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

Louise Brådvik, Peter Löwenhielm, Arne Frank and Mats Berglund
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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

IJERPH, 2019, vol. 16, issue 5, 1-14

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.

Keywords: suicide risk; substance use disorders; autopsy findings; case records; depression (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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