The study aimed to determine: 1. The characteristics of all recorded cases of fatal drug poisoning involving ‘novel’ benzodiazepines (NBZDs) in Australia; 2. The toxicology of cases; and 3. The major ...autopsy findings.
Retrospective study of all deaths due to drug toxicity in Australia in which NBZDs were present in blood toxicology, retrieved from the National Coronial Information System (2000–2021). Information was collected on case characteristics, toxicology and major organ pathology.
A total of 40 cases were identified, the first occurring in 2015, with a median age of 26.5 years and 87.5% being male. Death was due to accidental toxicity in 92.5% of cases. There were extensive histories of substance use problems (80.0%) and mental health problems (32.5%). Etizolam was the most common NBZD (87.5%), followed by flubromazolam (15.0%), with other NBZDs detected in 20.0% (delorazepam, diclazepam, flualprazolam, flubromazepam, lormetazepam). Multiple NBZDs were present in 27.5%. Other drugs were present in 97.5%, most commonly opioids (70.0%), registered benzodiazepines (62.5%), psychostimulants (45.0%) and gabapentinoids (32.5%). A CNS depressant other than a NBZD was detected in 95.0% (n = 38). Autopsies were conducted and available for 30 cases, with pulmonary oedema (76.7%, n = 23), aspiration of vomitus (46.7%, n = 14) and acute bronchopneumonia (36.7%, n = 11) the most common diagnoses.
The ‘typical’ NBZD-related death was a young male who died due to accidental toxicity. Deaths most frequently involved etizolam and multiple substances, particularly depressants.
•National profile of novel benzodiazepine (NBZD) toxicity deaths.•Median age was 26.5 years and 87.5% were male.•Etizolam was the most common NBZD (87.5%).•Multiple NBZDs were present in 27.5%.•Other drugs were present in 97.5%.
Aims: To determine 1. The characteristics of all recorded cases of fatal drug poisoning involving novel synthetic opioids (NSOs) in Australia; 2. The toxicology of cases; and 3. The major autopsy ...findings.
Review of all fatal poisonings related to NSOs in Australia 2000–2021 identified in the National Coronial Information System.
Thirty-one cases were identified, 96.8% due to unintentional drug toxicity. The mean age was 31.9 years and 87.1% were male. Only six were aged over forty. A history of substance use problems was documented in 80.6% and 58.1% had a history of injecting drug use. In 32.3% the final route of administration of a NSO was by non-injecting routes of administration. Ten NSOs were identified. Fentanyl analogues were present in 67.2%, most commonly furanylfenatyl (19.4%). Other NSO types were present in 39.7%, most commonly U-47700 (35.5%). Substances other than NSOs were present in 90.3%, most commonly benzodiazepines (67.7%) and other opioids (51.6%). A CNS depressant in addition to NSOs was present in 90.3%, and a new psychoactive substance other than a NSO in 25.8%. Pulmonary oedema was diagnosed in 82.6%, aspiration of vomitus in 30.4%, and acute bronchopneumonia in 17.4%.
Ten NSOs were identified. Case characteristics suggest a younger cohort whose profile is more typical of use of other NPS than of the established opioids. A large proportion used NSOs by non-injecting routes of administration.
•National profile of novel synthetic opioid (NSO) toxicity deaths.•The mean age was 31.9 years, 87.1% male, and 96.8% were unintentional.•Fentanyl analogues were present in 67.2%, and other NSOs in 39.7%.•Another CNS depressant was present in 90.3%.•In 32.3% the final route of administration was by non-injecting routes.
•Nearly 1 in 3 people who inject drugs meet a clinical diagnosis of depression.•Around one in four people who inject drugs has ever attempted suicide.•Self-harm and PTSD appear to be common among ...people who inject drugs.
A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID.
We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm.
We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0 % (95 % confidence interval CI = 21.3, 62.8 %), and for a depression diagnosis was 28.7 % (95 % CI = 20.8, 36.6 %). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1 % (95 % CI = 19.3, 24.9 %). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID.
Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.
There has been a substantial global increase in cocaine use and associated harms. The current study aimed to: 1. Determine the case characteristics and circumstances of death of cocaine-related ...suicide in Australia 2000–2021; and 2. Determine the toxicological profiles of cases.
Retrospective study of cocaine-related death in Australia, 2000–2021, retrieved from the National Coronial Information System (NCIS). Suicide intent was based upon the NCIS code for “Intentional Self-harm”, derived from case circumstances and coroners’ conclusions. Sex comparisons were made for all major variables.
