By Elin Lindqvist, Jacob Hollenberg, Mattias Ringh, Per Nordberg, Henrik Druid, Leif Svensson, Sune Forsberg

Background

Approximately 1% of Sweden's 90 000 annual deaths were reported caused by poisoning. In this study, we aim to describe this poisoning population's characteristics, autopsy frequency and results of toxicology testing.

Method

A national cohort study based on Swedish national registers. All deceased subjects older than 18 years with poisoning as the cause of death registered between 1 January 2000 and 31 December 2021 were included. Causes of death according to primary ICD-10 code were analysed along with the substances found in forensic chemistry testing.

Results

There were 27 057 poisonous deaths during the study periods 2 018 495 adult deaths. Subjects deceased due to poisoning had a median age of 53 years, and 18 838 (70%) were men. A private home was the most reported location of death (52%). In total, 23 260 (87%) did undergo some sort post-mortem examination. Drugs (synthetic narcotics, opioids, heroin) caused 12 448 (46%) deaths, and alcohols explained 9056 cases (33%). Positive toxicological tests were found in 22 550 (83%) of the subjects. The most common separate substances were ethanol, zopiclone and nordazepam.

Conclusion

Poisoning caused 1.3% of Swedish deaths. Men in their 50s were the most common victims, and their deaths were often cause by synthetic narcotics, other opioids or alcohol. The autopsy frequency was lower than expected for poisonous deaths.

Basic & Clinical Pharmacology & Toxicology, early view, 2024;1–8.

By Courtney McKnight , Chenziheng Allen Weng, Marley Reynoso, Sarah Kimball, Lily M. Thompson, Don Des Jarlais

Background: As the proportion of drug overdose deaths involving fentanyl continues to increase in the US, monitoring exposure to and possible changes in intention to use fentanyl among people who use drugs (PWUD) is of great public health importance. This mixed methods study examines intentionality of fentanyl use among persons who inject drugs (PWID) in New York City during a period of unprecedently high rates of drug overdose mortality. Methods: Between October 2021 and December 2022, N = 313 PWID were enrolled in a cross-sectional study that included a survey and urine toxicology screening. A subset of N = 162 PWID also participated in an in-depth interview (IDI) examining drug use patterns, including fentanyl use and experiences with drug overdose. Results: 83% of PWID were urine-toxicology positive for fentanyl, though only 18% reported recent intentional fentanyl use. Intentionality of fentanyl use was associated with being younger, white, increased drug use frequency, recent overdose (OD), recent stimulant use, among other characteristics. Qualitative findings suggest PWID tolerance to fentanyl may be increasing, which could result in an increased preference for fentanyl. Concern about overdose was common with nearly all PWID using overdose prevention strategies to avoid it. Conclusion: The findings from this study demonstrate a high prevalence of fentanyl use among PWID in NYC, despite an expressed preference for heroin. …

International Journal of Drug Policy , Article in Press, May 2023