•Postmortem blood for toxicology was sampled from six different locations: the right and left heart, carotid artery, jugular vein, ext iliac artery and vein.•Short PMI cases showed no concentration ...differences in central vs peripheral blood.•In cases with medium and long PMI, the mean concentration ratios increased.•Drug concentrations in arterial blood were generally higher than in venous.
Drug concentrations in postmortem blood samples can differ considerably, depending on the sample site — a phenomenon named postmortem redistribution. In this study, blood samples from 48 cases of suspected intoxications were collected during autopsy at the Department of Forensic Medicine in Stockholm, Sweden. Samples were collected from the right and left heart, the carotid artery, jugular vein, external iliac artery and external iliac vein. The mean ratio of right heart/iliac vein was 1.3, which confirms the results from previous studies that drug concentrations in central blood are generally higher than in peripheral blood. The mean ratio of the ext iliac artery/ext iliac vein and the ratio of the carotid artery/jugular vein were 1.3 and 1.4, respectively, suggesting that drug concentrations are higher in arterial than in venous blood. Drugs with a low volume of distribution had a lower ratio of central/peripheral blood than drugs with a high volume of distribution (1.2 vs 1.4) and also a lower ratio of arterial/venous blood (1.3 vs 1.4). In cases with a short postmortem interval (PMI) there were no significant concentration differences in central and peripheral blood, but in cases with medium and long PMI, the ratios increased (1.2 and 1.4). Cases with a long PMI had an arterial/venous concentration ratio of 2.0. The results suggest that postmortem blood sampling should be performed as soon as possible after death and that peripheral venous blood, if available, should be used for analysis.
Highlights • We analysed data on fatal poisoning in drug addicts in 2012 from five Nordic countries. • Differences in death rate among fatal poisoned drug addicts diminished between the countries ...compared to earlier studies. • Opioids were the main cause of death among fatal poisoned drug addicts in all countries. • Medicinal opioids had mainly replaced heroin/morphine. • New psychoactive substances emerged.
•Finland had a different drug profile compared to the other countries.•Opioids were the main cause of death among fatal poisoned drug addicts in all countries.•Cocaine and MDMA deaths increased in ...all countries.•Sweden saw a high number of deaths from fentanyl analogues.•New psychoactive substances have emerged in all countries except Iceland.
This study is the seventh report on fatal poisonings among drug addicts in the Nordic countries. In this report, we analyse data from the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. Data on gender, number of deaths, places of deaths, age, main intoxicants and substances detected in blood were recorded to obtain national and comparable Nordic data, and to allow comparison with earlier studies conducted in 1984, 1991, 1997, 2002, 2007 and 2012.
The death rate (number of deaths per 100,000 inhabitants) was highest in Iceland (6.58) followed closely by Sweden (6.46) and then lowest in Denmark (4.29). The death rate increased in Finland (5.84), Iceland and Sweden and decreased in Denmark compared to earlier studies. The death rate in Norway, which has decreased since 2002, has stabilised around 5.7 as of 2017. Women accounted for 7–23% of the fatal poisonings. The percentage was lowest in Iceland and highest in Finland and Norway. The age range was 14–70 years. The median age (41 years) was highest in Denmark and Norway. The other countries had a median age between 33 and 35 years.
Opioids were the main cause of death. Methadone remained the main intoxicant in Denmark, while heroin/morphine was still the main intoxicant in Norway, as was buprenorphine in Finland. However, the picture has changed in Sweden compared to 2012, where heroin/morphine caused most deaths in 2017. Sweden also experienced the highest number of deaths from fentanyl analogues (67 deaths) and buprenorphine (61 deaths). Deaths from fentanyl analogues also occurred in Denmark, Finland and Norway, but to a smaller extent. Over the years, the proportion of opioid deaths has decreased in all countries except Sweden, which has experienced an increase. This decline has been replaced by deaths from CNS stimulants like cocaine, amphetamine and methylenedioxymethamphetamine (MDMA). Cocaine deaths have occurred in all countries but most frequently in Denmark. MDMA deaths have increased in all countries but mostly in Finland.
Poly-drug use was widespread, as seen in the earlier studies. The median number of detected drugs per case varied from 4–6. Heroin/morphine, methadone, buprenorphine, cocaine, amphetamine, methamphetamine, MDMA, tetrahydrocannabinol (THC) and benzodiazepines were frequently detected. Pregabalin and gabapentin were detected in all countries, especially pregabalin, which was detected in 42% of the Finnish cases. New psychoactive substances (NPS) occurred in all countries except Iceland.