A total of 157 cases were identified, 82.2% male, 79.5% employed, with a mean age of 32.3 years. Concerns for mental health were documented in 65.6%, a previous suicide attempt in 21.0%, a history of substance use treatment and/or negative consequences of substance use in 45.9% and injecting drug use in 14.6%. Manner of death amongst both sexes was predominantly by physical means (82.8%). Written intent was documented in 29.3%. Intense agitation prior to the incident was noted in 28.0% and conflict in 24.8%. The median blood cocaine concentration was 0.060 mg/L (range 0.007–5.500). Other drugs were present in 95.5%, most commonly alcohol (63.1%) with a median concentration of 0.140 g/100 ml. Psychostimulants other than cocaine were present in 31.2%.
The ‘typical’ cocaine-related suicide case was a male, aged in their early thirties, who was highly likely to be employed. The majority of cases used physical means, and a substantial minority were highly agitated and engaged in conflict prior to the fatal incident.
•National profile of cocaine-related suicide deaths.•The ‘typical’ case was a male, aged in their early thirties, and likely to be employed.•The majority of cases used physical means.•Intense agitation was noted in 28.0%, and conflict in 24.8%.•The median blood cocaine concentration was 0.060 mg/L, ranging to 5.500.
To summarize the most recent peer-review literature on new psychoactive substances (NPS) within Australia.
NPS use among the general Australian population is low, yet more pervasive among specific ...subpopulations. There is considerable heterogeneity among people who use NPS, however, overall, they are not unique from those who use more established illicit drugs. NPS have been shown to be highly adulterated, used as contaminants, variable in dose, and changeable as to the specific substances available over time. Further, analyses of coroners' cases highlight the importance of consumer understanding of NPS effects, particularly where they differ substantially to their more traditional illicit drug counterparts (e.g., synthetic vs. plant cannabinoids). One study posited that legislative approaches to NPS have been (partially) effective in reducing harms, and there are new systems being established to identify NPS-related health harms.
There have been few studies recently published on NPS in Australia (n = 17), however, findings mostly align with the international literature with respect to the rapidly changing nature of the NPS market, the use of NPS as adulterants, and associated harms. These themes highlight the need for proactive, novel approaches to rapidly identify, and respond to emerging drugs of concern.
Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses.
To estimate all-cause and ...cause-specific crude mortality rates (CMRs) and standardized mortality ratios (SMRs) among people using extramedical opioids, including age- and sex-specific estimates when possible.
For this systematic review and meta-analysis, MEDLINE, PsycINFO, and Embase were searched for studies published from January 1, 2009, to October 3, 2019, and an earlier systematic review on this topic published in 2011.
Cohort studies of people using extramedical opioids and reporting mortality outcomes were screened for inclusion independently by 2 team members.
Data were extracted by a team member and checked by another team member. Study quality was assessed using a custom set of items that examined risk of bias and quality of reporting. Data were pooled using random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression.
Outcome measures were all-cause and cause-specific CMRs and SMRs among people using extramedical opioids compared with the general population of the same age and sex.
Of 8683 identified studies, 124 were included in this analysis (100 primary studies and 24 studies providing additional data for primary studies). The pooled all-cause CMR, based on 99 cohorts of 1 262 592 people, was 1.6 per 100 person-years (95% CI, 1.4-1.8 per 100 person-years), with substantial heterogeneity (I2 = 99.7%). Heterogeneity was associated with the proportion of the study sample that injected opioids or was living with HIV infection or hepatitis C. The pooled all-cause SMR, based on 43 cohorts, was 10.0 (95% CI, 7.6-13.2). Excess mortality was observed across a range of causes, including overdose, injuries, and infectious and noncommunicable diseases.
The findings suggest that people using extramedical opioids experience significant excess mortality, much of which is preventable. The range of causes for which excess mortality was observed highlights the multiplicity of risk exposures experienced by this population and the need for comprehensive responses to address these. Better data on cause-specific mortality in this population in several world regions appear to be needed.
•Cases were mostly young and overwhelmingly male.•Acute toxicity was the most common cause of death.•Cathinones were the most commonly detected new psychoactive stimulants.•Delirium was the most ...frequently reported clinical sign proximal to death.•Delirium was strongly associated with the phenethylamines.
