Jozef Šidlo

Institute of Forensic Medicine, School of Medicine,

Comenius University, Bratislava, Slovakia

sidlo45@gmail.com

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

BACKGROUND

Tramadol is centrally acting analgesic

with a multimode of action. Tramadol is

used to treat both acute and chronic pain

of moderate to severe intensity. Tramadol

is generally considered to be a relatively

safe analgesic and a medicinal drug with

low potential for addiction relative to

morphine.

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

BACKGROUND

At supra-therapeutic doses and rarely at

therapeutic doses, intoxications may

occur. Fatal intoxications are rare and

appear to be associated with large

overdoses of tramadol and co-ingestion

of other drugs (including ethanol).

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

BACKGROUND

There is growing evidence of abuse of

tramadol in some European, North and

West African and West Asian countries. In

Slovakia, tramadol is a prescription-only

medicine.

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

AIM

The aim of the work was retrospective

study of tramadol-related deaths in

Slovakia.

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

PATIENTS AND METHODS

The analysis of all deaths related to tramadol use/abuse in Slovak republic in the years 2004 and 2015 was performed. The autopsies and additional laboratory examinations were performed in all the cases reported. According to the EMCDDA method the cases were divided into two groups: direct and indirect tramadol-related deaths.

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

RESULTS

The criteria matched 106 cases. There

were 70 % of direct deaths and 30 % of

indirect deaths. Males comprised 67 % of

all cases and females 33 %. Most cases

(21 %) were reported in the year 2013.

The age categories from 35 to 59 years

represented 63 % of cases.

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

RESULTS

Combination of tramadol with ethanol was detected in 25 % and with benzodiazepines in 17 % of cases. In the group of direct deaths tramadol overdose in suicidal ideation was found in 46 % of cases. 54 % of all deaths occurred at home. In capital city Bratislava and its vicinity there were 28 % of all cases.

RATE OF CASES REPORTED

ACCORDING TO GROUPS

DIRECT 70%

INDIRECT 30%

RATE OF CASES REPORTED

ACCORDING TO SEX

MALES 67%

FEMALES 33%

RATE OF CASES REPORTED ACCORDING TO GROUPS AND SEX

Direct deaths Indirect deaths

MALES 66%

FEMALES 34%

MALES 69%

FEMALES 31%

NUMBER OF CASES REPORTED

ACCORDING TO YEARS

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

INDIRECT 1 0 0 0 2 4 4 3 3 4 5 6

DIRECT 0 3 4 0 4 2 6 5 12 18 7 13

DIRECT INDIRECT

NUMBER OF CASES REPORTED

ACCORDING TO YEARS

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

NUMBER OF DRD CASES REPORTED IN SLOVAKIA ACCORDING TO YEARS

0

20

40

60

80

100

120

140

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

NUMBER OF DRD CASES REPORTED IN SLOVAKIA ACCORDING TO YEARS

0

20

40

60

80

100

120

140

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

NUMBER OF DRD AND TRAMADOL DEATH CASES REPORTED IN SLOVAKIA ACCORDING TO YEARS

0

20

40

60

80

100

120

140

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

TOTAL DRD TRAMADOL

NUMBER OF CASES REPORTED

ACCORDING TO AGE

0

2

4

6

8

10

12

14

16

18

20

< 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 <

INDIRECT 0 0 1 3 1 2 1 1 8 6 4 5

DIRECT 0 2 4 6 4 10 10 10 12 7 4 5

DIRECT INDIRECT

NUMBER OF CASES REPORTED ACCORDING

TO THE NUMBER OF DRUG DETECTED

0

5

10

15

20

25

30

35

40

45

TRAMADOL 2 SUBST 3 SUBST 4 SUBST

INDIRECT 17 11 3 1

DIRECT 21 33 18 2

DIRECT INDIRECT

RATE OF CASES REPORTED

ACCORDING TO ETHANOL DETECTED

ETHANOL 25%

WITHOUT ETHANOL 75%

RATE OF CASES REPORTED ACCORDING TO ETHANOL DETECTED

Direct deaths Indirect deaths

ETHANOL 30%

WITHOUT ETHANOL

70%

ETHANOL 16%

WITHOUT ETHANOL

84%

RATE OF CASES REPORTED

ACCORDING TO BZD DETECTED

BZD 17%

WITHOUT BZD 83%

RATE OF CASES REPORTED ACCORDING TO BZD DETECTED

Direct deaths Indirect deaths

BZD 14%

WITHOUT BZD 86%

BZD 25%

WITHOUT BZD 75%

NUMBER OF CASES REPORTED

ACCORDING TO PLACE OF DEATH

0

10

20

30

40

50

60

AT HOME HOSP HOU/FLAT INTERIER EXTERIER

INDIRECT 18 1 1 1 11

DIRECT 41 14 8 5 6

DIRECT INDIRECT

RATE OF INDIRECT DEATH CASES

ACCORDING TO CAUSE OF DEATH

0

5

10

15

20

25

30

35

40

45

24 25 26 27 28

REGIONS OF SLOVAKIA

RATE OF CASES REPORTED

ACCORDING TO WORKPLACE

0

5

10

15

20

25

30

BA NR ZA MT BB PP PO KE

INDIRECT 10 3 1 4 2 1 1 10

DIRECT 20 10 10 6 8 1 5 14

DIRECT INDIRECT

RATE OF CASES REPORTED

ACCORDING TO REGIONS

0

5

10

15

20

25

30

35

40

45

50

WEST MIDDLE EAST

DIRECT INDIRECT

DRUG-RELATED DEATHS (DRD)

EMCDDA KEY INDICATOR ANNUAL EXPERT MEETING

18 – 20 SEPTEMBER 2017, LISBON, PORTUGAL

CONCLUSION

The results of the study showed

expressive increased occurrence of fatal

consequences of tramadol use/abuse in

Slovak republic - 64 % of all cases - in

the period of years 2012 - 2015.