title: Cause and manner of death in drug-related fatality: an analysis of drug-related deaths recorded by coroners in England and Wales in 2000.
abstract: This study investigated causes and manner of drug-related fatalities recorded in 2000 in the United Kingdom, measuring the 'masked' manner of death in cases typically recorded as overdose. A retrospective cohort study was used of 1037 cases of accidental drug-related fatalities reported by coroners in England and Wales to the National Programme of Substance Abuse Deaths. Whilst 802 cases were identified as direct acute overdose, representing 77% of the total accidental deaths, 23% of 'overdose' fatalities were caused by asphyxiation (7%), drug-related medical conditions (7%), non-drug-related conditions (4%), traumatic accidents (3%) and infections (2%). Younger people show higher risk of overdose and asphyxiation; older people show higher risk from pre-existing medical conditions. This study not only confirmed the high risk of overdose associated with heroin and polydrug use, but it also identified other high fatality risk factors for heroin/morphine users such as contracting an acute infection leading to septicaemia or endocarditis, or contracting a chronic infection such as HIV, HBV or HCV. In contrast, stimulants particularly featured in traumatic accidents, with amphetamine use most associated with cardio-vascular fatality. These findings highlight the 'masked' manner of death in cases commonly recorded as overdose and demonstrate the need for a more-detailed and systematic method of recording drug-related deaths in order to inform drug education and harm reduction strategies.
authors.affiliation: National Programme of Substance Abuse Deaths, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. l.i.webb@salford.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Webb
authors.forename: Adenekan
authors.initials: A
authors.lastname: Oyefeso
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Schifano
authors.forename: Survjit
authors.initials: S
authors.lastname: Cheeta
authors.forename: Mike
authors.initials: M
authors.lastname: Pollard
authors.forename: A Hamid
authors.initials: AH
authors.lastname: Ghodse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003334:Coroners and Medical Examiners; D062787:Drug Overdose; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000401:mortality*; D014852:Wales / Q000453:epidemiology