New psychoactive stimulants and hallucinogens comprise a range of “designer drugs” that have risen to prominence in the 21st century. The study aimed to: 1. Determine the characteristics, and circumstances of death, of all recorded cases of new psychoactive stimulant and hallucinogen-related death in Australia; 2. Determine the toxicology of such deaths; and 3. Determine the major organ pathology of cases.
All cases in which new psychoactive stimulants were a mechanism contributory to death were retrieved from the National Coronial Information System (2000–2017). Information was collected on cause of death, demographics, drug use history, circumstances of death, toxicology and major organ pathology.
82 cases were identified. The mean age was 30.7yrs and 86.6% were male. Circumstances of death were: accidental drug toxicity (59.8%), traumatic accident (15.9%), suicide (12.2%) and natural disease (2.4%). The most common clinical presentation observed proximal to death was delirium (26.8%). Delirium was mostly frequently observed after phenethylamine consumption (72.2%). The most common cardiovascular diagnosis at autopsy was replacement fibrosis, indicative of previous ischemia (10.5%). New psychoactive stimulants and hallucinogens detected in toxicology were: cathinones (75.7%), phenethylamines (22.0%) and piperazines (6.1%). Other substances were present in 83.5% of cases, most commonly established controlled psychostimulants (58.2%).
Acute toxicity was the most common cause of death, but more than a third of deaths were due to trauma. Cathinones were the most commonly detected of the new psychoactive stimulants and hallucinogens. Delirium was the most frequently reported clinical sign proximal to death and was strongly associated with the phenethylamines.
Introduction: Gamma hydroxybutyrate (GHB) has gained substantial popularity as an illicit recreational drug. The current study aimed to: (1) determine the characteristics and circumstances of death ...of all recorded cases of GHB-related death in Australia, 2001-2019; (2) determine the toxicology of cases; and (3) determine major organ pathology.
Methods: Retrospective study of all Australian cases in which GHB was a mechanism contributory to death retrieved from the National Coronial Information System (n = 74). Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology.
Results: The mean age was 31.5 years and 70.3% were male. The predominant circumstance of death was accidental drug toxicity (79.7%), including five cases attributed to a combination of toxicity and natural disease. Other deaths were due to trauma (12.2%) and suicide (8.2%). The fatal incident overwhelmingly occurred in a home environment (82.4%). In all cases, GHB was consumed orally. The median GHB blood concentration was 210 mg/L (range 13-1350 mg/L), and was significantly higher in toxicity cases than others (258 vs. 98 mg/L, p < .01). Other substances were present in 92.2%, most commonly psychostimulants (64.1%), hypnosedatives (28.2%) and alcohol (20.3%). Resuscitation was attempted in 20.3% of cases. Acute pneumonia (36.7%) and aspiration of vomitus (30.6%) were common.
Conclusions: The typical case was a young male, who swallowed GHB and used it with other substances, most commonly at home. While acute drug toxicity was the most common cause of death, there was a substantial minority due to trauma or suicide.
Gabapentinoids are centrally active GABA agonists whose use has increased substantially in the past decade. The current study aimed to provide a comprehensive clinical profile of a national case ...series of fatal poisonings related to gabapentinoids.
Retrospective study of all deaths due to drug toxicity in Australia in which gabapentinoids were a contributory mechanism, retrieved from the National Coronial Information System (2000-2020). Information was collected on case characteristics, toxicology and major organ pathology.
A total of 887 cases were identified, with a mean age of 45.7 years and 55.2% being male. Death was due to accidental toxicity in 81.3% of cases and intentional in 18.7%. Pre-existing disease was co-contributory to drug toxicity in 19.5%. Pregabalin was present in 92.9% of cases, with a median blood concentration of 7.6 mg/L (range 0.1-850.0 mg/L). Gabapentin was present in 7.2%, with a median blood concentration of 9.5 mg/L (range 0.5-1940.0 mg/L). Both pregabalin and gabapentin were present in five cases. No other gabapentinoids were detected. Drugs other than gabapentinoids were present in 99.8%, most frequently opioids (90.1%), hypnosedatives (76.9%) and antidepressants (60.5%). A body mass index in the obese range was seen in 45.4%. Clinically significant pre-existing disease was common, notably cardiomegaly (24.9%), emphysema (20.2%), nephrosclerosis (18.7%) and severe hepatic steatosis (11.7%).
The concomitant use of other drugs was close to universal, with CNS depressants predominating. Mental health problems, chronic pain and substance misuse were prominent.
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