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From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study

Author

Listed:
  • Louise Brådvik

    (Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, SE-22185 Lund, Sweden)

  • Peter Löwenhielm

    (Department of Forensic Medicine, Faculty of Medicine, Lund University, SE-22185 Lund, Sweden)

  • Arne Frank

    (Lund University, SE-22185 Lund, Sweden)

  • Mats Berglund

    (Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, SE-22185 Lund, Sweden)

Abstract

Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malmö from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1‰ was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed.

Suggested Citation

  • Louise Brådvik & Peter Löwenhielm & Arne Frank & Mats Berglund, 2019. "From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study," IJERPH, MDPI, vol. 16(5), pages 1-14, March.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:5:p:801-:d:211065
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    References listed on IDEAS

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    1. Louise Brådvik & Mats Berglund & Arne Frank & Peter Löwenhielm, 2017. "Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers," IJERPH, MDPI, vol. 14(3), pages 1-9, March.
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