title: London audit of drug-related overdose deaths: characteristics and typology, and implications for prevention and monitoring.
abstract: OBJECTIVE
  To describe the circumstances and draft a typology of drug-related overdose deaths.
  
  
  METHODS
  London, 2003.
  
  
  METHODS
  An audit of 148 drug overdose deaths (involving heroin, methadone, dihydrocodeine, cocaine, amphetamine or MDMA) investigated by coroners during 2003. Information extracted on toxicology, pathology and circumstances were used to identify drug(s) implicated in the death.
  
  
  RESULTS
  Poly- or multiple drug use was detected in the majority of deaths with at least 69 different combinations, including 66% for heroin and 42% for cocaine. Six categories of death were identified involving an opiate (100, 68%); cocaine (14, 9%); other controlled drug (five, 3%); mixed drug overdose (18, 12%); other prescribed drug (five, 3%); and other causes (seven, 5%). A witness was present and the death was not instantaneous in 92 (61%) cases, although evidence in the coronial file suggested that in the majority of cases the overdose went unnoticed until too late to intervene. In all, 15 (one in 10) of the deceased were released from prison within 3 months of death; and 37 (one in four) were reported as in receipt of a methadone prescription.
  
  
  CONCLUSIONS
  Perhaps for the first time in the United Kingdom cocaine was detected in more drug overdose deaths than methadone. However, reducing heroin use is central to the prevention of drug-related deaths. We recommend that overdose prevention encompasses strategies to encourage a 'mutual duty of care' among problem drug users, and in the United Kingdom further investigation of the relationship of methadone treatment failures on overall trends in drug-related deaths is merited.
authors.affiliation: Department of Social Medicine, University of Bristol, Bristol, UK. matthew.hickman@bristol.ac.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: Sandra
authors.initials: S
authors.lastname: Carrivick
authors.forename: Susan
authors.initials: S
authors.lastname: Paterson
authors.forename: Neil
authors.initials: N
authors.lastname: Hunt
authors.forename: Deborah
authors.initials: D
authors.lastname: Zador
authors.forename: Linda
authors.initials: L
authors.lastname: Cusick
authors.forename: John
authors.initials: J
authors.lastname: Henry
mesh_terms: D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008131:London / Q000453:epidemiology; D008485:Medical Audit; D019966:Substance-Related Disorders / Q000401:mortality* / Q000517:prevention & control