Abstract
In connection with medicolegal autopsies peripheral blood (e.g. from a femoral vein) is the specimen of choice for toxicological analysis, although alternative specimens are also sometimes ...submitted, such as bile, cerebrospinal fluid (CSF), vitreous humor (VH), bladder urine, pleural effusions and/or lung fluid. Ethanol concentrations were determined in duplicate in femoral blood and in various alternative biological specimens by headspace gas chromatography. The analysis was carried out on two different fused silica capillary columns furnishing different retention times for ethanol and both n-propanol and t-butanol were used as internal standards. The results were evaluated by linear regression using blood alcohol concentration (BAC) as dependent or outcome variable and the concentrations in an alternative specimen as independent or predictor variable. The Pearson correlation coefficients were all statistically highly significant (P < 0.001); r = 0.94 (bile), r = 0.98 (CSF), r = 0.97 (VH), r = 0.92 (urine), r = 0.94 (lung fluid) and r = 0.96 (pleural cavity effusions). When the regression model was used to predict femoral BAC from the mean concentration in an alternative specimen the mean and 95% prediction intervals were 1.12 ± 0.824 g/L (bile), 1.41 ± 0.546 g/L (CSF), 1.15 ± 0.42 g/L (VH), 1.29 ± 0.780 g/L (urine), 1.25 ± 0.772 g/L (lung fluid) and 0.68 ± 0.564 g/L (pleural cavity effusions). This large uncertainty for a single new observation needs to be considered when alcohol-related deaths are evaluated and interpreted. However, the analysis of alternative specimens is recommended in medical examiner cases to provide supporting evidence with regard to the origin of ethanol, whether this reflects antemortem (AM) ingestion or postmortem (PM) synthesis.
AH-7921 (3,4-dichloro-N-(1-dimethylamino)cyclohexylmethylbenzamide) is a designer opioid with ∼80% of morphine's µ-agonist activity. Over a 6-month period, we encountered nine deaths where AH-7921 ...was involved and detected in blood from the deceased. Shortly after the last death, on August 1 2013, AH-7921 was scheduled as a narcotic and largely disappeared from the illicit market in Sweden. AH-7921 was measured by a selective liquid chromatography–MS-MS method and the concentrations of AH-7921 ranged from 0.03 to 0.99 µg/g blood. Six of our cases had other drugs of abuse on board and most had other medications such as benzodiazepines, antidepressants and analgesics. However, the other medicinal drugs encountered were present in postmortem therapeutic concentrations and unlikely to have contributed to death. In addition to the parent compound, we identified six possible metabolites where two N-demethylated dominated and four mono-hydroxylated were found in trace amounts in the blood. In conclusion, deaths with AH-7921 seem to occur both at low and high concentrations, probably a result of different tolerance to the drug. Hence, it is reasonable to assume that no sharp dividing line exists between lethal and non-lethal concentrations. Further, poly-drug use did not seem to be a major contributing factor for the fatal outcome.
Abstract The frequency of medico-legally examined fatal poisonings in 2007 among drug addicts was investigated in five Nordic countries; Denmark, Finland, Iceland, Norway, and Sweden. The number of ...deaths, age, sex, place of death, main intoxicant, and other drugs present in blood samples were recorded to obtain national and comparable Nordic data, as well as data to compare with earlier studies in 2002, 1997, and 1991. Norway had the highest incidence of drug addict deaths by poisoning followed by Denmark, with 8.24 and 6.92 per 100,000 inhabitants, respectively. The death rates in Finland (4.02), Iceland (4.56), and Sweden (3.53) were about half that of Norway and Denmark. Compared with earlier studies, the death rates were unchanged in Denmark and Norway, but increased in Finland, Iceland, and Sweden. In all countries, fewer deaths (29–35%) were recorded in the capital area compared with earlier studies. Females accounted for 11–19% of the fatal poisonings. Iceland deviates with a more equal distribution between men and women (40%). Deaths from methadone overdoses increased in all Nordic countries, and methadone was the main intoxicant in Denmark in 2007, accounting for 51% of the poisonings. In Norway and Sweden, heroin/morphine was still the main intoxicant with a frequency of 68% and 48%, respectively. In Iceland, 3 deaths each were due to heroin/morphine and methadone, respectively. Finland differs from other Nordic countries in having a high number of poisonings caused by buprenorphine and very few caused by heroin/morphine. The total number of buprenorphine deaths in Finland doubled from 16 in 2002 to 32 in 2007, where it constituted 25% of deaths. The general toxicological screening program showed widespread multi-drug use in all countries. The median number of drugs per case varied from 3 to 5. The most frequently detected substances were heroin/morphine, methadone, buprenorphine, tramadol, amphetamine, cocaine, tetrahydrocannabinol, benzodiazepines and ethanol.
