PMID- 32563797 OWN - NLM STAT- MEDLINE DCOM- 20210209 LR - 20210209 IS - 1872-6283 (Electronic) IS - 0379-0738 (Linking) VI - 313 DP - 2020 Aug TI - Fatal poisoning in drug addicts in the Nordic countries in 2017. PG - 110343 LID - S0379-0738(20)30205-X [pii] LID - 10.1016/j.forsciint.2020.110343 [doi] AB - This study is the seventh report on fatal poisonings among drug addicts in the Nordic countries. In this report, we analyse data from the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. Data on gender, number of deaths, places of deaths, age, main intoxicants and substances detected in blood were recorded to obtain national and comparable Nordic data, and to allow comparison with earlier studies conducted in 1984, 1991, 1997, 2002, 2007 and 2012. The death rate (number of deaths per 100,000 inhabitants) was highest in Iceland (6.58) followed closely by Sweden (6.46) and then lowest in Denmark (4.29). The death rate increased in Finland (5.84), Iceland and Sweden and decreased in Denmark compared to earlier studies. The death rate in Norway, which has decreased since 2002, has stabilised around 5.7 as of 2017. Women accounted for 7-23% of the fatal poisonings. The percentage was lowest in Iceland and highest in Finland and Norway. The age range was 14-70 years. The median age (41 years) was highest in Denmark and Norway. The other countries had a median age between 33 and 35 years. Opioids were the main cause of death. Methadone remained the main intoxicant in Denmark, while heroin/morphine was still the main intoxicant in Norway, as was buprenorphine in Finland. However, the picture has changed in Sweden compared to 2012, where heroin/morphine caused most deaths in 2017. Sweden also experienced the highest number of deaths from fentanyl analogues (67 deaths) and buprenorphine (61 deaths). Deaths from fentanyl analogues also occurred in Denmark, Finland and Norway, but to a smaller extent. Over the years, the proportion of opioid deaths has decreased in all countries except Sweden, which has experienced an increase. This decline has been replaced by deaths from CNS stimulants like cocaine, amphetamine and methylenedioxymethamphetamine (MDMA). Cocaine deaths have occurred in all countries but most frequently in Denmark. MDMA deaths have increased in all countries but mostly in Finland. Poly-drug use was widespread, as seen in the earlier studies. The median number of detected drugs per case varied from 4-6. Heroin/morphine, methadone, buprenorphine, cocaine, amphetamine, methamphetamine, MDMA, tetrahydrocannabinol (THC) and benzodiazepines were frequently detected. Pregabalin and gabapentin were detected in all countries, especially pregabalin, which was detected in 42% of the Finnish cases. New psychoactive substances (NPS) occurred in all countries except Iceland. CI - Copyright (c) 2020 Elsevier B.V. All rights reserved. FAU - Simonsen, K Wiese AU - Simonsen KW AD - Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik V's vej 11, 3, DK-2100, Copenhagen, Denmark. Electronic address: kirsten.wiese@sund.ku.dk. FAU - Kriikku, P AU - Kriikku P AD - Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Forensic Medicine, University of Helsinki, P.O. Box 40, FI-00014, Helsinki, Finland. FAU - Thelander, G AU - Thelander G AD - Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, SE-587 58, Linkoping, Sweden. FAU - Edvardsen, H M E AU - Edvardsen HME AD - Department of Forensic Sciences, Oslo University Hospital, P. O. Box 4950, 0424, Oslo Norway. FAU - Thordardottir, S AU - Thordardottir S AD - Department of Pharmacology and Toxicology, University of Iceland, Hagi-Hofsvallagata 53, IS-107, Reykjavik, Iceland. FAU - Andersen, C U AU - Andersen CU AD - Department of Forensic Medicine, University of Aarhus, Brendstrupgaardsvej 100, DK-8200, Aarhus, Denmark. FAU - Jonsson, A K AU - Jonsson AK AD - Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, SE-587 58, Linkoping, Sweden. FAU - Frost, J AU - Frost J AD - Department of Clinical Pharmacology, St. Olavs Hospital - Trondheim University Hospital, Professor Brochs gate 6, N-7030, Trondheim, Norway. FAU - Christoffersen, D J AU - Christoffersen DJ AD - Section of Forensic Toxicology, Departmen of Forensic Medicine, Faculty of Health Sciences, University of Southern Denmark, Winslowparken 17B, DK-5000, Odense, Denmark. FAU - Delaveris, G J M AU - Delaveris GJM AD - Department of Forensic Sciences, Oslo University Hospital, P. O. Box 4950, 0424, Oslo Norway; Institute of Forensic Medicine, University of Oslo, N-0027, Oslo, Norway. FAU - Ojanpera, I AU - Ojanpera I AD - Department of Forensic Medicine, University of Helsinki, P.O. Box 40, FI-00014, Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland. LA - eng PT - Journal Article DEP - 20200520 PL - Ireland TA - Forensic Sci Int JT - Forensic science international JID - 7902034 RN - 0 (Illicit Drugs) SB - IM MH - Adolescent MH - Adult MH - Age Distribution MH - Aged MH - Drug Overdose MH - Drug Users/*statistics & numerical data MH - Female MH - Humans MH - Illicit Drugs/poisoning MH - Male MH - Middle Aged MH - Poisoning/*mortality MH - Scandinavian and Nordic Countries/epidemiology MH - Sex Distribution MH - Substance-Related Disorders/*mortality MH - Young Adult OTO - NOTNLM OT - Drug abuse OT - Drug addict death OT - Fatal poisoning OT - Main intoxicant OT - New psychoactive substance OT - Nordic country COIS- Declaration of Competing Interest None. EDAT- 2020/06/22 06:00 MHDA- 2021/02/10 06:00 CRDT- 2020/06/22 06:00 PHST- 2020/01/29 00:00 [received] PHST- 2020/05/13 00:00 [revised] PHST- 2020/05/14 00:00 [accepted] PHST- 2020/06/22 06:00 [pubmed] PHST- 2021/02/10 06:00 [medline] PHST- 2020/06/22 06:00 [entrez] AID - S0379-0738(20)30205-X [pii] AID - 10.1016/j.forsciint.2020.110343 [doi] PST - ppublish SO - Forensic Sci Int. 2020 Aug;313:110343. doi: 10.1016/j.forsciint.2020.110343. Epub 2020 May 20.