Unintentional drowning: Role of medicinal drugs and alcohol

Abstract

BackgroundAlcohol is a well-known risk factor in unintentional drownings. Whereas psychotropic drugs, like alcohol, may cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning because of its high medico-legal autopsy rates.MethodsDrowning cases, 2000 through 2009, for which post-mortem toxicological analysis was performed, came from the database of the Toxicological Laboratory, Department of Forensic Medicine, University of Helsinki, using the ICD-10 nature-of-injury code T75.1. The data were narrowed to unintentional drowning, using the ICD-10 external-injury codes V90, V92, and W65–74. Each drowning case had its blood alcohol concentration (BAC) and concentrations of other drugs recorded. Evaluation of the contribution of psychotropic drugs to drowning was based on their blood concentration by means of a 6-grade scale.ResultsAmong victims ≥15 years old, unintentional drownings numbered 1697, of which, 303 (17.9%) were boating-related and 1394 (82.1%) non-boating-related. Among these, 65.0% of boating-related and 61.8% of non-boating-related victims were alcohol-positive (=BAC ≥ 50 mg/dL). The male-to-female ratio in alcohol-positive drownings was 7.3. At least one psychotropic drug appeared in 453 (26.7%) drowning cases, with some victims’ bodies showing up to 7 different drugs. Overall 70 different psychotropic drugs were detectable, with 134 (7.9%) cases both alcohol-negative and psychotropic-drug-positive, of these, 59 (3.5%) were graded 4 to 6, indicating a possible to very probable contribution to drowning. Our findings suggest that psychotropic drugs may play a significant role in drowning, in up to 14.5% of cases, independently or in association with alcohol.ConclusionsPsychotropic drugs alone or in association with alcohol may be an overlooked risk factor in drowning, due to their effects on psychomotor function and cognition. Future studies should also address other mechanisms—for instance drug-induced long-QT syndrome—by which drugs may contribute to drowning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4306-8) contains supplementary material, which is available to authorized users.

The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

“…For example, some landlocked countries may have more exposure to drowning in inland waterways such as rivers and lakes 41. This study did not explore the circumstances leading to drowning, aquatic location where the incident occurred, or the impact of alcohol, which is a significant contributor to drowning 42–44. There is also further work required to quantify the burden of drowning among migrants.…”

“… 41 This study did not explore the circumstances leading to drowning, aquatic location where the incident occurred, or the impact of alcohol, which is a significant contributor to drowning. 42–44 There is also further work required to quantify the burden of drowning among migrants. Future drowning studies should also encompass all drowning deaths (ie, transport related, disaster related, unintentional, intentional and undetermined intent).…”

A Retrospective, Cross-Sectional Cohort Study Examining the Risk of Unintentional Fatal Drowning during Public Holidays in Australia

“…Alcohol is a known risk factor for drowning [5], with alcohol known to be present in 26% of Australian river drownings between 2002-2012 [21], 38% of drowning deaths in Sweden between 1992-2009 [22], 65% of boating-related drownings in Finland between 2000-2009 [23], and 37% of drowning deaths in Canada between 2008 and 2012 [24]. This study identified 26% of drowning deaths which were known to involve victims with a BAC ≥0.05, with an increased risk of alcohol-related drowning when compared to non-holidays.…”

Alcohol use, aquatic injury, and unintentional drowning: A systematic literature review

“…• • More beachgoers in the 16-29 age group consumed alcohol prior to swimming (38%) than the (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) 16% and 50+ (13%) age groups alcohol and 38.3% of participants reported their dive clubs as having a responsible attitude toward alcohol. In summarising these findings, several trends were evident.…”