During 2012, the designer drug 5-(2-aminopropyl)indole emerged in Sweden, and became available at different web sites under the name 5-IT or 5-API. This compound is an indole derivative and a ...positional isomer of alpha-methyltryptamine. In this paper, we report the pathology and toxicology from 15 deaths involving 5-IT. Routine postmortem toxicology was performed in femoral blood, using a targeted screening for pharmaceuticals and drugs of abuse with liquid chromatography time-of-flight technology, and positive results were quantified using chromatographic techniques. For 5-IT, a new method was developed using ultra-high-performance liquid chromatography and tandem mass spectrometry. In 11 cases, intoxication was the cause of death. Two cases were signed out as causa ignota, and they were considered to be natural deaths. All determinations of 5-IT were performed in femoral blood and the concentrations ranged from 0.7 to 18.6 µg/g. Two cases had 5-IT as the only drug identified, while the others presented with other psychotropic drugs or medications in the blood as well. Shortly after this series of deaths, 5-IT was scheduled as a hazardous substance according to the regulation Certain Goods Dangerous to Health on 18 September 2012 prohibiting the handling and selling of the drug. Since then, no positive cases have been found.
We estimated wind turbines in the Altamont Pass Wind Resource Area (APWRA), California, USA, kill >100 burrowing owls (Athene cunicularia hypugaea) annually, or about the same number likely nesting ...in the APWRA. Turbine-caused mortality was up to 12 times greater in areas of rodent control, where flights close to the rotor plane were disproportionately more common and fatalities twice as frequent as expected. Mortality was highest during January through March. Burrowing owls flew within 50 m of turbines about 10 times longer than expected, and they flew close to wind turbines disproportionately longer within the sparsest turbine fields, by turbines on tubular towers, at the edges of gaps in the turbine row, in canyons, and at lower elevations. They perched, flew close to operating turbine blades, and collided disproportionately more often at turbines with the most cattle dung within 20 m, with the highest densities of ground squirrel (Spermophilus beecheyi) burrow systems within 15 m, and with burrowing owl burrows located within 90 m of turbines. A model of relative collision threat predicted 29% of the 4,074 turbines in our sample to be more dangerous, and these killed 71% of the burrowing owls in our sample. This model can help select the most dangerous turbines for shutdown or relocation. All turbines in the APWRA could be shut down and blades locked during winter, when 35% of the burrowing owls were killed but only 14% of the annual electricity was generated. Terminating rodent control and installing flight diverters at the ends of turbine rows might also reduce burrowing owl mortality, as might replacing turbines with new-generation turbines mounted on taller towers.
The leaves of Kratom, a medicinal plant in Southeast Asia, have been used as an herbal drug for a long time. At least one of the alkaloids present in Kratom, mitragynine, is a mu-receptor agonist. ...Both Kratom and an additional preparation called Krypton are available via the internet. It seems to consist of powdered Kratom leaves with another mu-receptor agonist, O-desmethyltramadol, added. O-Desmethyltramadol is an active metabolite of tramadol, a commonly prescribed analgesic.We present nine cases of intoxication, occurring in a period of less than one year, where both mitragynine and O-desmethyltramadol were detected in the postmortem blood samples. Neither tramadol nor N-desmethyltramadol was present in these samples, which implies that the ingested drug was O-desmethyltramadol. The blood concentrations of mitragynine, determined by ultra-performance liquid chromatography-tandem mass spectrometry, ranged from 0.02 to 0.18 µg/g, and O-desmethyltramadol concentrations, determined by gas chromatography with nitrogen-specific detection, ranged from 0.4 to 4.3 µg/g. We believe that the addition of the potent mu-receptor agonist O-desmethyltramadol to powdered leaves from Kratom contributed to the unintentional death of the nine cases presented and conclude that intake of Krypton is not as harmless as it often is described on internet websites.
Highlights • A validated LC-MS/MS method for quantitative analysis of 3-MeO-PCP is described. • 3-MeO-PCP continues to be abused in Sweden despite being scheduled. • Symptoms include tachypnea, ...tachycardia, hypertension, fever and lactic acidosis. • 3-MeO-PCP half-life was approximately 11 h and confirmed previous data. • In a fatal mono-intoxication the blood concentration of 3-MeO-PCP was 0.38 μg/g.
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