Factors associated with fatal overdoses in Oslo 2006-2008 Linn
Gjersing, Thomas Clausen, Jrgen Bramness, Helge Waal, Stian Biong
& Edle Ravndal
Slide 2
Definitions Drug-induced deaths Deaths directly due to use of
illegal substances, although these often occur in combination with
other substances such as alcohol or psychoactive medicines. These
deaths occur generally shortly after the consumption of the
substance Overdoses or poisonings (EMCDDA 2009) Universitetet i
Oslo
Slide 3
Definitions Drug-induced deaths Deaths directly due to use of
illegal substances, although these often occur in combination with
other substances such as alcohol or psychoactive medicines. These
deaths occur generally shortly after the consumption of the
substance Overdoses or poisonings Drug-related deaths Drug-induced
deaths Deaths caused indirectly by the use of drugs, usually by
concurrent factors related to the method of use Motor vehicle
accidents, violence, suicide (EMCDDA 2009) Universitetet i
Oslo
Slide 4
Background Universitetet i Oslo EMCDDA 2009 s 84
Slide 5
Background City council of Oslo March 2009 Investigate all
overdoses in Oslo and identify possible causes Norwegian Centre for
Addiction Research (Seraf) November 2009 To identify all
drug-induced deaths in Norway 2006-2008 To assess the drug-induced
deaths in Oslo Assess toxicology Place of death (street, low
threshold housing facilities, hospitals) Possible causes Role of
primary and secondary health care services Universitetet i
Oslo
Slide 6
Methods Epidemiological study Cross-linked Qualitative research
study Universitetet i Oslo
Slide 7
Ethics The project has received all approvals Ethical committee
Data inspectorate Oslo University Hospital The Higher Prosecuting
Authority Universitetet i Oslo
Slide 8
Cases Overdoses European Monitoring Centre for Drugs and Drug
Addictions (EMCDDA) definition T42.4 benzodiazepines Alcohol F100
Acute intoxication X45 Accidental poisoning X65 Intentional
poisoning < 70 r Universitetet i Oslo
Slide 9
Underlying cause of deaths EMCDDAs definition Disorders F11
Opioids F12 Cannabinoids F14-F16 Cocaine, other stimulants,
hallucinogens F19 Multiple drug use Accidental poisoning X41*
antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic
drugs, not elsewhere classified: Antidepressants, barbiturates,
hydantoin derivatives, iminostilbenes, methaqualone compounds,
neuroleptics, psychostimulants, succinimides, oxazolidinediones,
tranquillizers X42** narcotics and psychodysleptics
[hallucinogens], not elsewhere classifide: cannabis (derivatives),
cocaine, codeine, heroin, lysergide [LSD], mescaline, methadone,
morphine, opium (alkaloids) X44 other and unspecified drugs,
medicaments and biological substances: agents primarily acting on
smooth and skeletal muscles and the respiratory system,
anaesthetics (general)(local), drugs affecting the: cardiovascular
system, gastrointestinal system, hormones and synthetic
substitutes, systemic and haematological agents, systemic
antibiotics and other anti-infectives therapeutic gases, topical
preparations, vaccines, water-balance agents and drugs affecting
mineral and uric acid metabolism Intentional poisoning X61* X62**
X64 Poisoning undetermined intent Y11* Y12** Y14 *T43.6
Psychostimulants with abuse potential ** T40.0-.9 Narcotics and
psychodysleptics
Slide 10
Identification of cases General Mortality Registry Cause of
death Contributing cause of death Age Date of death Residency
according to Directory of Residents Region of death Place
(hospital, home, street etc) Universitetet i Oslo
Slide 11
Registries The Incarceration Registry 2/3 time, end of time,
date of release Registry for Drug-related Deaths Toxicology reports
The Drug Prescription Registry The Norwegian institute of Public
Health Prescribed medications previous 12 months before death
Universitetet i Oslo
Slide 12
Patient records Hospitals Community health care services
Outpatient emergency clinics Low threshold facilities Housing,
street clinics Outreach services Social welfare offices Treatment
centres Detoxification units Salvation army, Bymisjonen, P22,
Fredheim, Tyrilistiftelsen Universitetet i Oslo
Slide 13
Preliminary results Deaths in Oslo 200620072008Total EMCDDA
deaths 1067382261 Oslo residents71%63%76%70% Women28%22%21%24%
Median age Women 44 yrs (20-57) 43 yrs (18-59) 47 yrs (19-59) 44
yrs Men 34yrs (22-68) 37yrs (22-56) 40yrs (19-64) 36 yrs
Universitetet i Oslo
Slide 14
Age of death 50 yrs Total32 (12%)93 (36%)97 (37%)39 (15%)
Women22%14%28%41% Universitetet i Oslo
Slide 15
Place of death 200620072008Total At home41%38%28%36% Other
places35%33%24%31% Hospitals or institutions8%11%9%
Unknown16%18%39%24% Universitetet i Oslo
Slide 16
Type of deaths 200620072008Total Disorders3 (3%)1 (1%)2 (2%)6
(2%) Accidental93 (88%)63 (86%)71 (87%)227 (87%) Women26%16%18%47
(21%) Intentional10 (9%)9 (12%)9 (11%)28 (11%) Women60%67%33%15
(54%) Universitetet i Oslo
Slide 17
Release from prison 200620072008Total 6 months before death9
(9%)5 (7%)5 (6%)19 (7%) No of women1113 Time in prison (range)162
days (0-181) 176 days (39-179) 127 days (58-182) 162 days (0-182)
Time from prison release (range) 20 days (1-182) 6 days (3-143) 55
days (0-124) 20 days (0-182) Universitetet i Oslo
Slide 18
Age and death after prison release 50 yrs Total no21250
Universitetet i Oslo
Slide 19
Preliminary conclusions 70% Oslo residents 20% women Women
older than men Most deaths accidental First month after prison
release critical Majority of those that die after prison release
were between 26 and 36 yrs Universitetet i Oslo