heroin and Death--Sudden

To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome.. Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation.. Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations.. Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.

Topics: Analgesics, Opioid; Death, Sudden; Drug Overdose; England; Heroin; Humans; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Risk Factors; Scotland; Substance Abuse, Intravenous; Substance-Related Disorders

Topics: After-Hours Care; Analgesics, Opioid; Death, Sudden; Drug Overdose; England; Heroin; Humans; Medication Errors

This study is the first study that addresses drug abuse associated fatalities in Jordan. It is aimed to give a close picture to the demography, toxicological data, manner, cause of death and other associated findings in such cases. Postmortem forensic pathology reports for all autopsies examined in the National Institute of Forensic Medicine were reviewed over a 5-year period and drug abuse associated deaths were selected. The study revealed that 44 cases (0.76%) out of the 5789 total autopsies were attributed to drug abuse associated deaths. The age range was from 20 to 60 years (mean+/-S.D.=32.7+/-7.2). More than 80% of cases were Jordanian males. The reported abuse substances as single drug or in combination were alcohol in 56.8%, morphine 36.4%, heroin 15.9%, benzodiazepines in 11.4% and cocaine in one body packer case. Surprisingly, neither a case with amphetamine or amphetamine analogue, nor with marijuana or methadone was recorded. In 75% of cases the death was accidental and only one case was reported to be suicidal, while in 18.2% and 4.5% death was due to sudden death and road traffic accidents, respectively. Regarding the cause of death, it was related to drug overdose in 50% of cases and in 34.1%, 11.4% and 4.5% of cases it was attributed to drug related medical complications, non-drug related complications, and trauma, respectively. Alcohol was mainly associated with accidental death; morphine and heroin were associated with drug overdose and abused through intravenous route. Injection marks were reported in 56.8% of cases and in 52.3% death occurred at home. This study confirmed the variation in the incidence and type of abused substances in Jordan compared with different countries.

Topics: Accidents; Accidents, Traffic; Adult; Benzodiazepines; Cause of Death; Central Nervous System Depressants; Cocaine; Death, Sudden; Drug Overdose; Ethanol; Female; Forensic Toxicology; Heroin; Humans; Jordan; Male; Middle Aged; Morphine; Narcotics; Retrospective Studies; Substance-Related Disorders; Suicide

This is a histological report of a myocardial lesion of a 44-year-old white man who was found dead in a hotel with circumstances strongly suggestive of heroin intoxication. Based on. autopsy findings and toxicologic analysis, the present case was an instance of straight forward heroin overdose in snorter. The most striking pathologic finding of the heart was a few patches of marked dark mottling appearance in the left ventricle and ventricular septum. Histological appearance of the lesions revealed marked congestion with intramyocardial extravasation of blood. Since the deceased had patent coronary arteries without evidence of atheroma, the lesions were thought to be the results ofcoronary artery spasm. There has also been substantial evidence in the previous reports to believe that the condition is secondary to heroin-induced coronary artery spasm. However its actual underlying mechanism remains unclear.

Topics: Adult; Death, Sudden; Drug Overdose; Heart; Heroin; Heroin Dependence; Humans; Male; Myocardium

Heroin injection entails a risk of infection and can result in sudden collapse and death. During the past few years alternative routes of heroin use have been introduced. During 1997-1998 we observed six deaths which occurred suddenly following heroin snorting. These victims were all temporary drug users in good health and physical condition. They all died with low morphine concentrations; however, three had relatively high blood alcohol concentrations and two were under the influence of medicinal drugs. Temporary use of heroin is characterized by low drug tolerance; snorting of heroin appears to entail the same risk of sudden death as injection.

Topics: Administration, Intranasal; Adult; Death, Sudden; Drug Tolerance; Female; Forensic Medicine; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Risk Factors

Topics: Adult; Autopsy; Body Fluids; Death, Sudden; Heroin; Humans; Male; Morphine; Poisoning

We report seven fatalities resulting from the ingestion of illicit drugs packaged in condoms, rubber balloons, or plastic bags which were observed in the last 4 years at the Office of the Chief Medical Examiner, State of Maryland. All the victims, with the exception of one, were men ranging in age from 19 to 37 years. There was no racial predominance. No drug paraphernalia was found at any scene. In two cases, seizure-like activity was documented. One victim had recently returned from Nigeria; therefore, Lassa fever was initially suspected. Two of the victims were "body packer" contrabanders who had just arrived from Africa. They used body cavities to hide large amounts of heroin to avoid U.S. Customs. The other five cases were "mini-packers," small-time illicit drug dealers who had swallowed a single bag of cocaine to avoid police detection. The possible mechanism of leaking or rupture of the latex container is discussed.

Topics: Adolescent; Adult; Baltimore; Cocaine; Death, Sudden; Female; Heroin; Humans; Illicit Drugs; Male; Nigeria; Substance-Related Disorders; Travel

Drug-related deaths encompass fatal overdoses, the medical derangements from chronic consumption, and violent death from the alteration of normal behavioral patterns. Determining the extent to which a drug contributed to a death necessitates correlation of all aspects of the death investigation; autopsy and toxicologic findings must be interpreted in the light of antecedent events, medical and social history, and thorough scene investigation. The approach to the medicolegal investigation of drug-related deaths is discussed along with some legal ramifications and certain potential problems of death certification.

Topics: Autopsy; Cocaine; Death, Sudden; Drug Prescriptions; Ethanol; Forensic Medicine; Heroin; Humans; Illicit Drugs; Marijuana Abuse; Pharmaceutical Preparations; Substance-Related Disorders; Tattooing; Toxicology

Topics: Adult; Airway Obstruction; Crime; Death, Sudden; Heroin; Humans; Male

Topics: Death, Sudden; Drug Contamination; Drug Tolerance; Ethanol; Heroin; Heroin Dependence; Humans; Morphine; Time Factors

Topics: Adolescent; Adult; Child; Death, Sudden; District of Columbia; Drug Synergism; Drug Tolerance; Ethanol; Female; Heroin; Heroin Dependence; Humans; Male

Topics: Adolescent; Adult; Alcoholism; Barbiturates; Bradycardia; Cocaine; Death, Sudden; Electrocardiography; Female; Heart; Heart Rate; Heroin; Humans; Male; Methadone; Middle Aged; Morphine; Quinine; Substance-Related Disorders

Topics: Autopsy; Death, Sudden; Ethanol; Half-Life; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Lung; Morphine; Morphine Dependence; Poisoning; Time Factors

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Death, Sudden; Heroin; Humans; Infant; Liver; Middle Aged; New York City; Racial Groups; Vitamin A; Wounds and Injuries; Wounds, Gunshot