Transcript Slide 1

Factors associated with fatal overdoses
in Oslo
2006-2008
Linn Gjersing, Thomas Clausen, Jørgen Bramness, Helge
Waal, Stian Biong & Edle Ravndal
Definitions
• Drug-induced deaths
– Deaths directly due to use of illegal substances, although these often
occur in combination with other substances such as alcohol or
psychoactive medicines. These deaths occur generally shortly after the
consumption of the substance
• Overdoses or poisonings
(EMCDDA 2009)
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Background
Universitetet i Oslo
EMCDDA 2009 s 84
Background
• City council of Oslo
– March 2009
– Investigate all overdoses in Oslo and identify possible causes
• Norwegian Centre for Addiction Research (Seraf)
– November 2009
– To identify all drug-induced deaths in Norway 2006-2008
– To assess the drug-induced deaths in Oslo
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Assess toxicology
Place of death (street, low threshold housing facilities, hospitals)
Possible causes
Role of primary and secondary health care services
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Methods
• Epidemiological study
– Cross-linked
• Qualitative research study
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Cases
• Overdoses
– European Monitoring Centre for Drugs and Drug Addiction’s
(EMCDDA) definition
– T42.4 benzodiazepines
• Alcohol
– F100 Acute intoxication
– X45 Accidental poisoning
– X65 Intentional poisoning
• < 70 år
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Underlying cause of
deaths
EMCDDA’s definition
Disorders
F11 Opioids
F12 Cannabinoids
F14-F16 Cocaine, other stimulants, hallucinogens
F19 Multiple drug use
Accidental poisoning
X41* antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere
classified: Antidepressants, barbiturates, hydantoin derivatives, iminostilbenes, methaqualone
compounds, neuroleptics, psychostimulants, succinimides, oxazolidinediones, tranquillizers
X42** narcotics and psychodysleptics [hallucinogens], not elsewhere classifide: cannabis
(derivatives), cocaine, codeine, heroin, lysergide [LSD], mescaline, methadone, morphine, opium
(alkaloids)
X44 other and unspecified drugs, medicaments and biological substances: agents primarily acting on
smooth and skeletal muscles and the respiratory system, anaesthetics (general)(local), drugs
affecting the: cardiovascular system, gastrointestinal system, hormones and synthetic substitutes,
systemic and haematological agents, systemic antibiotics and other anti-infectives
therapeutic gases, topical preparations, vaccines, water-balance agents and drugs affecting mineral
and uric acid metabolism
Intentional poisoning
X61*
X62**
X64
Poisoning
undetermined intent
Y11*
Y12**
Y14
*T43.6 Psychostimulants with abuse potential
** T40.0-.9 Narcotics and psychodysleptics
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Identification of cases
• General Mortality Registry
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Cause of death
Contributing cause of death
Age
Date of death
Residency according to Directory of Residents
Region of death
Place (hospital, home, street etc)
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Registries
• The Incarceration Registry
– 2/3 time, end of time, date of release
• Registry for Drug-related Deaths
– Toxicology reports
• The Drug Prescription Registry
– The Norwegian institute of Public Health
– Prescribed medications previous 12 months before death
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Patient records
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Hospitals
Community health care services
Outpatient emergency clinics
Low threshold facilities
– Housing, street clinics
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Outreach services
Social welfare offices
Treatment centres
Detoxification units
– Salvation army, Bymisjonen, P22, Fredheim, Tyrilistiftelsen
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Preliminary results
Deaths in Oslo
2006
2007
2008
Total
EMCDDA
deaths
106
73
82
261
Oslo residents
71%
63%
76%
70%
Women
28%
22%
21%
24%
Women
44 yrs
(20-57)
43 yrs
(18-59)
47 yrs
(19-59)
44 yrs
Men
34 yrs
(22-68)
37 yrs
(22-56)
40 yrs
(19-64)
36 yrs
Median age
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Age of death
<25 yrs
26-36 yrs
37-50 yrs
> 50 yrs
Total
32 (12%)
93 (36%)
97 (37%)
39 (15%)
Women
22%
14%
28%
41%
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Place of death
2006
2007
2008
Total
At home
41%
38%
28%
36%
Other places
35%
33%
24%
31%
Hospitals or institutions
8%
11%
9%
9%
Unknown
16%
18%
39%
24%
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Type of deaths
2006
2007
2008
Total
Disorders
3 (3%)
1 (1%)
2 (2%)
6 (2%)
Accidental
93 (88%)
63 (86%)
71 (87%)
227 (87%)
26%
16%
18%
47 (21%)
10 (9%)
9 (12%)
9 (11%)
28 (11%)
60%
67%
33%
15 (54%)
Women
Intentional
Women
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Release from prison
2006
2007
2008
Total
9 (9%)
5 (7%)
5 (6%)
19 (7%)
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1
1
3
Time in prison (range)
162 days
(0-181)
176 days
(39-179)
127 days
(58-182)
162 days
(0-182)
Time from prison release
(range)
20 days
(1-182)
6 days
(3-143)
55 days
(0-124)
20 days
(0-182)
6 months before death
No of women
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Age and death after prison release
Total no
<25 yrs
26-36 yrs
37-50 yrs
> 50 yrs
2
12
5
0
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Preliminary conclusions
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70% Oslo residents
20% women
Women older than men
Most deaths accidental
First month after prison release critical
Majority of those that die after prison release were between 26
and 36 yrs
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