: Introductionmentioning

confidence: 99%

Concomitant drugs with buprenorphine user deaths

Mariottini

Kriikku

Ojanperä

2021

Drug and Alcohol Dependence

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“…A recent review of overdose deaths in five north European countries showed that the median number of detected drugs per case varied from 4 to 6. Opioids were the main cause of death but as well as heroin/ morphine, included methadone, buprenorphine and fentanyl analogues (Simonsen et al, 2020). Similarly, the analysis of a Finnish national post-mortem toxicology database showed that there were no death cases with buprenorphine as the only toxicological finding, with concomitant benzodiazepines commonly detected (Mariottini et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Is Europe facing an opioid epidemic: What does European monitoring data tell us?

Seyler

Giraudon

Noor

et al. 2021

European Journal of Pain

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This paper addresses the question of whether Europe is facing an opioid epidemic and utilizes data from the European monitoring system on opioid use, harms and availability, to help assess the situation. Data sources covering the last decade on overdose deaths, drug treatment entrants and drug-related emergencies suggest that the health burden associated with opioid use is mostly related to the consumption of heroin -and to a lesser extent diverted opioid substitution treatment medicationsand that it is primarily affecting an ageing cohort of vulnerable users, with little evidence of an increase in initiation. While opioid-related deaths are currently at much lower levels than in the United States, they still represent a large preventable health burden with differences across EU countries. There is also increasing concern related to the high availability of heroin, illicitly produced synthetic opioids and diverted opioid pain medications on the European drugs market. Trends in the latter categories are poorly monitored and we may miss signs of emerging problems. Moreover, the economic recession following the COVID-19 pandemic has a potential to lead to resurgence in opioid use and harms. Significance: This paper looks at data from the European monitoring system to address the question of whether Europe is facing an opioid epidemic. It reviews available health and supply side indicators, considering the limitations of each data source.A summary of the available evidence would suggest that while opioid-related deaths in Europe represent a large preventable health burden with differences across EU countries, Europe as a whole is not facing an opioid crisis of the size and nature seen in the US.How to cite this article: Seyler T, Giraudon I, Noor A, Mounteney J, Griffiths P. Is Europe facing an opioid epidemic: What does European monitoring data tell us?.

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“…While the recreational use of opioids is not common in Norway, the relative number of opioid-related fatalities is higher than in most other European countries. The main cause of opioid overdoses used to be heroin, but in recent years the numbers of fatal overdoses by oxycodone, methadone, and buprenorphine has increased (Simonsen et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Illicit Drug Use among Norwegian Nightlife Patrons

Jørgenrud

Furuhaugen

Gjerde

2021

Substance Use & Misuse

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Background: Nightclubs and bars are recreational settings with extensive availability and consumption of alcohol and recreational drugs. Objectives: This study aims to determine the proportion of nightclub patrons in Norway that tested positive for illicit drugs, moreover, we examined the correlation between positive test results and demographic and substance use characteristics. Methods: Patrons were recruited outside nightclubs on Friday and Saturday nights between 10:00 pm and 04:00 am. Substance use was determined by breath testing and oral fluid testing for alcohol and drugs, respectively, using accurate and specific analytical methods. Questionnaires recorded demographic and substance use characteristics. Results: Of the 1988 included nightclub patrons, 90% tested positive for alcohol, 14% for illicit drug use, and 3% for two or more illicit drugs. The proportion of patrons who tested positive for illicit drugs was highest in the early hours of the morning. Nine out of ten who tested positive for illicit drugs also consumed alcohol. Testing positive for one or more illicit drugs was most strongly correlated with being male and unemployed, using tobacco or other nicotine products, and early on-set illicit drug use; further the correlations were strongest among those who tested positive for two or more illicit drugs. Conclusions/ Importance: Patrons who used illicit drugs before or during nightclub visits most often combined drug use with alcohol consumption. Substituting alcohol with cannabis or other drugs was not common in this cohort. The study results provide evidence to introduce harm-reduction prevention programs to address illicit drug and excessive alcohol consumption.

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Fatal poisoning in drug addicts in the Nordic countries in 2017

Cited by 54 publications

References 13 publications

Concomitant drugs with buprenorphine user deaths

Concomitant drugs with buprenorphine user deaths

Is Europe facing an opioid epidemic: What does European monitoring data tell us?

Prevalence and Correlates of Illicit Drug Use among Norwegian Nightlife Patrons

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