Number of addictive substances used related to increased risk of unnatural death: a combined medico-legal and case-record study.
BACKGROUND
Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death.


METHODS
All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects.


RESULTS
Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse.


CONCLUSIONS
The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.
Brådvik
Louise
L
Clinical Alcohol Research, Malmö, Sweden. louise@bradvik.se
Berglund
Mats
M
Frank
Arne
A
Lindgren
Anna
A
Löwenhielm
Peter
P
D000059:Accidents / Q000401:mortality*; D000328:Adult; D000437:Alcoholism / Q000401:mortality; D016739:Behavior, Addictive / Q000401:mortality; D002423:Cause of Death; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D005554:Forensic Medicine; D006556:Heroin Dependence / Q000401:mortality; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009021:Morphine Dependence / Q000401:mortality; D009026:Mortality; D009293:Opioid-Related Disorders / Q000401:mortality; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality*; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data