The analysis of fatal and non-fatal intoxications
in Latvia (1995-2000)
J. Volgram
Latvian State Center for Forensic Medical Examinations
Summary
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In 1995-2000 a number of fatal and non-fatal intoxications has increased rapidly. In non-fatal cases intoxications by benzodiazepines, opioids, barbiturates were most frequent. Some new substances (zolpidem, zopiclone, melperon, midazolam, sulpyrid etc.) have been found in biological material. A first case of fatal methamphetamine poisoning in Latvia was investigated. Among fatal poisonings heroin overdosage was the most common.
Introduction
In Latvia, forensic toxicology and emergency toxicology have been centralized at the laboratory of forensic chemistry and toxicology of Latvian State Center for Forensic Medical Examinations. Every year more than 8,000 specimens of autopsy cases and 1,000 specimens of emergency toxicology have been analyzed for different kind of toxic substances, e.g. ethanol, carbon monoxide, drugs of abuse, psychotropic substances, heavy metals, domestic chemistry, pesticides, organophosphorous compounds etc.
In 1995-2000 a number of fatal and non-fatal intoxications has increased rapidly.Intoxications by alcohol predominated during a period.
The main target of our study was the analysis of toxicological data obtained at the laboratory of forensic chemistry and toxicology in 1995-2000.
Materials and methods
The material consists of fatal and non-fatal intoxications occuring in persons 15-60 years of age and submitted to medicolegal autopsy and subsequent toxicological investigation in 1995-2000. Death in which immediate cause of death was hypothermia or bronchopneumonia, etc. resulting from intoxication were included in the study. The results of alcohol intoxication were not included in this study.
Results and discussion
Non-fatal intoxications investigated in 1995-2000 in Latvia are shown in Tab. 1. Non-fatal intoxications by benzodiazepines, opioids (heroin etc.), barbiturates and diphenhydramine were the most popular in the period. It could be explained by availability of narcotics and psychotropic substances in "black market" and drug stores and by hard socio-economical situation in Latvia. Some new drugs have been found during the period: zopiclone, zolpidem, midazolam, tramadol, alprazolam, triazolam, flupentixol, sulpyrid etc. Non-fatal poisonings by amitryptiline, benzhexol, imipramine, trimipramine, clomipramine, were investigated more often than before. This is important indicator of antidepressant and neuroleptic use and abuse. Third-generation sedatives (zolpidem, zopiclone, alprazolam, midazolam, triazolam) usually were used alone or in combination with ethanol or opioids.
Table 1. Non-fatal intoxications in Latvia (1995-2000)
Substances 1995 1996 1997 1998 1999 2000 ------------------------------------------------------ 1,4-benzodiazepines 49 81 56 74 187 300 Opioids (heroin incl.) 4 3 4 10 104 116 Barbiturates 18 36 49 43 51 72 Diphenhydramine 7 14 16 8 36 58 Clonidine 3 2 1 2 12 32 Zopiclone - 1 1 7 25 21 Ephedron 3 3 1 1 3 4 Amphetamine - 2 1 - 3 4 Cocaine - - - - 2 3 Haloperidol - - 2 1 4 11 Clozapine - - 4 3 10 15 Carbamazepine - 6 - 7 35 66 Phenothiazines - - 2 11 6 33 Benzhexol (cyclodol) 2 - 11 4 12 17 Amitryptiline 6 10 16 17 27 36 Chlorprotixene - - 1 3 11 19 Zolpidem (Stilnox) - - - - - 12 Imipramine - 1 - 1 - 5 Clomipramine - - - - - 2 Trimipramine - - - - - 3 Alprazolam - - - - 2 4 Midazolam - - - - - 1 Triazolam - - - - - 1 Salicilates 4 5 7 18 7 34 ------------------------------------------------------ Substances 1995 1996 1997 1998 1999 2000 ------------------------------------------------------ Analgin - 2 3 6 18 19 Tramadol - - - - 2 21 Drotaverine (no-ðpa) 1 - 3 3 8 11 Theophylline - 1 1 1 8 12 Paracetamol 1 2 1 2 6 12 Glibenclamid 2 2 2 - 1 1 Flupentixol - - - - - 4 Sulpyrid - - - 1 3 2 ------------------------------------------------------
In Tab. 1 is shown, that a total number of non-fatal intoxications increased significantly during a period. Fatal intoxications in Latvia in 1995-2000 are shown in Tab. 2. Heroin overdosage was the most serious problem in the period. Fatalities occured by heroin i.v. injection of very concentrated pure heroin or in combination with other drugs (tramadol, benzodiazepines, barbiturates) and alcohol. A number of heroin-related death increased to 63 in 2000 (in 1996 - 4); Benzodiazepines (clonazepam, nitrazepam, diazepam) and non-benzodiazepine sedatives (zopiclone, zolpidem) and antidepressants have been found more often than before. A first case of fatal methamphetamine poisoning was investigated in 2000. A peak of cocaine fatalities was in 1999 (7). The age distribution of the fatalities was similar from year to year, mostly in 25-35 years, showing an increasing number of intoxications with year. In addicts the proportion of ethanol-positive cases was somewhat lower, than in none drug-related cuases of death.
Table 2. Fatal intoxications in Latvia (1995-2000)
Substances 1995 1996 1997 1998 1999 2000 ----------------------------------------------------- Opioids (heroins incl.) - 5 7 11 38 63 1,4-benzodiazepines 2 20 18 18 31 42 Barbiturates 5 7 3 8 10 25 Amphetamines 3 2 - 2 9 4* Cocaine - - 1 - 7 - Ephedron - 1 3 2 - - Methadone - - - 2 - - Tramadol - - - - - 3 Cannabinoids - - 1 1 1 3 Oxybutyrate sodium - - 1 - - - Benzhexol(cyclodol) - - - 1 1 1 Phenothiazines 1 8 2 2 2 3 TCA ** 1 1 1 4 3 6 Zopiclone - 1 2 1 2 4 Zolpidem 1 - - - - - Carbamazepine 2 - 4 2 9 3 Clozapine 3 - 3 1 1 - Chlorprotixene 1 - 1 - - - Dipiridamol - - - - - 1 ----------------------------------------------------- Substances 1995 1996 1997 1998 1999 2000 ----------------------------------------------------- Diphenhidramine 1 1 - 4 1 6 Drotaverine (no-ðpa) 2 - 3 5 1 - Analgin 3 - 7 4 7 6 Salicilates - 3 - 5 1 9 Paracetamol - - 2 1 1 1 Theophylline - - 1 - - 1 Alprazolam - - - - 1 1 Melperone - - - - 1 - Fenibut 1 - - - - - Fluphenazine - 1 - - - - Tofizopam - - 1 - - - ----------------------------------------------------- * methamphetamine incl. ** tricyclic antidepressants
The materials used in this study were culled from existing forensic toxicological data and in part therefore reflect real situation of drug abuse in Latvia.
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